Examining The Orientation of Public Health Practice in The Gambia: Letter to my Lecturer

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Dear Mr Nget,

10 years ago this week, I was seated right in your classroom as a student at The Gambia College – School of Public Health in Brikama Campus. Those moments will ever be cherished. Haha! Ok.

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Very well, please allow me to offer you my honest professional and intellectual reaction to the service I have dedicated my life so far in this country.

Sir, since 1887 when the first public health ordinance was passed in The Gambia, our focus has steadily been on general public health practice. Until 1961 when the Ministry of Health was established, The Gambia continued to rely on the expertise of few public health experts who managed to situate the said Ministry. And then in 1964, the seriousness of the focus of general public health practice was well scoped, further creating an Endemic Disease Unit, mass vaccination campaigns, and upgrading the then Village Dispensaries to Rural Health Centers. Beautiful!

However, in examining the orientation of Public Health Practice in The Gambia, we need to move away from general public health practice to precision public health. The world today has lost sight of general practice to speciality skills utilization. This has fueled and favored precision public health over general public health practice.

We do not necessarily have to shift focus from the population care approach over individual patient, but we need to swift focus now on giving right treatment at the right time, every time to the right person. Of course this has been the goal of public health practice but there is a lot of hype around this as per it’s real application.

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Precision public health practice will allow a good moderation for targeted population interventions. Yes, the general public health practice has been the bread and butter method of our health care system that had made us achieved this much as a country. But then, in this day and age, we cannot do good public health practice without health technology and speciality skill-sets. Colonial public health practice does not match the realities of the current trends of emerging diseases and other health emergencies. The sand has shifted!

Our approach in Public Health Practice today must take into account the individual variability of genes. This is why genomic epidemiology is needed today best than ever! We need to have essential gadgets in measuring our environmental factors and not merely using perception score tools or flipping pages of health diaries. Our approach to disease surveillance must shift without heavily relying on printed investigation forms but a networked surveillance platform that will sink real time information and run the analysis for risk trends on the spot as well as wearable tech-gadgets. We should be able to see the real time case events on a standard emergency dashboard that can be monitored by personnel’s of the Public Health Emergency Operation Center (PHEOC) at Kotu.

Sir, we must act fast and intelligent to revolutionize public health in this country. Are we not jealous of this beautiful cadre? We need to advance our demographic risk mapping with such speciality skills that can provide us with an in-depth analysis of disease penetration in our communities and the care delivery logistics needed. Such mapping can better inform our gallant field forces – Public Health Officers – in the conduct of performing contact tracing for individuals that may have been exposed to a certain disease to slow the speed of community transmission. At least we have done well with MobileHealth – 1025 Operations.

Today, our roads are a death trap for the productive population of this country. Precision public health will allow a more proactive tailored intervention-based strategies for our driving population and road users. The factors responsible for road crashes are multilayered. We have to attack the layers one after the other, from policy, road engineering and markings, speeding resolves, user behaviors and knowlege, etc.

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Sir, finally, we have to break the barriers to better understand case profiles, predict risk and outcome, and act upon that evidence at the right time, every time to the right population.

Let me use this opportunity to ask the Almighty Allah, to bless you abundantly. You imparted a great deal of knowledge on me. Thanks!

Your Student,
SG Sillah
Public Health Commentator

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