Public awareness and education is an evolving process.
Doherty et al. 2006;84:90-96
22 March 2006 - The article by Doherty et al. (1) brings out an interesting aspect of public health. It highlights the difficulties that may be encountered in attaining public health objectives. While mother-to-child transmission (MTCT) is predominantly due to vertical transmission, breastfeeding is also shown to contribute in MTCT of HIV. Public education and awareness remains an important milestone towards attaining a healthier society. Its importance is not merely restricted to awareness of breast feeding as contributing to MTCT. When the author mentions “when they see me coming with the tins, they laugh at me”, it outlines the refractoriness and apprehension of people to embrace any new concepts. However evolution of health concepts goes through various phases of public awareness and eventually become a standard practice.
Historically public health has seen tremendous resistance and difficulties both in accepting and implementing good practices. I use this opportunity to revisit the importance of hand washing. While hand washing in patient care is now a common sense and standard practice, healthcare professionals found hand washing both amusing and cumbersome. It was at the Vienna General Hospital that Semmelweis began investigating the causes of puerperal fever much against the resistance of his superiors. Transmission of puerperal fever was believed to be non-preventable. He was the titular house officer of The First Obstetrical Clinic, where national mortality rate due to puerperal fever was 13.10%. While another facility within the same hospital, called The Second Obstetrical Clinic had mortality rate due to puerperal fever of only 2.03%. While both the facilities used the same techniques and were located in the same hospital, they differed in the individuals that worked there. While the former was training place for medical student, the latter was selected for the instructions of midwives. In 1847, his friend Jakob Kolletschka died following an infection contracted after he accidentally punctured his finger with a knife during a postmortem examination. Lolletchska's autopsy showed a pathologic situation similar to that of the women who were dying from puerperal fever. This prompted Semmelweis to propose a connection between cadaveric contamination and puerperal fever, and following a detailed study of the differences in mortality rates of both obstetrical clinics he implemented a policy that medical students wash their hands with a solution of chlorinated lime between autopsy work and the examination of patients. Following this step, the mortality rate of The First Clinic dropped significantly and became comparable to that of The Second Clinic. Despite this brilliant observation and the 'discovery' of hand washing, his theory found extra ordinary resistance and led to bureaucratic turbulence (2).
On a personal experience, during Polio immunization campaign in India, I was frequently confronted by the local village population about the intent and effectiveness of Polio immunization. The resistance was enormous. The villagers recognized Polio immunization as a government conspiracy against them. They thought the intent of Polio drops was to sterilize their children and was a measure to curb population explosion. As a young medical student, often times I had to take a few drops of the vaccine in front of the villagers to ascertain that the drops were not ill-intended.
In conclusion, education and awareness of scientific principles is an integral part of attaining healthcare objectives. Public awareness is often (if not always) interrupted by local beliefs and practices; this is also highlighted in this article by Doherty et al. As public health professionals, it is imperative for us to recognize the obstacles that might come and develop suitable awareness strategies.
- Tanya Doherty et al. Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me". Bull World Health Organ 2006;84:90-97
- Daniels IR. Historical perspectives on health. Semmelweis: a lesson to relearn? J R Soc Health. 1998 Dec;118(6):367-70
Deepak Asudani M.D Division of General Medicine, Baystate Medical Center / Tufts University School of Medicine, Springfield, MA USA (Email: Deepak.Asudani@bhs.org)