If we can spend billions of rupees for smart cameras to follow us from the cradle to the grave, why cannot we have a family doctor to monitor our health throughout that same period of time?
By Sada Reddi
Ideally, any person having a health problem should have easy access to a health professional who can assess him, make good judgment what is desirable and feasible, given the health situation of the patient and advise accordingly. This is what every person would expect from a personal doctor. Many families have been privileged to have personal doctors to look after their health, but the overwhelming majority of the population do not have access to a personal physician to provide them with the necessary health support. Is it not time that some serious thought be given to the introduction of a family doctor service in our health set-up?
Readers must have heard of many families living mostly in the urban areas who had a family doctor whom they would consult for both minor and even major ailments; that was the case not so long ago and the doctors looked after one or two generations or more of those families. On the other hand, the overwhelming majority of the people had to resort to the hospital doctor for major illnesses. When it came to other illnesses, they usually turned to folk medicine. Most people had to rely on either family knowledge to cure certain illnesses, or in other cases, it was the neighbourhood nurse or the pharmacist or even pharmacy dispenser of the locality who would provide medical advice to families to deal with a variety of diseases which afflicted the population.
Talking to a few people about their family doctors in the past brought up a number of names like Dr Laurent and Dr Seewoosagur Ramgoolam. One family in the South had Dr Chu Wan Cheong as family doctor for over three generations. In Curepipe several names crop up, among them Dr Levieux, Dr Bhagheerutty and Dr Harel.
There is no doubt that a family doctor has always played a crucial role in providing medical care to many families. Attachment to a family and the vast amount of family history available have played a major role in preventive medicine and preserving the health of these families. In fact, all the private doctors were family doctors for a number of families. They were the reliable first contact for all health problems for family members of all ages.
In England, the National Health Service was set up in 1948 by Aneurin Bevan, a trade unionist who became the health minister in the Atlee government. Even then, it had taken a long time for the idea, which was first put forward in 1912 by a Liverpool physician, Benjamin Moore, before it was taken up in the Beveridge Report and implemented by Bevan. In Mauritius some of the progressives in the government had toyed with the idea of a National Health Service in the 1950s, but it was soon forgotten.
In the 1970s, Donald Chesworth and his socialist friends, who had been contemplating to introduce the concept of a family doctor for the population, revived the idea. In a letter to Sir Veerasamy Ringadoo on 1st November 1976, he wrote: “The Prime Minister had over a considerable period encouraged consideration of the possibility of a scheme which would give access without payment to general practitioners, of those seeking medical advice.” Chesworth and his friends prepared a detailed note and suggested that something along those lines might be practicable. The issue had been discussed in London with Professor Brian Abel Smith, Tony Lynes and Dr Michael Young (the founder of the Open university in Britain and of the Mauritius College of the Air) and concluded that “Beveridge Report it was now quite practicable to declare the creation of such a service an object of Government in the next five years.”
What made those Fabian socialists so optimistic about the feasibility of setting up a ‘National Health General Practitioner Service’, apart from their ideological inclinations? They had studied several reports on health in Mauritius — one by Professor Fendall of the Liverpool School of Tropical Medicine and Dr Dickson Mabon as well as the two Five Year Plans 1971-1975 and 1975-1980. They surveyed the health sector as well as the economic situation in the island. They found that the health services had been geared in the past towards curative medicine and there was then the intention to restore the balance by giving priority to preventive medicine. Efforts were already planned for integrative services in the ministry and the creation of health centres in the five-Year Plans.
In line with this new approach, they found that the creation of family doctors was most opportune. First, the Prime Minister had taken the decision to offer government postings to all returning doctors in the island. Second, the projection for increasing the number of General Practitioners in the second Five Year Plan 1975-1980 had already been attained in 1975 itself. The number of General Practitioners in the country had risen from 223 in 1971 to 360 in 1975, while the government’s projection for 1980 had been 244. By 1980 they expected 500 doctors for a population of 950,000, about one doctor for every 1900 persons; if we exclude medical specialists, it would come to approximately 3300 for one General Practitioner.
In the circumstances of those times, the number of General Practitioners would still be insufficient, but the scheme could only function with a trained nursing support. Nurses would be trained to assume greater responsibilities while medical practitioners would spend less time with matters which do not require the skills of a long and complicated training. A more judicious use of skilled manpower would give both doctors and nurses increased job satisfaction and help to achieve higher standards. In the mid-70s, the number of trained nurses in the island was 1049, and midwives in government service 185. In the proposed scheme they envisaged an increase in the number of nurses so that the ratio of General Practitioners to nurses would be 1:1.
In 2017, with a population of 1.2 million, we had about 1188 medical officers in government service excluding medical specialists and about 4000 trained nurses. The medical scene has changed considerably since the 1980s and today there is no shortage of doctors or nurses to implement a family doctor scheme. Obviously, like any sector, the health sector is crisscrossed by a number of interests and there will always be a number of arguments for and against such a scheme. One of them could be that it would be superfluous, as we already have a National Health Service similar to the one that has been set up in England.
For the population which has never benefited from the service of a family doctor, it would not only enhance the health standard of the population and bring an immense contribution to preventive medicine in the island, it would also cut costs and make our health system more efficient. A bold initiative in this direction has become a necessity. If we can spend billions of rupees for smart cameras to follow us from the cradle to the grave, why cannot we have a family doctor to monitor our health throughout that same period of time?
* Published in print edition on 17 January 2020
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