TRAINING IN VENEREOLOGY

by M. P. Vora

The Bombay Civic Journal

Official organ of the Municipal Corporation of Greater Bombay

Volume No – XIV, Number 2 of April 1967.

Page No. 90 to 92.

The Association for Moral and Social Hygiene, Maharashtra Branch, Bombay, deserves hearty congratulations on its unique decision to start free refresher courses in venereology for the benefit of the medical practitioners in Bombay. The distinction of being the only place to have sponsored such a scheme for the first time in India rightly goes to Bombay. There is an urgent need for improved education of medical students and doctors in venereal diseases. It is incredible that medical students still receive practically no instructions about V.D. throughout the whole course of their training. One feels certain that this programme will remedy this omission to some extent. Desire for knowledge in venereology among medical practitioners is evident from the large number of doctors who attended the last course more than forty doctors had registered their names for the training.

NEEDED URGENT ATTENTION

Patients with venereal diseases and their problems need an urgent attention. Venereal diseases are the most potent and frequent cause of illness. They usually pass from person to person without knowledge. Their influence on good breeding, premature death, disablement and national economy are not sufficiently known to larger section of the public. They exact a heavy toll on the health and efficiency of men and women. It is, therefore, of utmost importance to plan in an organised way for their control at the national, state, district and town levels. Haphazard measures are bound to fall miserably. To neglect these patients, as it is now done, is to neglect national health and happiness.

It is essential to establish separate venereal authority the Directorate of Venereology and entrust it with all problems connected with V.D. such as planning, establishment of clinics, collection of statistics, teaching, supervision of venereal clinics and institutions, adoption of uniform policies, and their application all over the country, and to provide services tailored to the needs of a particular area and situation, and to advice health authorities. The State Government must also set up a separate venereal division, the Deputy Directorate of Venereology as a part of the Central Health Organisation, for the purpose. To encourage the organised and planned growth of V.D. institutions and clinics and to ensure their smooth running, such a step is of prime importance. Without such a central authority, co-ordination of efforts, adoption of uniform measures and enforcement of suitable policies throughout the country can never be possible. Besides, it will do away with the discriminatory attitude often shown by hospital authorities towards venereal clinics in regards to their requirements of staff accommodation, equipment and supply of medicines.

A STRONG PLEA

Venereology and Dermatology are not to be combined in one unit. Two separate chairs and departments for these two specialities need to be instituted in every teaching medical college and its attached hospital. Every general hospital ought to have a separate department of venereology with adequate staff, equipment and accommodation. This is the only way to provide specialised medical services to venereal patients, and to ensure proper training in venereology for medical students. Experience of the past few years has amply proved that venereal work, patients and training of students are totally neglected in a hospital, where there is a combined department of skin and V.D. The way patient are dealt with herein, is nothing short of quackery. A reliable diagnosis, correct treatment, education of the patient, contact-tracing, follow up tests to ensure complete and permanent cure etc., are rarely done even in the so-called teaching institutions. This is very shocking but absolutely true. To remedy the situation, it is all the more important to encourage venereology as an important branch of medicine, and institute a post-graduate degree or diploma in venereology. In consonance with the basic principle, the universities of Madras and Delhi have already instituted a separate post-graduate qualification in venereology. For the sake of national interest and uniformity, it is necessary to follow the same policy everywhere. The need to remove this somewhat glaring inconsistency in medical education does not seem to have received the attention, it deserves.

This is an age of specialisation and students of medicines ought to get all facilities to equip themselves properly in venereology. Equally important is that venereal patients get specialised medical services; for, unskilled medical services are not only useless but also dangerous from the point of the patient’s health as well as public health.

There is a strong case of expediting decisions on venereal policy. There is such a stalemate in our medical services and education today, that bold decisions can only pay good dividends and this can only happen after agitation on the part of an enlightened public.

URGENT NEEDS

It is necessary to provide adequate and free diagnostic and treatment facilities for venereal patients. At present, there are very few diagnostic-cum-treatment facilities for venereal patients even in the cities and in the country as a whole, though the incidence of V.D. is alarmingly high. It is a fact that many private and public hospitals are generally very reluctant to appoint venereologists and to provide specialised medical services to the venereal patients in their establishments, though this can be done easily and without any additional burden. This apathy on their part must end the sooner the better. A venereologist must constitute a part of the comprehensive team of specialists for each and every hospital. A chain of laboratories such as central laboratory, district laboratory, town laboratory and field laboratory must be provided all over the country. This is the most important step; for neither an early and accurate diagnosis of V.D. nor its permanent cure can be established without laboratory aids. Clinical impressions or assumptions are totally untrustworthy and often dangerous. Medical practitioners in private practice, who are the back-bone of health services, usually lack in this necessary facility, and are in great want of laboratory aids. With the help of these laboratories, they can effectively share the responsibilities in the control of V.D. and help to reduce the load of medical work on public hospitals. It is the duty of civic authorities, to cater for these needs. To allow the patients to go untreated or uncared for, creates danger to society and the public in general. This fact needs to be realised clearly by the people in authority.

EDUCATION & LEGISLATION

Education of the public with regard to these diseases by means of press, radio, cinema, talks and posters need to be undertaken in right earnest. Some type of legislation needs to be enacted making the blood test syphilis necessary as apart of routine physical examination or check-up before employment, marriage and in the cases of pregnant women. Deliberate transmission of infections to others has to be made a crime. Treatment of defaulters in treatment and infectious diseases must be made compulsory.

Each state ought to have an institute of venereology where medical and paramedical personnel can be trained in specialised work. The growing number of clinics would need trained personnel and the institute can be of relief to prepare and supply them. In 1958, the then Government of Bombay announced its decision to establish a training centre. Equipment worth lakhs of rupees was purchased and a building worth ten lakhs was built; however, one does not know when it will start functioning. Does this not clearly show how much the State Government cares for the subject? Its apathy is colossal. It should be no exaggeration to say great damage has been done to the cause of public health by our sustained indifference to the interest of venereal patients. The havoc is grimmer and more distressing because of haphazard policy that is adopted by the Government in regard to venereology.

CREATING MOTIVATION

The crisis of health services needs an urgent and adequate attention. It should help to alert the public to the urgent requirement for more active planning and priority setting for health and medical services. If the nation has the will, two things are necessary, i.e. motivation and dissemination by stimulating concern over the problem. Private agencies are all important in creating motivation. But large-scale results can come only when the Government boldly takes the lead. And the Government action seldom comes, until an alarmed public demands it. Hence it is the duty of the public to demand the provision of specialised medical services for venereal patients, elimination of V.D. and protection against risks of health.

DOES THE PROBLEM OF V.D. NEED AN URGENT ATTENTION?

Of all the social ills of man, the least confined, the least manifest and the least likely ever to be static is venereal diseases which constitute the most dangerous hazard to public health and happiness with the heaviest impact on our national economy. Accurate statistics regarding V.D. are non-existent in India. However, some idea of the wide prevalence of this scourge can be held from the figures obtained from different authentic sources.

SERO-POSITIVITY RATES FOR SYPHILIS

The prevalence rate of syphilis alone for the country as a whole could not be under ten per cent. Incidence of gonorrhoea is higher than syphilis. The prevalence rate of V.D. in western countries like U.K., U.S.A., and France is often less than one per cent. The economic loss to the country resulting from these diseases is colossal.