The Indian Researcher Building A Community-Based Approach To Medicine

Medicine should be about empowering communities. 

That’s the philosophy of medicine that Dr. Madhu Gupta—a professor of community medicine at the Institute of Medical Education and Research in Chandigarh, India—has spent her entire career trying to promote. 

It’s a mission that’s taken her everywhere from bustling urban centers to small rural villages in hopes of better understanding the intersection between India’s complex socio-cultural dynamics and the vast inequalities that exist in the country's healthcare system. 

In conventional medicine, Gupta said, the principal unit is the individual, but she wants to shift that focus from the individual to the family, and, more largely, the community. 

“To take a community-based approach to medicine is to put in the spotlight the social determinants of health,” Gupta said. “So it’s not just the individual you’re working with, but the family members as well. You have to look at what they eat, where they live, what kind of sanitation do they have access to, what degree of access to the healthcare system they have.” 

“Oftentimes, we’ve seen that conventional health interventions simply aren’t sustainable in the communities they’re implemented,” she added. “I try to advocate for an approach where the community is empowered to help themselves, and where they are empowered to make decisions about their own health.” 

Much of Gupta’s work has focused on inequalities in maternal health. She’s led 31 research projects on the topic (many funded by organizations like UNICEF and the WHO) in India, which continues to have one of the highest rates of maternal mortality in the world. Since the chance of either a mother or child dying varies so widely depending on their social and geographic circumstances, of particular importance to Gupta has been finding methods for safe deliveries that are feasible within the community’s existing means.

Like many other doctors and medical researchers around the globe, Gupta now finds herself on the frontlines of the war against COVID-19. She’s been instrumental in the country’s pandemic response, helping to create the safety protocols that allowed essential health services—such as maternal care and routine health checkups for children—to continue, even during one of the world’s strictest lockdowns. 

After previously running clinical trials of pentavalent and rotavirus vaccines in India, Gupta is now also leading a large clinical trial for the country’s home-manufactured ‘Covishield’ vaccine. 

Throughout her front and center role in India’s battle against COVID-19, Gupta continues to emphasize the need to understand the social variables that influence the spread of the virus, not just the medical ones. While understanding the mechanics of how a sneeze can transmit the virus is important, she said, just as significant is understanding how factors like financial necessity and stigma can make someone infected with the virus refuse to isolate. 

In particular, Gupta pointed to India’s large migrant worker population—one of the groups hit hardest by the pandemic and the accompanying economic fallout. 

“I remember I was helping in the hospital [in Chandigarh] during the earlier months of the pandemic and this woman came in to give birth,” she said. “She was from a migrant worker community, and when we tested her for COVID-19 the result came back positive.”

“I remember how scared she was when we told her,” Gupta continued. “At the time, and still, there’s a lot of stigma attached to being positive. She had a family to take care of and she needed to work. Isolating seemed like an impossibility to her. We talked her through the situation, we told her we could support her in any way that we could through this difficult moment, and thankfully things turned out alright.”  

But the story of the woman was indicative, Gupta said, of the lesson medicine needs to learn from the pandemic: that public health can never be one size fits all. It’s a lesson she will continue to share as she helps in India’s struggle to rebuild a healthcare system battered by COVID-19. 

“That experience really proved to me that we as doctors need to understand that a positive result doesn’t mean the same thing for everybody,” she said. “This pandemic has exposed and taught us the ways in which inequality and social factors can create different realities of health and illness for people.”

“We as a nation are going to have to work really hard to return our healthcare system to pre-COVID levels,” Gupta concluded, “and, as we do, we are going to have to keep that lesson in mind.”