“मेरो बर्ष २०७४: म स्वस्थ, मेरो देश स्वस्थ”

Healthy Year 2074: A New Start in Nepal's Health System

This is a promising start from health minister Mr. Gagan Thapa in Nepalese Public health sector. It triggered many of us; It impressed many forerunners in health profession. Indeed, we need something, be it some goals, deadlines or slogans to keep us moving. Let’s remember, we are so much driven by millennium development goals and sustainable development goals to meet their targets. So, this new campaign of “My Year 2074: I am Healthy, My country is healthy” (this is my unofficial translation of the slogan) will surely motivate us to remain committed for keeping ourselves and our people healthy.

Our health system was quite sensitive towards tobacco related products but the alcohol drinking was overlooked issue and this commitment is expected to aware people of harmful effects of alcohol resulting reduced consumption. Our country is being rapidly urbanized and many of us live sedentary lives in a chair so the slogan of remaining physically active will surely benefits many of us, who are living sedentary lives.

Another slogan refers to appropriate and right consumption of locally available healthy and balanced diet. As we say, ‘We are what we eat’, this will encourage us in supplementing the diet required for growth and development and regeneration of people in every age group. Regular health checkup screens diseases in its early phases making primordial, and primary prevention enough. This further reduces cost of individual and the health system. The fifth slogan tries to accommodate all the health issues related to family planning, child bearing and rearing, neonates, infants and children and old age people.

Some addition in set of commitments

If we critically see the slogans of this campaign, it is much oriented towards preventing the non-communicable diseases. It has proactively attempted to capture the transition of our communicable disease burden to non-communicable diseases. But, we still have pre-existing conditions that trigger the transmission of communicable diseases such as lack of improved sanitation and safe drinking water. This bothers us many of public health professionals including me, much than remaining physically active. Though, we have come in the 21st century, only the time passed, we are still far behind.
In some parts of the country, people live the lifestyle of early twentieth century and some live like in 21st century. Because of this vast differences in life styles, living standards, awareness level, I seriously want to include the components of waste management, personal hygiene, sanitation facilities, clean city and improved housing, improved drinking water in this slogan. Let’s quit the use of tobacco product and alcohol drinking; Let’s remain physically active; Let’s have healthy and balanced diet; Let’s perform regular health check up; Let’s spread awareness on Family and community health issues.

“My commitment to My Year 2074”

I will Commit to following points in Year 2074 and onwards..

I will quit the use of tobacco product and alcohol drinking.

I will remain physically active.

I will have healthy and balanced diet.

I will perform regular health check up.

I will remain aware of Family and community health.

Yes,

I will keep personal hygiene.

I will keep my house and city clean.

I will have improved sanitation and safe drinking water.

A Message to PHD Aspirants!!

by Dr. Jamal Hisham Hashim

After having completed a PhD degree myself, and having supervised, co-supervised and examined a number of PhD students over the years, I would like to offer some humble advice and pointers to those aspiring to pursue a PhD degree themselves. I find that many Malaysians misunderstood the purpose of getting a PhD degree and the commitments and sacrifices that it calls for.

Why pursuing PHD is different than other degrees?

A PhD is the highest academic and research degree from a university. I have seen both remarkable successes and disappointing failures amongst students pursuing this academic accolade. It takes more than just brain power to complete a PhD. A degree by research is very different from a degree by coursework. A course degree whether at the undergraduate or masters level is heavily structured. A student just have to be disciplined and rigorous in following this predetermined structure regimentally, without much creativity required from him or her. Of course, creativity is demanded from the student in completing assignments and projects but the demand is nothing close to what is required for a PhD degree. The most important prerequisites for pursuing a successful PhD program are passion, inquisitiveness, creativity, discipline, persistence, perseverance and meticulousness (or attention to detail). I did not mention intelligence not because it is not important, but because it is less important than the other attributes I mentioned. At least, it is in my book. Others may feel differently.

A key ELEMENT to success PHD: Passion!!

Of those many attributes, I consider passion the most important. Some students start out enthusiastically but loses steam halfway through or towards the end. They lack passion or the love of knowledge. Ever heard of the saying, "when the going gets tough, the tough gets going?" Success in a PhD is simply that. The harder it becomes, the harder you will strive. Sometimes, you do not see the light at the end of the tunnel but you still keep looking for it because you know it is there. When you love what you do, failure is not an option.

A good reason!

Some people do PhD for the wrong reasons. Some take up postgraduate because they could not secure a job after their first or second degree. Some do it because the jobs they have taken up require them to acquire a PhD, for e.g. an academic or a research post. This cannot be more wrong. You cannot force yourself to do a PhD. You must want to do it badly enough. You cannot force yourself to love something; you must love or want something bad enough to force yourself to get it.

What to expect from your supervisor

Your supervisor is your mentor, guide and consultant, not your teacher. He cannot teach you your PhD knowledge, you have to teach yourself through his guidance and wisdom. He is more your friend than he is your master. He does not dictate to you what you must do, he merely points you in the right direction. At the end of your PhD journey, you would have been more knowledgeable on the subject of your research than your supervisor. I have heard of students not being able to complete their PhD because they could not get along or see eye to eye with their supervisor. This is the worst scenario that can happen to you. If you do not have a supervisor you can work with, you will not get your PhD no matter how good you are or how hard you work. So, choose your supervisor well, not just the university you want to do your PhD in. Just a few months back, I met a doctoral graduate who told me that to be supervised by this one professor carries more prestige among his peers in the working world.

Get along or work alone??

The PhD is an academic journey. There will be failures but mainly successes along your way. You may encounter some foes but mainly friends in the same boat as yourself. It always help to be in a group of students to share both your setbacks and achievements. Working alone in a silo is the worst you can do to yourself. There are certain things you want to discuss with your fellow students that you cannot discuss with your supervisor; matters that are either academic or personal. A PhD degree needs sacrifices, especially when you are a family person; a wife, mother, husband or dad. Family is always important and should always be your priority. However, you and your family members must be willing to make sacrifices that are necessary. There can be no gain without pain. That is why when you finally get your PhD degree, your family members can even be happier and more proud of you than you yourself, because it is as much their accomplishment as it is yours. Their sacrifices must be duly appreciated.

Is this your achievement?

So what does it mean when you have a Dr. before your name? Does it mean that you are an expert on a certain subject matter? Hardly so, I think. It means that you are both a seeker as well as a generator of knowledge. It means that you have enriched the world and added on to the vast body of knowledge through your PhD contribution. The world has become a slightly better place from the knowledge that you have contributed through your PhD thesis and publications. The world now knows more on a subject than before you completed your PhD. Your work get referred and cited by other researchers in your field, as they absorb your new knowledge to generate new knowledge of their own.

Your PhD is an end of your one journey that should be justified by its means. The research methodology, the analysis and the interpretation should justify the conclusion. The new knowledge must have been tested and challenged by your peers and rigorously defended by you. It is an accomplishment unequal by any other feat. Once you have obtained a well-deserved PhD degree, you become your own teacher as self-teaching becomes common practice. You are always curious and tends to read a lot, not just on your subject matter but on everything. You will find doing new things, exploring new frontiers and taking up new challenges more scintillating. In other words, it will change your life and your outlooks forever.

I hope I have inspired some of you to pursue a PhD degree if what you read here is what you really want from a PhD. On the other hand, I hope I have also discouraged others who have a misconception of what a PhD degree entails, so that you will not go down the road of failure. A PhD is not for everybody. You may share this post if you think it would help people you know in deciding whether pursuing a PhD degree is the right path for them to take.

Thanks to Prof. Jamal Hisham Hashim for agreeing to share his thoughts in this blog. Dr. Jamal Hisham Hashim is Professor of Environmental Health in United Nations University.

Let’s get into the Action: World Mental Health Day 2016: Psychological First Aid

7^th October, 2016: While I was coming out of the W.T. Young Library, University of Kentucky after short session of study, I was stopped by a girl. She politely asked me to fill up the form if I have time. I couldn’t decline it.

The form was standardized assessment tool for mental health status and when I completed filling up the form, the other girl immediately scored my test and referred me to a trainee consultant, who counseled me for short time. May be I didn’t require longer counseling based on my score and she informed me to come to the center if I need any help. They were providing psychological first aid. They were essentially working in response to World Mental health day 2016 with theme of Psychological first aid. That simple information actually helped me to find ways if I need any help in the future.

We are human and I feel human emotions are the most unpredictable things in the world and the distance between our normal mental status and abnormality is very thin. Anyone can switch over to other side at any moment. An instant of stress, anxiety, physical diseases, imbalance in the neurotransmitters could switch us to dark side of our mental health status. Especially when the world is turning competitive, eccentric, individualistic, we may suffer the things which we don’t want to. Even the healthiest looking human could be living with unseen turmoil and emotional disturbances around us.

A case of Nepal: Nepal was about to recoil from the wreckage of ten years long civil war (1996-2006) and was about to produce its precious new constitution. In April 2015, massive earthquake hit the Nepal and left many people bereaved due to loss of family, home, tangible and intangible valuables. Still many of us see its aftermath in shattered, cracked walls of home, teary eyes of the people who lost dear ones, mother, father, sisters, brothers, sons, daughter and other relatives, frustration because of amputated legs, nails and wires lingering in the bones, scarred skin and faces, frightful expression of kids and adults when something shakes the bed.

This is just an example of a disaster in Nepal. There are other several emergencies like war and violence in Syria and other countries, everyday hurdles, deadlines, and racing and fleeting lifestyle in which we have to fit ourselves for every new advances, we are in constant need of psychological assurance and social settings that pacify our emotional disturbances and racing hearts.

In such scenario, expert consultation from psychologists and psychiatrists is not available and accessible all the time due to their inadequate number and limited presence only at the tertiary level care centers and urban areas. We need someone by our side who can provide psychological first aid just the way a simple trained person can deliver cardio pulmonary resuscitation to a dying person with cardiac arrest. A person who can make someone accept the reality and help to find the ability to fight with the reality. A person who can arouse the passion for something in life, a person who find time to listen and create social environment that bind people together.

World Health Organization (WHO) is celebrating this mental world health day on October 10 with the slogan of Psychological First Aid. This harbinger is innovative and pragmatic way to achieve the holistic health as our current health system is mainly focused on physical symptoms and illness. This will surely sensitize our current health care service.

What can we do?

Most of the time, I see the trend of celebration of such important days with conferences and workshop where all the professionals and specialists gather up and share knowledge and stimulate each other. But we fall short in taking action, providing and continuing the services to the people in need. I hope psychologists, psychiatrists, mental health nurse experts, public health professionals, social workers would be leading this motto to action. Training and Preparing a bunch of people for first aid is only one aspect dealing with it. Other measures like formation of some form of society and communities such as literary clubs, professional’s clubs, youth clubs, mother’s group, Recreation group in the college, schools, villages with principles of inclusion, group work and cooperation would be equally helpful.

Who are Public Health Professionals: Any Boundary??

Public health is not a very new subject. The history of Cholera epidemic and study led by John Snow and subsequent action of sanitary reforms dated in nineteenth century provide insight into evolution of modern Public health. Nevertheless, definition, area of Public Health remained vague for a long time.

We used to have discussions on definitions, scope and boundaries of Public health in Classes. I remember we agreed that Public Health is broad. Some even said, “the scope of Public Health ranges from beneath the land to the sky. There is no limit in the zone of Public health.” We concluded that everyone who are working to improve the health of people are Public health professionals. We weren’t completely wrong though. Indeed, if you are working for the welfare of people, that's absolutely public health action. But in my today’s understanding, it contravenes against the essence of Public Health.

Why do we need demarcation?

Before I clarify why it contravenes the principle of public health, I would like to focus why it is necessary to demarcate the scope and to define Public Health professionals.

Professional growth of Public health: Once you are certain that which land is yours, then you will be better able to design the city there. People will design the buildings, roads, other infrastructures, and invest money to expand the area. In similar fashion, Once the scope and area of Public Health is demarcated, it will be a lot easier to decide on what to invest, where to invest. At least the government will not be baffled whether to build a Hospital or Public health outlet providing education to a target group when government allocates funds on the title of Public Health.

Solidarity: only the wolfs form the pack, fishes make the school and animals make horde and similar people make the community. They can set a goal, solidify and work to reach that goal provided that they have resources. Such Unions will help to strengthen the communal feelings and they work for their advancements. This will help in leaving impact to the society.

Working Environment: This demarcation will help in ensuring the capacity and limitation of the public health professionals.

Who are Public Health Professionals?

Institute of Medicine defines Public Health Professionals, “a person educated in public health or a related discipline who is employed to improve health through a population focus”. Scutchfield and Keck in Principles of Public Health Practice restate that “The test for whether something should be considered part of public health is the presence of a focus on a population group or community and on a preventive strategy or a preventable outcome.” There are two key things that public health focuses an action of prevention and approach as population group or the community. The action of prevention ranges from primordial prevention to tertiary level of Prevention and this should be targeted to the Population health. To define a public health professionals and public health practice, these two factors should always be taken into consideration.

Because of vague definition of Public health professionals, it has become really difficult to enumerate Public health workers and It is a global issue. Physician, Nurses, veterinarian, engineers, administrators, anyone can be public health workers. However, the two key elements should be taken into consideration. It is essential to devise workforce taxonomy in Public health because of its current undefined nature. Public health occupations can broadly be divided into four main categories: 1. management and leadership, 2. professionals and scientific, 3. technical and 4. outreach and support services. Theses public health professionals should have professional competencies to carry out certain essential public health services such as monitoring health status, diagnosing and investigating health problems and health hazards in the community, informing, educating and empowering people about health issues, mobilizing community partnerships to identify and solve health problems, developing policies and plans that support individual and community health efforts, enforcing laws and regulations, Research.

It is necessary to reevaluate definition of Public health workforce for professional growth, unity and benchmark. 

References:

F. Douglas Scutchfield and C. William Keck. Principles of Public Health Practice. 2009.