 Hello Learners, I am Dr. Midoosh Mitha Duhara, Assistant Professor of Social Work KK Handic State Open University. I welcome you all to this class of the course that is of Bachelor of Social Work 5th semester. The name of the course is Health and Mental Health. Of this particular course today we will be discussing an important aspect that is medical social work. So before we start with this class I would like to let you all know that in this class we will be discussing the basic concept of what is medical social work, the concept of community health and how a social worker can contribute to the medical social work field. So let us move on with the first concept that is community health. Community health is termed bringing into two concepts together that make an umbrella term that is health and community. World Health Organization in the year 1947 they have given a definition that health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. In the context of community health, a community is a group of people who have common characteristics. Communities can be defined as per the location, race, ethnicity, different age groups, occupation, interest in particular problems or outcomes of common beliefs. They have something which is called a community bond. So that is what defines the term community. Now a healthy community is a place where people provide leadership in assessing their resources and needs, where the public health and the social infrastructure and policies support health and welfare of the general public. It is essential that public health services including quality health care are available. So that is about the concept of community health. It refers to the health status of a defined group of people and the actions and conditions both private and public and public meaning governmental to promote, protect, preserve their health. For example, the health status of the people of Majuli in Assam is the biggest riverine island in the world and the private and public actions taken to promote, protect, preserve the health of this community that is given the example of Majuli would contribute to community health of the people living in that particular island. So that was an example. So community health activities are those activities that are aimed to protecting or improving the health of a population or community. Maintenance of accurate birth and death records and also the maternal records protection of the flood, water supply, participating in fund drives for voluntary health organizations such as for example maybe Lang Association are examples of community health activities. Also an example would be if you conduct a maternal health camp or an eye camp for the elderly. So these are examples of community health activities where the people of the community participate and they make a program participatory in nature regarding the health concerns of the particular people living in a particular community. So if we keep these things in mind we will be sure that factors that influence community health are many. It is not only physical or geographical but also social and then individual behavior, the economy in which a particular community situated, the political environment, all these things influence the community health of a particular community. There are many great factors that affect the health of a community. As a result the health status of every community is different. For example if you consider the health status of a developed nation, the community situated there and that to a second world country or a developing country, all the community health factors or health status will differ from each other. These factors may be physical, social, cultural and many other aspects. It will be impacted by various aspects. This also includes the ability of the people to organize and work together as a whole or as a community with togetherness as well as the individual behaviors of these community affects the overall community health. Now coming to the different factors we will be discussing firstly the physical factors. The physical factors include the influences of geography, the environment, community state and the industrial development. Geographical factors, a community's health problems can be directly influenced by its attitude, the altitude of the particular land and how accessible it is to the general health infrastructure. The infectious diseases that might be, you know, more people might be more vulnerable to certain infectious diseases and leading to community health problems. Therefore the geographical location of a particular community is also very important. The quality of our environment is directly related to the quality of our ownership over it. Many experts believe that if we continue to allow uncontrolled population growth in a particular land there will be population explosion and also it will deplete the non-renewable natural resources. Therefore our succeeding generations will face a lot of crisis and in this it will affect the overall community health. Therefore protecting the environment and not exploiting it, not exploiting the soil, water and air resources will lead to a healthy environment for a community and therefore it will contribute to a healthy community health. The larger the community size, the greater is range of health problems and the greater the number of health resources. For example, larger communities have more health professionals, better health facilities than smaller communities. That we can take the example of, you know, a semi-urban area and an urban area, an urban community, a semi-urban community or a rural community. In this particular, keeping this example in mind we will, we know that the health benefits, the health infrastructure differ from place to place. Also the economy of the particular region, how developed it is, the industrial development, the socio-cultural factors, the cultural beliefs, religious practices and traditional medicines and practices all influence the community health. Because the religious beliefs also, the traditional practices of medicine, that is alternative medicine, will again be different from that of the latest development in the medicine industry. So therefore all these things might come in conflict. Now it is on the community's discretion to decide on which particular form of, you know, medication or treatment or health facilities to be utilized by a particular community. The individual behavior also, individual behavior of every member of the community will also impact the community health in an overall way. So coming to the community health programs, the main objectives of community health programs are basically to reduce the threat of, you know, infectious diseases by creating safe environment for local people and the medical professionals need to be updated. To reduce the risk factors and to enhance the protective factors of non-communicative diseases and injuries by promoting a healthy lifestyle and environment is important for a community health program. So there are different or diverse forms of community health programs that we will be discussing in the coming sections. So to empower the vulnerable groups of people with the support of their families and communities by promoting social activities is important under any community health program. Lastly, to strengthen the capacity of a local health sector which would contribute to the improvement of accessibility of healthcare and amplify the quality of medical services is important for any community health program. So we see that community health programs play a very important role in making sure that we have a good community health status in our country or in the community. So coming to community health programs in India, we know that people's access to healthcare, education, the condition of work, leisure, determine the chances of living their full lives or to have a fulfilling life. Addressing rural health concerns through the National Rural Health Mission earlier it was known as NRHM and now it is known as National Health Mission that is NHM was based on the principle of convergence with other determinants like water sanitization and nutrition. So we know that when we talk about health as a whole and that too when the concept of community health comes in the other aspects, the important aspects like water, how clean is the water that we have access to or the water that we are drinking or using in our food and also for sanitization and nutrition all these together play an important role in the community health status. So in India the NHM had a holistic approach or perspective because it took into consideration all these various aspects. The NHM also adopted the model of ASHA that is accredited social health activists, ASHA workers and the auxiliary nursing midwives who function as community health workers. It seeks the convergence with the Ministry of Women and Child Development, ICD that is the Integrated Child Development Services which also utilizes the services of Anganwadi child that is childcare centers and Anganwadi workers to increase its outreach. Because in the Anganwadi system we know that the children are looked after and also provided nutrition and other essential needs are fulfilled through the Anganwadi system. Therefore ASHA workers play an important role. Also other community health programs in India the health workers were primarily drawn from the community itself. Therefore there was more participation and involvement of the community workers. It derived a tremendous impact on others and neglected health concerns due to certain inaccessibility of medical services like immunization, self-delivery and contraception or nutrition. Therefore all these aspects were given awareness about the different medical services, the immunization system that are important then safe deliveries, then use of contraception or nutritional values of different food items how food should be more nutritional in nature how it can be you know we can include different forms of diet all these were given training under these different schemes. One of the examples of community health programs initiated in India is Rajiv Gandhi Mahila Vikas Pravejana which functions as the model of community ownership and participation by the women. Therefore women work as, directly work as health activists in their own community. Therefore there is empowerment, there is participation of the women belonging to those communities. It brings a sense of responsibility and fulfillment among them aims to help the poor women in rural areas to get empowered in the form of self-help groups SHGs through community institutions. Therefore it played an important role in empowering process. The recent development in formulating community health programs has also started making an effort to create social behavior change that is SBC and initiatives to accelerate healthy behavioral changes some of them are like safe sex, use of contraception hand washing, use of ORS, benefits of breastfeeding then you know making sure that menstrual cycle is you know ensured that it is safe and cleanliness is maintained all these are given training to both male and female sections of the society. Therefore these community programs are important for ensuring community health. Now when we have talked about these different community health aspects we realize that how important medical social work is. So who are medical social workers? Medical social workers are those trained social workers who will be specializing in the field of medical health and hospital settings psychiatric settings and also inpatient and outpatient departments of the hospitals to work in rehabilitations to work with people with disability and various other forms of fields of social work where medical social workers are important. Medical social work is the application and adoption of methods and philosophy of social work in the field of health and medical care. So medical social work makes selected and extended views of different aspects of social work knowledge and methods which are particularly relevant to people helping persons who have health and medical problems not only helping the patient directly but also working in close collaboration with the families in distress because they have someone who is not well or facing serious illness in the family. Medical social workers are responsible for integrating care with the patient's personal life and support systems. Areas that do not fall under the practice of you know of doctors and nurses only. Medical social workers form a very important support system to the family to the patient who are having health crisis. This means that assessing the impact of all social, financial, emotional, cognitive and environmental, financial and other support needs of the patients communicating with the different systems or different departments or liaisoning with different departments is very important. So to the external systems such as home care establishing plans for you know continued treatment care and well-being of the patient all these are important role of a medical social worker who are going to guide the family, the patient in dealing with the health crisis. Social workers enter the healthcare arena to increase the access to healthcare services of the poor and in need. Managing a chronic or a terminal condition which is a very shocking and you know a very depressing phase for the entire family or for the patient. It becomes exponentially very important for patients with barriers such as mental illness who are substance dependents who have you know huge financial incurrence for treatment, housing, instability, low-income socioeconomic families and then inadequate access to healthcare. All these families and patients have the need to have access to different healthcare facilities and also financial assistance. So in this particular phase comes the important role of a medical social worker. It is the application, adoption of the method and philosophy of social work in the field of health and medical care. So therefore medical social work is an important branch of social work that deals with the social, physical, psychological aspects of the patients and the patient's family. Social work in the medical setting is important here. Using relevant social skills, knowledge to help the patients is an important task of a medical social worker. So medical social work considers human health with the broad perspective. The treatment is not the final solution for illness in medical social work but the diseased and the diseased person or someone who is not well and needs a lot of prolonged treatment and prolonged financial support. So they are very different from the other aspects. We know that when we look at a medical crisis or a health crisis there are different factors that come into play. There is emotional depression then also financial instability a sense of insecurity that sets in among the patient and the family members and it is basically a crisis situation for the entire family. So here the medical social workers play an important role. Medical science gives emphasis on the disease but ignores the other aspects. The other important aspects like the emotional need of the diseased person what could be the turmoil of the family members. So medical social work studies not only the diseased person the psychological aspect but also the social aspect and the emotional needs of the family and the diseased person or the patient. Medical social work deals with the prevention of disease by creating awareness if the disease still occurs after care of the patients is important that is known as the social rehabilitation process of a patient. So social rehabilitation is something which medical social work looks into. So we know that medical social work is not only limited to the treatment process but also how a person is adjusting or accepting the disease or the treatment that one needs to go through. So these are important aspects of a medical social work domain. So social work in the medical field was first introduced in the year 1936 by Dr. Clifford who was an American missionary and started a formal training of social work program in India through the Dorabji Tata Graduate School of Social Work in Mumbai that is now known as TISS Tata Institute of Social Sciences in Mumbai. In 1946 the first medical social worker was appointed in JJ Hospital Bombay and from 1960s onwards the scope of medical social workers has been increased in India. Today about almost majority of the teaching institutions and medical universities have conducted PG program in social work and you know how social workers are important in a medical field. In the Northeast India it is still gaining importance slowly and also in other mainstream India in many places especially in South in Kerala as I know they have established the important role of medical social workers in their hospitals and in the inpatient and outpatient departments of the hospitals. So Tata Institute of Social Science is the first pioneering institute in earlier that had less created awareness and practice in the field of medical social work. So since we have talked about how the medical social workers play an important role and why their role is indispensable for the well-being of the patients and the patients family let us discuss some of the settings in which medical social workers can work. In the hospice and rehabilitation and emergency setup medical social workers play an important role. How the patients need to be rehabilitated in the emergency section for when example a patient is brought in the after an accident or after you know a person has reached the last stage of a deadly disease in all these crisis situations the medical social worker plays an important role. In the inpatient and outpatient department the medical social workers help the family of the patient to understand the hospital formalities to have access to the financial if they have insurances you need to connect them to the different insurances and then help the link in providing financial assistance for the treatment of their patient these are important roles that are done by medical social workers. So why is a social work degree important to carry out these activities because in medical social work when a person is being trained in the field of medical social work he or she is given training about the different diseases about the different medical terms the complexity of the diseases and other things and these are inbuilt in the curriculum of social work in the medical field in the medical and psychiatric field therefore the person who is the trained medical social worker is aware of the kind of diseases of the kind of treatment that might be required and also once the medical social worker is appointed under any hospital or any department of a hospital they are given training as to how the different formalities are to be done so after getting the training they in turn help the families of the patient and also maybe the patient directly and tell him or her about how the things need to be done the formalities need to be done and what is going to be the line of treatment that needs to be communicated with the doctor so the medical social worker acts as a licensing person between the medical team and the family of the patient so that there is clear communication about the line of treatment that is going to take place in community health centers the medical social worker play an important role creating awareness about the different diseases how it can be prohibited and then how treatment can be done of particular diseases of certain bad habits like smoking, drinking and tobacco consumption all these things are given awareness by medical social workers in working with persons with disability medical social workers help the persons with disability and their families have access to the different government schemes have access to the different social services that are provided so persons with disability who might will have a lot of problem in having access to the different schemes and benefits and first of all to be aware of the different schemes and benefits and how to proceed forward with all the formalities in getting access to the schemes is assisted by a medical social worker so in working with persons with disability medical social workers have a huge role to play so also there are medical and psychiatric departments in hospitals psychiatric social workers can give treatment therapeutic treatment to the patients and medical social workers can guide the patients and the families in how to have access to these different treatment lines social work in different departments of hospitals to work as a team with the doctors and the nurses so that the patients and the family feel a sense of assisted or support from the medical social workers is an important aspect of this particular field the role of medical social worker also is to make the patients and the families aware of their rights the patients rights in healthcare are something which are not given much importance in our country and it is something which is hardly discussed so medical social workers need to create awareness or let the patients family and the patient know that you have certain rights in the healthcare during your treatment so to maintain transparency or to maintain a clear line of treatment as to what is going to be the next step where you are going to have access to in the coming step in the coming treatment all these things need to be clearly communicated to the family or to the patient directly so these are some of the important roles of medical social workers in this class I have focused on mainly community health the community health programs in India and the role of medical social workers the role of psychiatric social workers is very much different from that of medical social workers psychiatric social workers provide direct treatment to psychiatric issues faced by the patients so in this class we have stick to the role of medical social workers which is mainly the licensing and you know bringing up a support system for the patient and the patient's family is the main focus of medical social work thank you so much