Rural Health Training centre Activities for Internee doctors – A Real Time Exposure to Rural Community Health

Internship is a phase of training wherein a medical graduate is expected to conduct actual practice of medical and health care and acquire skills under supervision so that he/she may become capable of functioning independently. It was a recommendation of Bhore Committee that there should be three months training of medical undergraduates in preventive and social medicine to prepare “social physicians” during their internship training.

There is two months training for internee doctors in community medicine; one month in Rural Health Training centre and urban health training centre each. The focus of this training duration is to orient the internee doctors at community located either at rural or urban area, so that they can be prepared of dealing with community at large after successful completion of internship. This article is an attempt to help the officials to plan or direct the internee doctors for various activities in field during their posting in community medicine department.

Nandan D et al. (2013) recommended in their study that the need of the hour is that medical colleges should realize their social responsibility towards rural India by shifting the teaching & training programmes with increased orientation towards rural community. The different departments of Medical colleges such as community medicine department should play an active role in implementation of the national health programmes such as NRHM and outreach services may be provided to the community in the periphery or vicinity of the Medical colleges around 1 lakh population. Medical colleges also have an important responsibility of imparting training to the cadre of workers (Health workers and AN Ms) and providing them skills in public health.

NSSO 2004 data reveals that the private sector has become the dominant source of health care services, both institutional and non-institutional, for patients in rural and urban areas. The utilization of public facilities is only very marginally higher among the poorest segments. So RHTC of private medical colleges can play a significant role in health care programmes. Reorienting medical education to support rural health issues including regulation of medical care and medical ethics is one of the key supplementary strategies of NRHM as per RHSreport of 2012.

A transect walk is a tool for describing and showing the location and distribution of resources, features, landscape, and main land uses along a given transect. Village walk can be an initial step to orient the interns at their practice area during their posting. They can have idea about the composition or structure of community, its social customs and norms, availability of health services and its use by the community as well as environment and sanitation conditions of the community.

The another aspect of internee posting in community medicine is to make them aware about the various monitoring and supervision activities of public health personnel; Village Health and Nutrition Day session monitoring, Water, Sanitation and Hygiene at health premises, cold chain maintenance at Cold Chain Point, Biomedical waste management practices at health care centres, Rapid Immunization Coverage Survey etc. A community physician provides technical expertise to plan, implement, monitor, and evaluate health programs. S/he may also be a part of expert groups or committees in various health programs. S/he also provides technical expertise during outbreaks/epidemics. The internee doctors can be a part of the team along with the faculty member responsible for carrying out these activities. By observing the monitoring and supervision activities they can have better idea of this branch to choose community medicineasacareerpath forpostgraduation course.

Family health Survey register is an important document for RHTC denoting the work area and its composition for RHTC staff. The internee doctors can be a part of this bi-annual survey team. The update of Family health Survey register can be a continuous process throughout the year by determining the fixed day activity in a month. This process of survey can help to develop the communication skill of interns as well as community may be sensitized to utilize the services available at RHTC.

Research Is an important component of postgraduate study. Actually it is a prerequisite for eligibility in examination. Research methodology is an essential constituent of postgraduate curriculum in community medicine. New programs or strategies are pilot tested before launching them on large scale. A community physician plays an Important role in linking research to policy and program. Internship is a good opportunity to orient interns towards clinical and community research. They should be encouraged for short term research project during their posting in community medicine. The faculty members can act as a mentor for successful research project. Operational research methods are useful for the systematic identification of problems and the search for potential solutions. Many innovative applications in developing countries are not evaluated so there is a clear role for operational research to assess them and to improve their design and delivery. Operational research may be the good starting point in this direction; it will promote further research to improve functioning of health system.

Analysis of health related data provides the basis for major programmatic decisions. It also helps in improvement of health indicators if they are acted upon by the program managers. Ample amount of data Is generated at primary health centres, subcentres and anganwadi centre level, As the internee doctors are well conversant with biostatistics and epidemiological methods, they can be involved in analysis of these health data and generation of health indicators. It will be a great help to the medical officer taking the evidence based decisions for improvement of PHC functioning.

Outreach community sessions are held to benefit the people residing in hard to reach areas or who are not utilizing the health services for varied reasons, These people are In great need of health services sometimes. Internee doctors can be a part of this mobile team in providing clinical and supportive services along with medical officers and other team members during the session. They can also deliver health education to the beneficiaries attendingthe session.

NGOs are important in identifying the people's needs, providing services, linking government and community, and in sharing their expertise. NGOs are contributing to curative health service delivery by providing human and financial resources, materials and equipment, sharing information as well as developing joint projects with government. It may be the great opportunity for the internee doctors to work with these NGOs during their training in community medicine. They can learn the lessons of management while working with these institutes, Sometimes these institutes are in need of health care functionaries for provision of various health services in their catchment area.

Multipurpose Worker Male is responsible for carrying out door to door surveillance of endemic communicable diseases prevalent in the community, They are crucial for anti-larval activities, disinfection of drinking water at household and community level, active search for cases of malaria, filaria, tuberculosis, leptospirosis etc. Interns can accompany these ground level workers during their field visits and may provide technical support to these health functionaries; it is an opportunity to observe the field activities which will be beneficial for supervision activities in upcoming years when they would join as a medical officer.

Village health sanitation and nutrition committee meeting is held every month at village level. The committee has been formed to take collective actions on issues related to health and its social determinants at the village level. The representatives of Gram Sabha, ASHA worker, ANM and AWW are its members. Various issues are discussed in this meeting for improving the health care delivery in the village. The internee doctors can also attend this meeting to learn the structure and functions of this committee.

Thus internship period in community medicine can be a great opportunity to orient themselves towards the key aspects of public health before theyenterin real practice.