Community Transforming Doctors… Doctors Transforming Communities

The notion that health is produced socially and is dependent not only in biological but largely on social factors has major implications on the training needs of doctors. As doctors have major influence in health programs, any paradigm shift must start with redesigning their training. The Ateneo de Zamboanga University School of Medicine, a small medical school in Southern Philippine, attempts to implement this paradigm shift. The curriculum is driven by Problem Based Learning (PBL), Community engaged medical education. In contrast to conventional approach, learning is structured around local community health problems and priorities. Two month of each of their first three years of medical education is spent working, learning and living in one community setting, with their entire 4th year spent in that same community. Students use multi-sectorial participatory action to strengthen community organization, participation and health development. They survey local community health needs, present the results through an inter-sectorial forum for the community validation, then allow the community leaders to prioritize local health concerns, and together develop and implement collaborative comprehensive health plans (CHP) aligned with the community health needs. These CHPs are completed to coincide with the graduation and disengagement of the students from the community. In nineteen years of its existence, it has produced 305 graduates, 98% have successfully passed the NLM Board Examination, 94% are still practicing in the country, 81% in the region, 74% working in doctorless rural areas while only 6% went abroad. In the rural communities where the students are assigned, changes have taken place. The community have seen health practices change from availability of potable water, latrine building, increased immunization, drop in child malnutrition, cottage industries for generating incomes, proper garbage disposal, ecological cleaning of rivers, creating vegetable gardens and medicinal plants, including dog immunization. The infant mortality rate has dropped from 55.6/1000 live births in 1995 to 14.6/1000 live births in 2003, and 8.2/1000 live births in 2008. This video clipping documents the student disengagement from their assignment community. While these students have been instrumental in the transformation of the community – the community in turn have transformed the students.