The need to change medical education system in Afghanistan

The goal of medical education is to improve the health of population. Historically, illnesses that were unknown, such as plague, or did not have cures, such as the TB and chickenpox, had killed millions of people within large populations,. Thus, medical educations were designed to focus on the cure of diseases. Today, the situation has changed. We have some diseases that do not have available and accessible cures such as the HIV or the Ebola, but most diseases that kills millions of people are easily preventable and have easily accessible cures.

In Afghanistan, around 600 children under five die every day in Afghanistan, that is more than 20,000 children every year. The causes of these deaths are pneumonia, diarrhoea, malnutrition, and other preventable diseases. They are easily preventable and simply curable. Afghanistan does not need cutting-edge medical technology to take care of her children, the country simply needs basic drugs and heal. Financially, out of US$1.5 billion Afghan national health expenditure, more than US$1 billion comes out of the pocket of Afghan people.

One of the major problems lies in the medical education system of the country. First, it is a model of medical education that focuses on complicated and hard to cure diseases. Treatment of pneumonia, diarrhoea and malnutrition for trained medical doctors is a piece of cake, and it does not challenge them. Treatment of a complicated cardio-pulmonary disease might be an interesting case, but not a simple cough that drug dispenser can treat with a bottle of syrup and a dozen of cotrimoxazole. And courses like preventive medicine, public health and epidemiology has a zero value in this education system.

Second, training of those professional physicians takes up a lot resources and times. It takes 7 years to train a medical doctor, and only the top school graduates are finding a spot in medical school. Most of them choose to go to medical school for social status and not becoming a physician to help the most in need in rural villages of Afghanistan. These pool of talented youths go to become physicians who might, only might, work in the field of medicine in big cities. The chances of them going to work as physicians in the rural Afghanistan is very low.

Third, the trained physicians have confined the system in a way that do not allow changes within the system to accommodate the needs of the society. The system serves the physicians and the hospitals in the big cities, rather than the larger populations who live in communities.

This system creates more physicians, so that they are accommodated in more hospitals, where more patients with complicated illnesses are treated. It is not a health focused medical education system, it is a disease focused one.

Thus, there is a need to shift the entire system of medical education in the country. We need semi-professional health providers doctors, trained in shorter time, and willing to work in the rural settings where they are most needed. There are two solutions for that; change in the current system in a way that allows more students from rural population to enter the program and shorten the period of education. The change will be very daunting and time-consuming. Second, establishing a new medical education system that has two levels of education. This system may include a three-year program to train ‘public doctors’, and another 3 years to train ‘professional doctors’. The entrance to these programs should be based on the population that need the most doctors.  The courses should equally focus on disease management and preventive medicine. Afghanistan need doctors who treat populations, not individuals.

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