Taylor's Case Study: Humanising Medicine

With the move into a new lifestyle and emerging stress due to the COVID-19 pandemic, mental health issues have, in varying degrees, affected our lives. Though some are fortunate to address these mental health concerns, many still lack that luxury and oftentimes put it on the backburner. 

This pandemic has been particularly cruel to the poor and the vulnerable, typically in the B40 communities. With little to no savings, many of these people, who are informal workers or hold odd jobs with daily wages, aren’t adequately covered by social safety nets and, as a result, have lost their rice bowl. Subsequently, as survival needs kick in, the importance of physical health is no longer a priority so what more mental health?

Receiving the Hind Rattan Award (Jewel of India) in 2020 for her contribution in the field of Public Health Completing her MBBS and M.D. in Public Health, Dr. Sapna Shridhar Patil, Senior Lecturer from Taylor’s School of Medicine, shares with us why mental health must be prioritised among the urban poor and the role of doctors in educating themselves about the people around them.

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Q: Share with us how your research tackles mental health among the urban poor. 

A: My current research assesses the self-perceived quality of life and mental health, including depression, anxiety, and stress, among the adult population of the PPR Sri Pantai community. Based on the increasing prevalence of mental health issues among different people, their quality of life has been affected. What makes things worse is that the vulnerability of the urban poor is determined by socioeconomic and environmental factors. 

When emotional distress affects the quality of life, it could culminate into self-harm and debilitating ailments. As a Public Health physician, I felt that there was an unmet need to study the dynamics between mental health and quality of life to identify the possible factors that could improve the health of the underprivileged. 

For this research, we went through a process to gather the needs and requirements of the community aside from providing those that need help by referring them to the right personnel. We also have undergraduates to help us with the research. Recently, my undergraduate students and I had our paper conditionally accepted by a journal publication which we’re now trying to publish the data collected so far. 

In the past, when done physically, the students collected and analysed the data and later presented it to the community during an on-ground health awareness day for the members of the community which includes presentations of their findings, health screenings, and also demonstrations.

Q: What are the direct impacts COVID-19 has on the urban poor?

A: Because of the different lockdowns and losing economic independence, the urban poor communities have been pushed further into poverty. If you look at the current situation, their income is much lower than the median wage of RM4580 per household

Aside from the responsibilities at home including care for younger children, aging parents, and ailing family members, some have completely lost their jobs causing them to struggle in making ends meet. In fact, UNICEF’s Families on the Edge survey showed many of these families facing mental health problems because of uncertain economic and financial losses faced. Naturally, health doesn’t remain a priority anymore because they’ve to look into all these areas.

Plus, the problem with mental health is that the symptoms aren’t obvious and it’s often tricky to identify them. When a person has a wound or a body part cut off, we know that there’s a problem. If a person has crutches, we know the person is unable to walk. Oftentimes people don’t realise they’re suffering from mental health issues because it’s not something tangible. Even if they do, it’s put in the back burner and not prioritised. Unfortunately, this affects their quality of life.

Q: So how can we help them to understand the importance of prioritising mental health when they’re struggling so much to survive?

A: Mental health is something that makes us. So, it’s important to generate awareness and share valuable information that’s scientific and sound for any community. But there needs to be a tailored-approach using understandable and feasible language that meets the particular needs of that community as each of us have very different needs — even you and me!

The other aspect is linkages

What should I do about it? Who should I go to for help? Linking communities to NGOs to provide support for mental health is of vital importance. 

Through our research, we’re assessing the problems faced and then creating awareness on them so they know the issues as well as the factors influencing their condition. 

This must be a multi-disciplinary approach — it isn’t just the problem of governments, healthcare industries, and NGOs, but also our responsibility to coordinate efforts on linkages and references.

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Lastly, we must also increase awareness of their social networks. In these communities, there are usually heads or leaders and they become our gateway to help the community. 

We’re trying to network with them to strike the awareness of mental health so that we can manage mental health issues earlier and better. In other words, managing emotions and building resilience is something we’re looking at.

Q: Earlier you mentioned how students also participate in the research through collecting, analysing, and presenting data to the community. Why is it important for students to be immersed with these communities?

A: Ah… Let me tell you of how it first started. Before coming to Taylor’s, I’d already worked with many urban poor communities throughout Malaysia. When I started teaching in Taylor’s back in 2013, I realised that the students had very patchy knowledge on community medicine and weren't interested in learning about the people’s actual living conditions. That was when I started doing projects with the community in Lembah Subang. A lot of our students come from affluent families and this experience became an eye-opener for students since they got to see their living conditions. 

It’s important for a doctor to know where their patients are coming from. Just talking and prescribing medication for the patient wouldn’t give them an idea of how they live in — their economical issues, financial constraints, how they come to the clinic, simple things that influence their access to health care. 

Students would also be able to gain skills like data analysis, statistics, and learn to communicate in Malay and Mandarin — which is very essential among these communities. There are several soft skills we want to develop and a way to ignite their compassion.

Q: What was the initial reaction when you introduced this programme back in 2013?

A: They didn’t like and weren’t happy initially. When we first started in Lembah Subang, the NGO working with us shared that they have to take care of their safety. 

But because these students aren’t normally concerned about losing their safety and belongings, they became really frightened and even mentioned this in their module evaluation that they weren’t given enough information about their safety even though nothing happened to them! Some even rebelled by doing subpar work in the research that resulted in us having to redo the data collection.

That was our hiccup in the beginning. Slowly, as the programme gained momentum and had several modifications, students started enjoying it. Though it’s a lot of work and they'd complain about the workload, they always come out as better individuals that look at their patients with empathy and understanding the zone they’re coming from. 

It truly brings back the humanistic dimension of learning medicine. Sometimes we need to remember that learning doesn’t just come from your books but as an individual growing into a humble person.

Q: What’s the one memorable event from your research that you can’t forget?

A: Looking at the students taking the lead and doing a good job in conducting the health awareness campaign and getting into action was so memorable.

They even went a mile further by giving to the community members some groceries and vouchers as a token of our appreciation to the attendees. You could see the happiness plastered on their faces and their content and gratefulness for what the students did for them. In fact, some students were invited by the families to come back and visit them in their homes. 

Seeing them develop connections and practising that human element of medicine is very encouraging. I feel that some of them aren’t even aware of how much they’ve grown with the skills they’ve developed through the different challenges. I really miss these health awareness days and hopefully we can conduct physical activities one day.

Q: What are some of the biggest challenges that we could face in the next 5 years and how can we prepare for them now?

A: When we look at mental health, these problems are masked and not obvious. The most important thing to do is identify these issues early on. The short-term impact is that people are worried, fearful, and stressed. But we hope that it stops there and not lead into depression because that can lead to suicide and losing loved ones.

I hope the economy can be improved and emotions managed well to prevent long-term economic stress and health issues. 

Because when we’re at home and having less physical activities, it’s likely that non-communicable issues, like obesity, would rise.

 People need to be aware that their physical activity is equally important because it makes you happy and helps your mental health. 

Both physical and mental health are interlinked and we’ll see a never-ending cycle if we don’t identify and address the triggers.

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The consequences would change for different age groups so we need to come up with a unique solution for each individual. 

My only worry is that the economic downturn may lead people to depression so some economic opportunities need to be provided to prevent long-term problems.

Q: Last question. What’s your advice to students keeping up with the situation at hand?

A: Two words — be resilient. Being in a medical programme itself is a stresser. When a student enrolls, they’re aware that they’ll be losing out on several pleasures in life and they’re groomed to take the onslaught of all the challenges. However, they haven’t faced a pandemic before and their education has transformed overnight. 

For now, stay strong, safe, and resilient. You can definitely overcome this situation. Although it’s a unique situation, it isn’t permanent so don’t let it overcome your life. Your health, especially your mental health comes before anything else —  even your education! If you’re not healthy, you wouldn’t be able to give your best anyway.

There’ll be times when you feel like giving up. Just take a break and get up from there.