“We live in a world with infinite possibilities. Hearts are transplanted, DNA is decoded, and new medical discoveries are made every day. Yet we continue to be stymied by how best to reach those in resource-poor settings with the most basic care and medicines that we take for granted” –Bill Frist & Richard Sezibera. The Lancet, 2009;374:1485-1486
International agencies, national governments and various stakeholders from across the world in a bid to break this paradox, where in spite of all the progress being made by mankind humanity is at stake, had in the past tried various models . Almost everything has been tried – from “free medicines” to “compulsory licensing” , from primary health care centres in the remotest district to sophisticated state of the art tertiary care centres, from basic sanitation and drinking water to massive eradication drives but the one aspect that has largely being ignored is understanding and meeting the healthcare information needs of the people.
Healthcare Information As An Effective Public Health Intervention Tool :
It is common knowledge that thousands of people die every day from diseases like diarrhoea , pneumonia and malnutrition – diseases against which cost effective interventions have been available since decades. A closer analysis of factors causing such deaths reveal that often it is not availability of medicines or healthcare facilities that is a major killer. The fact is that the parent/health worker or in certain cases even physicians do not know what to do and where to seek help . Yes it is clear now that People are simply dying for the lack of healthcare knowledge. And for each person who dies, there are many more who survive with unnecessary pain, disability or reduced quality of life due to failure to receive timely care.
A few facts make the above mentioned point more clear and focussed . In spite of ORS (oral rehdration solution) being available and the importance of fluid resuscitation being stressed on from decades, many mothers and healthcare workers actually do not give ORS to a baby with diarrhoea – in fact they often give less fluid than they would normally, thereby tragically increasing the risk of death from dehydration. A study in Maharashtra, India showed that 42% of mothers still believed that a child with diarrhoea should receive less fluid than normal. Maharashtra is one of the affluent states in India so we can only imagine how bad the ground scenario is in the economically backward states of the nation. The scenario is similarly grim for many diseases like TB, malaria , Leprosy and even the modern afflictions like Diabetes and Hypertension where patient education is the key to determine success in effective management of the disease.
Misinformation rules in the community from the poor villager to the urban slum dweller to the man living in the top floor of a multi-storied building – everyone has their own concepts of health and disease. Patient education is arguably the most cost effective way to save and improve lives and yet it is largely ignored as a healthcare measure . Lack of healthcare knowledge also leads to delays in seeking health care. A very good example of this are snakebite deaths – most of which is due to the fact that the golden hour of treatment after the bite is spent with the “Ojhas” or traditional faith-healers. The Government of India has made AVS (antivenom) widely available and yet people go to healthcare facilities only at the last moment – when it is too late. This is due to lack of healthcare knowledge: the people do not know that a visit to the traditional healer will delay the administration of antivenom and will therefore reduce their chance of survival.
Healthcare Information Needs Of Health Workers:
Health workers need healthcare information to be able to learn to give quality modern evidence based care to patients which is not only safe , appropriate and effective but also acceptable and user friendly. Though access to health information should be considered as equally important as to access to drugs and equipment it is largely being ignored world over. A World Bank Study conducted in 2008 show that only 25% of healthcare providers in Delhi enquired for blood/mucus in stool from children with diarrhoea and only, 49% asked for fever and only 7% actually checked for depression in skull fontanelle of infants. A Study from Jamshedpur, India published in the internationally acclaimed journal Burns clearly show that only 22.8% of patients had received appropriate first aid for burns. The reason behind this is not always the lack of facilities. It was seen that many of these remaining patients in the above mentioned study received improper first-aid care. A example of this can be found out by the fact that lack of proper healthcare information leads to errors in diagnosis and ineffective or even harmful treatments. This in effect means that the billions of dollars put in to develop healthcare infrastructure and make essential medicines and scarce human resources available do not lead to any real-term improvement in the ground scenario.
The Way Forward :
The need of the hour is to recognise the importance of healthcare information and knowledge as an indispensable part of the healthcare system. The development of reliable, relevant, usable information sources for the general public and for health workers must be improved as a priority. Those with access to the internet need to be able to know if any particular health website is reliable or not reliable. Those without internet access need health information in other forms, as appropriate according to their level of literacy and socio-economic status: print, radio, television, dance and/or drama. There is no one-size-fits-all with health information. What is important is that the information that people read or receive is accurate, honest, evidence-based, understandable, and appropriate to their needs. It is time to ensure that misinformation is reduced and eventually eliminated. Drug companies must not be allowed to continue to make false claims about their products, or to mislead people into spending more on an expensive drug when a cheaper one may be as good, or better. Quacks – people who pretend they are doctors but do not have formal medical training – must not be permitted to claim they can cure illnesses that they cannot. Ultimately it is the responsibility of the Government of India to realise, progressively, the right to health of the citizens of india. It is therefore the responsibility of the Government of India to promote the availability and use of reliable, life-saving healthcare knowledge, and to prevent the dissemination of misinformation on health. To find out more about these issues, and to interact with a global network of over 5000 health professionals representing 2000 organisations in 167 countries worldwide one might join HIFA2015 . It is a campaign and a health care knowledge network involving health workers , health librarians , medical professionals and publishers worldwide with the motto to create a world where people are no longer dying for lack of knowledge.
Dr. Soumyadeep Bhaumik,
Resident Editor , Your Health and
Country Representative ,India, HIFA2015(Health Information for All by 2015)
Dr Neil Pakenham-Walsh
Coordinator, HIFA2015 (Health Information for All by 2015)
Co-director, Global Healthcare Information Network
Article Published in November 2012 issue of Your Health of Indian Medical Association. Please contact original Publisher for Copyright Information.
Thank-you for informative post which extends Frist & Sezibera. I am not knowledgeable in medicine but find info made me once again realise how we must be lifelong teachers and learners in best, local community education models.
Thank you a lot. HIFA2015 is a global group whihc aims to create by 2015 a world where people are no longer dying due to the lack of knowledge.