Community medicine: The “first-born” of a marriage between medical education and medical care

Abstract

In Southern Israel, rapid development and industrialization have generated strains affecting both the population (ca. 0.5 million immigrants and ca. 50,000 Bedouin) and the medical care agencies (of the General Labour Federation and other Sick funds, the Health and other Ministries, etc.). In Beer-Sheva, the Center of Health Sciences (CHS) of the Ben-Gurion University of the Negev (BGUN) is the scene of a concerted effort to change the orientation of health care. The direction of change is away from the impersonal (the hospital and the disease) and towards that demanded by the public (the community and the person). It is being accomplished by fundamentally changing the education of health personnel. Change is being implemented and mediated by a coordinating consortium of in-region and BGUN care and/or welfare agencies, that plans and evaluates the process and progress of change for which each agency is responsible. Infrastructural innovation, somewhat hampered by the inertias of tradition, consists of making the university hospital effectively serve the regional network of hospital-affiliated, community-oriented primary care clinics. Curricular innovation, enthusiastically accepted and flourishing, uses the concept of “the natural history of disease” in basic-science and clinical teaching. Teaching takes place not only in the wards, but also in outpatient and primary care clinics, and in the facilities for occupational health, rehabilitation and public health.