Intervention brings quacks back on right track: Study
An apparent yet little community intervention has brought several unregulated quacks on right track to practising allopathy in rural areas, but public health scientists say many challenges are still ahead for the outcome to sustain.
The success came after three and a half years of research and a year of intervention in 11 villages in Cox's Bazar.
The social and behavioral sciences unit of International Center for Diarrhoeal Diseases and Research (ICDDR, B) did the job between 2007 and 2010.
According to preliminary findings, motivational training among informal village doctors and a simple guideline for primary healthcare have substantially cut the tendency to prescribe inappropriate and harmful medicines, especially antibiotics for infection control.
The inappropriate use of medicine by village doctors was brought down to less than nine per cent this year from nearly 75 per cent in 2007, says the study.
The tendency of prescribing antibiotics, key concern for bacterial resistance among rural poor, has also come down remarkably over the period.
"Encouraging results were found from personal motivation for "do's" and "don'ts" among the village doctors in Chakaria," says Dr Mohammad Iqbal, the master trainer and one of key investigators of the study.
He says over 100 village doctors have now been practicing medicine rationally and with certain degree of appropriateness.
Dr Iqbal said the trained doctors, who are better known as 'Shasthya Sena' locally, have now been facing stiff competition with non-trained quacks, who are neither properly educated nor are aware of their harmful practices.
"The non-trained quacks used to suggest antibiotics at will to get financial benefit from drug sales, but we cannot do so because of our education," he said.
"Suggesting antibiotics is common to every village doctor for several reasons -- to give patients quick relief, continue permanently with a customer and earn money from drug sales from his own stores," reads the study.
Despite training, it was equally important to hold the village doctors accountable through strong regulations by the government, said ICDDR, B Deputy Executive Director Abbas Bhuiyan, also principal investigator of the study.
The government regulations would enhance the quality service by village doctors and make them rational, added Abbas.
"Despite controversies, village doctors are now an integral part of our rural health system in Bangladesh, whom we cannot deny. We need to direct them properly and hold them accountable like qualified doctors," said Dr Mahbubul Alam, upazila health and family welfare officer of Chakaria, yesterday.
His deputy Dr Abdus Salam says the practice of village doctors should continue since they offer low cost, and MBBS doctors are scarce right now.
Moreover, finding alternative to such quacks is a big challenge, Dr Salam added. "So it is better to utilise their service so long the country is not ready with sufficient number of qualified doctors".
He, however, said legal and ethical regulations are necessary to stop the quacks' harmful practices.
According to a statistics, the country has a shortage of 12,000 qualified doctors with nearly 48,000 doctors currently available.
Bangladesh also needs 483,000 paramedics and 280,000 nurses, say the statistics.
The public and private medical colleges now release nearly 4,000 medical graduates annually in the country, which depicts a severe shortage of qualified doctors in Bangladesh at least for next 15 years.
The village doctor-cum-Shasthya Sena at Boroitoli village said they are not competitor of MBBS doctors; instead complementary to them.
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