تاريخچه كوتاهي از پيدايش و گسترش پزشكي اجتماعي در ايران

Creation and Expansion Community Medicine in Iran

با بررسي جامعي كه نويسنده در سال 1350 در دانشگاه Johns Hopkins به عمل آورد، چنين نتيجه گيري شد كه 90٪ پزشكان فارغ التحصيل شيراز و 40٪ پزشكان دانشگاه تهران به آمريكا مهاجرت مي نمايند. با بررسي بيشتر پزشكان علت مهاجرت خود را سربازي، درآمد، خانه و مسائل سياسي قلمداد كرده بودند. يكي از مهم ترين علت مهاجرت ناهمگوني برنامه هاي دانشكده هاي پزشكي ايران با نياز جامعه روستائي سالهاي 1350 بود و به خاطر درمان چنين نارسائي بخش پزشكي اجتماعي تشكيل شد تا برنامه هاي پزشكي شيراز را با نياز جامعه هماهنگ سازد. با وجود تلاش فراوان دانشگاه شيراز و گسترش برنامه هاي دستياري پزشكي اجتماعي در چهل سال گذشته، روند مهاجرت پزشكان پس از انقلاب اسلامي نيز ادامه يافته است. برنامه هاي جانبي تربيت بهداران روستائي و برنامه هاي روستائي تا حدود زيادي موفقيت آميز بود و پوشش درماني پذيرفتني در سطح روستاها و خانه هاي بهداشت در كشور به وجود آمد، ولي تغييرات دموگرافي و رشد بي قاعده جمعيت از 25 به 70 ميليون و مهاجرت روستائيان به حاشيه شهرها برنامه ريزان بهداشتي را سرگردان كرده است و اوضاع پزشكي برپايه گزارش هاي نظام پزشكي و وزارت بهداري هنوز نياز به تغييرات بيشتري دارد. هم اكنون گرفتاري بزرگ پزشكي در ايران سود بردن غيرلازم از تكنولوژي و هزينه هاي گزاف براي درمانهاي بيهوده و غيرلازم است و وظيفه پزشكي اجتماعي در ايران زير و رو شده و در حال حاضر پيدا كردن و رهنموني براي كم كردن هزينه هاي غيرلازم و تأكيد بر تندرستي و پيشگيري از بيماريهاست. متأسفانه تصميم گيرندگان بهداشت و درمان كشور پزشكان متخصص و فوق تخصص ها و صاحبان بيمارستان ها هستند كه به راستي پيشگيري از كجرويها به سودشان نيست و كلاف سردرگم "درمان" خود دشواري بزرگي براي سيستم درماني كشور شده است.

In 1972 a research was performed by the author at John’s Hopkins University, regarding migration of Iranian medical graduates to the United States. We found (our) up to 90% of Shiraz medical graduate and 40% of Tehran graduate were permanently migrating to the United States. Further research indicates the cause of migration to be military housing income and sociopolitical facts. Furthermore we found the curriculum of most medical schools in Iran is a carbon copy of western medical schools and had no relevance with the need of over 70% of Iranian population who were residing in rural communities in 1970s. In order to alleviate these, we established the department of community medicine in 1972 in Shiraz to modify the curriculum of Shiraz medical school with an established and strong academic of clinical discipline was not an easy job, particularly when the medical staff was determined to make Shiraz a “center of excellence” and we in the department of community medicine felt we are desperate for a “program of relevance”. As I was professor of both medicine and community medicine and the chairman of medicine was extremely friendly with our program. We could compromise and eventually we decided to embark on a new medical school with totally new program. The new medical school which was established in Fasa was a successful program of recreating students from small town and we found recently 90% of graduates of first two years are still residing and practicing in Fars province. Unfortunately later this medical school was joined with all other medical school with national matching program, which was against our initial purpose for recruiting from small towns. The other major achievement of the department of community medicine was establishing a health houses in rural community which was evaluated and approved by WHO and within eight years more than 1.5 Million rural population were covered by that program