is public health working?

if u look at how the healthcare system works, it incorporates not just primary healthcare (direct doctor patient handling) but more importantly, public health.

we were going thru this PBL on Trichuris Trichuria (a parasitic worm) some time ago in my GIT module.

it was about this Bangladeshi foreign worker who was diagnosed with infection of this worm. his current living conditions - poor sanitation, poor diet (only1 meal a day which prob consists of cheapest non-nutritious food d/2 his meagre salary) and horrible sewage management. (the waste all directed into the river thingee - like u all saw in Slumdog Millionaire).

patient was treated, stabilised, sent home.


what do u tink's gonna happen to him in a few wks time? or say.. few months. or his neighbours.


re-infection. comes back to hospital.


the vicious cycle continues.


we DO have things like public health to educate public, increase awareness, campaigns etc..
for this case.... easy right? doctors just have to notify local authorities, get them to check out and perhaps improve living conditions for those foreigners.


question 1: Was he a legal or illegal foreign worker?

in the case he is legal, do local authorities have any incentive to help foreigners? in comparison to responding to complaints from the locals themselves on drainage/ waste disposal / electrical problems that mountain sky high.

in the case he is illegal, the place he's staying is prob a squatters area and either nothing will happen bcz that area doesnt even exists on the local municipal's map, Or.... maybe a few years or decades down the road whn the gov decides to build sth at that area then the whole area will be demolished.

either way, no help comes.


question 2: does Mr. X have any incentive / avenues to improve his own living conditions?

looking at his condition, he probably is fighting to survive to even think about improving conditions. furthermore, avenues to improve conditions are lacking. foreign workers get thrown into 3D jobs the locals dun wana do. its tough to come up and fight for worker's rights with ur employer when u have no means to get legal representation or $$ in the 1st place. rather than doing that n suffer from losing his job, he'd rather stay the way he is.


question 3: Can awareness supersede inconveniences?

while Mr. X thinks that yeah, getting this infection won't KILL me as of yet, its ok to continue living here, practice bad hygiene and live on 1 meal per day bcz that's what i can afford and ev1's doing the same thing. no1's making a big deal of the toilet that contaminates n stinks the river, n i'm not going to start. earning RM25 a day does not enable him to change living conditions. yeah maybe practising washing hands would help, but if the water's already contaminated, no diff.



so that basically illustrates the failure of public health to intervene in this patient's problem.


it leaves efforts of doctors who tirelessly diagnose and treat, diagnose and treat and ADVISE lol over n over again in vain.


it makes us realize that problems like this do not only occur in cases of foreign workers like him, but also among locals who're out of reach for proper health care or faced with sheer poverty.


perhaps things will change when ppl (those w power) start to realise:

- how infections like Trichuris trichuria that do not prevail in Msia (it was brought over from the patient's country) can become a problem in Msia s well. n so it bcums an incentive to do sth about it then.

- how upholding worker's rights are important, for the very reason of respecting every human's right to live deservingly.

- how not all diseases are curable by medical intervention (drugs, surgery) and start carrying out self responsibility to practise hygiene.

- how complications of diseases are hardly reversible. that's when it's reli too late.



one of my coursemates who went for a home visit last week described the living conditions of her patient.

picture this.


- obese, semiparalysed (on the right from head to toe), on feeding tubes (cant eat), drugs (hypertension, high cholesterol, diabetes), immobile (lies on the bed) for the rest of her life. bcz of the stroke, she cant converse properly, n is practically nearly a vegetable. bcz of the semiparalysis, it impaired movement of her gut (the peristalsis that helps in digestion) and every once in maybe a few days, she regurgitates feces from her mouth.


just imagine the amount of toxicity from that. n what she has to go thru everyday the moment she wakes up. thankfully she's positive about life.


we empathize. but could this be prevented in the 1st place? (i'm not saying its her fault or anything but

> did parents of obese children ever thought it was their responsibility to control their children's diet?

> did they ever imagine their children to end up as above (not saying they will definitely end up that way, just saying its a possibility).



if the current situation isnt enough to shake some sense into ppl to practise taking care of themselves, public health needs to step in.


n it needs to do better.


heralding MS! ahaha. (its one of my subjects pertaining public health that most ppl study the least / last minute heheh)