Family Medicine in Resource-Poor Settings: The Need for a Paradigm Shift

Family Medicine is that discipline which provides continuing, coordinated, comprehensive healthcare for all patients irrespective of their age, sex, or type of illness. Family Medicine approaches care from a holistic perspective putting into consideration the patient’s family, environment, culture and community and integrating other specialties in a new whole thereby successfully eliminating the reductionist approach to care.
The Family Physician views the family as a unit of care since the concept of family dynamics in health and disease posits that the family influences the causation, perpetuation, therapy, rehabilitation and prevention of disease. Family Medicine takes cognizance of the General Systems Theory which holds that natural entities and phenomena can be organized into specific systems that share common properties. These systems can in turn be allocated into a hierarchy of systems giving rise to the concepts of the suprasystem or biosphere (the community, culture, family) and subsystem (the person/personality, organs, cells, organelles, molecules, atoms and subatomic particles incorporating the genetic makeup). The individual is managed in this context recognizing that an imbalance in either system can lead to ill health.
The well-trained Family Physician has acquired the requisite skills to build on the strength of the family unit since the family is able to harness resources more than the individual in crisis situations.
The Family doctor thus provides primary, family and secondary healthcare, coordinating care when referrals are needed.
I have just described the ideal above. I make bold to say this situation is not what obtains in many resource-limited communities since I am a trainee Family Physician working in such a community. For ages, the West has realized the cost effectiveness and efficiency of using Primary care/Family Physicians in meeting most of the health needs of its citizenry. Current evidence supports this. Though there are instances of inter-specialty wrangling in some Western countries, policymakers/governments still do the right thing by equipping primary care physicians to take care of most ailments in a sustainable way.
Resource-poor countries must quickly shift position and move in this direction even in the face of constraints such as brain drain, poor remuneration of physicians that are still around, prolonged duration of training of Family Physicians, obsolete training facilities, dearth of trainers, inadequate motivation to enter into residency training, excessive workload on those who decide to train, inter-specialty/discipline bickering, among others.
And we must not shift this responsibility to the government alone-all must be involved in creating this system that sustains itself.