A recent experience

I had the opportunity to spent 3 ½ days with a group of enthusiastic path breakers, who are engaged in primary care and medical education with a difference, across our nation.  This 3 ½ days spent with “The Group” at Vellore was an invigorating, encouraging and a challenging one! After a few days of these meetings, I am still reflecting – how can I be enthusiastic, passionate and pathbreaking like “The Group”.An enlightened group, who have understood what is important for the context of our nation.

Let me expand what I experienced here. The time with this group was invigorating because, there was a palpable and perceptible passion, a passion that was instilled in all! Passion for primary care, passion for teaching, passion for facilitating learning, and the desire and hope to make a difference. 

Echoing what was shared by one facilitator from the Franciscan blessing 

“And may God bless us with enough foolishness to believe that we can make a difference in this world, so that we can do what others claim cannot be done, to bring justice and kindness to all our children and the poor.”

That “foolishness” was palpable, to make a difference in our nation, where health care has become compartmentalized, commercialized, and out of reach for many. To be an alternative voice, and develop multiple models of cost effective wholistic family based primary care. 

It was encouraging because there was innovation in various fields. Innovation in learning, in training, in models of primary care, in understanding of what family medicine, wholistic care and methods of learning to learn. Everyone was talking about newer ways of doing things, breaking out from age old paradigms and ways of doing things, challenging each other to be path breaking in their approaches.

It was encouraging because, the average age of the group might have been in mid or late 30s. But for a few of us, wo might have shifted the median to the right side of the scale, rest were in their mid or late thirties. An assurance that primary care is in the hands of the right group of people, who with their passion and enthusiasm can make a difference in our nation for the next few decades. And hopefully facilitate a movement across our nation to come back to family medicine and primary care as the answer for the health of our nation. 

At the same time, it was personally a challenging time for me, sitting and listening to these passionate, path breakers. Because there were couple of Déjà vu moments for me, taking me back my memory lane. 

I was taken back the memory lane, 20 years back when as a hard-core clinician, who in one sense cared nothing for community engagement or primary care and was only concerned with clinical medicine and hospital-based care, was forced by circumstances into the path of “enlightenment”. 

The enlightenment being one of a realization that what I do within the four walls of the institution, does not do much to change the health of the community or the family, but many a times destroy the economics of the family and community. That only by engaging with the social determinants of health that we can make a difference. 

A truth that I have known since then, but many a times fail to put into practice, amid the business and busyness of clinical care and escalating costs of health care today.  

I was taken back the memory lane to 15 years back, to a season of life when I was part of a team that worked on continuum care concepts and models of care for those infected with HIV. And seeing many live transformed through such continuum of care provided at clinic and at home. 

Continuum of care as a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care.  Whether at home, or for primary, secondary tertiary and quaternary care individuals and populations should have access to cost effective rational and excellent care.  

A concept that I knew very well, but many a time unable to put into practice today because of the challenges of context. 

I was reminded of a statement our team wrote about 10 years back, regarding reaching out to a high-risk community challenging our teams to hold the urgent and the important together. (paraphrased here)

“We realize that we should be addressing the “Important” – i.e. issues which has contribute to increasing high risk behaviors in the community, but at the same time, we have the “Urgent” issues of disease transmission and lack of access to care at hand. We hope that by addressing both the urgent and the important we can facilitate developing resilient and caring communities.”  

Again, another concept of holding the urgent and the important together but one fails to hold it together amid the multiplicity and ‘urgency’ of urgent situations. 

I hope the ongoing engagement with the members of “The Group” would help many like me to return to enlightenment, reorient our practices and return to what is important. The important being, person, his or her family, wholistic care, continuum of care and looking into the social determinants that affects each patient whom I encounter!