Perspective.

I work in public health, not medicine. I've had people ask me why I didn't just go to medical school. Because they're different things, I usually respond. I didn't want to study medicine, I wanted to study public health.

We focus on health at the population level, not on treating individuals. By learning which factors affect different diseases in populations and then how we might be able to modify them, the goal of public health is to prevent those diseases (or complications) from occurring. In many ways the goal of both medicine and public health is the same -- reducing illness and suffering -- but the approach is different.

This can be frustrating at times. On the one hand, it can be hard to see the impact of public health. When a doctor treats a sick patient and they get better, that may be obvious. But it's not always so easy to show that someone didn't get sick in the first place because of what you do. On the other hand, because I'm not a physician dealing directly with patients, I don't always have the opportunity to personalize it.

Today was one of those opportunities. We went to the clinic at the field site here (a very poor urban area on the outskirts of a poor urban Dhaka), and did rounds first with the doctor, before meetings. We stopped for a bit at one patient... a 13-year-old boy with a recurrent case of active TB, and now likely with a secondary case of pneumonia. By all rights, he should be hospitalized, but was refusing. Thus, they were making due at the clinic, with a daily injection of IV antibiotics. The clinic is not designed to be the area TB testing or treatment center, but the alternative was he would stay home and die.

Injecting antibiotics can be painful, though he was sitting there patiently. He has come back for six days now, but was very, very thin, and clearly still struggling to breathe. I am not sure how many times he will be back.

I'm not usually one to get outwardly emotional, but watching this was sobering. Childhood pneumonia is what I have been spending a large part of my work on lately, and what I am researching more here. Pneumonia is the leading cause of death worldwide in children under 5, and although I know the statistics, a small boy today helped give me some extra perspective.