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VisionPublic Health ContributionYearwise PublicationsSubjectwise Publications

Vision

Preamble

The Indian Council of Medical Research (ICMR) is the apex body of the Government of India for formulation, co-ordination and promotion of biomedical research in the country. ICMR sets its research agenda in consonance with national health priorities. As part of this mandate and in view of the special nature of desert-related health problems, particularly in the context of various developmental activities, the ICMR established on 27th June, 1984 the Desert Medicine Research Centre (DMRC) in the western desert region at Jodhpur as a nodal institute for the arid zone in the country.

Arid zones constitute about one-seventh of the earth's land surface. These areas are characterized by extremes of temperature, scanty rainfall, lack of water, scarce plant life and specific flora and fauna. Most of the arid zone in India lies in the state of Rajasthan (69%), besides Gujarat (21%), Haryana and Punjab (10%). Nearly 80% of the land area in Rajasthan consists of hot arid zones, covering 12 north-western districts with a population of more than 225 lakhs (Census, 2001). In addition to scanty rainfall in this region, almost every fourth year is a drought year, which leads to undernourishment, mainly in children. Sparse and scattered human population in remote and inaccessible areas makes it difficult to set up and maintain outreach health facilities. Frequent migration of people and cattle pose a challenge to health administrators for providing adequate health services.

A national seminar on 'Desert, Man and Health', held at Jaipur (30th May to 1st June, 1981), highlighted that a large number of known and unknown health problems await solutions in the desert environment and need immediate attention. The idea to establish a Centre in the region was supported at the seminar, which subsequently led to the creation of DMRC to address the health research issues in the context of desert ecology.

During the two decades of its existence, DMRC has contributed to (i) the generation of baseline data on nutritional problems faced by the population of desert areas; (ii) an understanding of the dynamics of transmission of vector-borne diseases, such as malaria and dengue, in the changing ecology of desert areas; (iii) the study of other health problems such as silicosis, hypertension, renal stones, specific maternal-child health issues and elimination of guinea worm disease, etc. The Centre has several ongoing programmes on dengue, malaria, vector bionomics, insecticide resistance, novel herbs with potential for use as insecticides, as well as anti-infective agents, hypertension, diabetes, non-communicable diseases risk factor surveillance, and various nutritional deficiencies in vulnerable populations.

DMRC is also striving to establish itself as a centre of excellence on health problems with special reference to desert ecology. The Centre has expanded its horizons from research to teaching and training. It has already been recognized for a Ph. D. programme. As the Centre is geared to fulfill its mandate more effectively, it was considered an opportune moment to have a re-look at DMRC's vision and mission vis-à-vis its original mandate.

Mandate          

  •   Undertake and promote research on health problems specific to desert areas.


  •   Study the changing patterns of health problems especially in view of various developmental activities taking place in the region.


  •   Strengthen the scientific and technical expertise of state as well as local health agencies.

Vision          

DMRC to serve as a Centre of Excellence in medical research to address health problems of the desert population.

The Scope          

In continuation of the Centre's past contributions to the field of health development research, the Centre's future role is being defined with a focus on the desert as the guiding principle.

Guided by its mandate, the DMRC shall look beyond common health research issues and pursue studies to contribute to the understanding of the burden of diseases in desert areas, in collaboration with other specialized centres of the ICMR and other agencies, so as to serve as a regional nucleus that would provide solutions to these problems.

Guiding Principles          

1. Desert-centric: DMRC's work shall be specific to desert areas, dedicated to improving people's health in the region and responding to their needs but this should not be a limiting factor for responding to regional health research needs.

2. Result-oriented: Research activities shall lead to the delivery of relevant and identifiable results.

3. Innovative: The Centre shall strive to adopt innovative approaches and research methodologies.

4. Inclusive: The Centre shall establish research partnerships and strategic linkages at the local, regional and national levels to achieve its goals.

5. Relevance: The Centre shall develop new knowledge to address both existing and emerging areas of vulnerability, and suggest possible solutions and areas for improvement of the health system.

Mission          

A few thrust areas and high priority goals have already been identified in view of the past output of the Centre and on the basis of the reviews conducted by the Centre and its Scientific Advisory Committee (SAC).

With new commitment, the Centre is poised as never before to translate its given mandate by developing a new vision to further advance its activities in a changing scientific and social environment. It is thus envisaged that DMRC will become a Centre of Excellence for Research, Reference and Training on the health problems of the desert regions of India, and a resource centre in the area of Desert Health, both nationally and internationally.

DMRC was established to address the health research issues arising from health problems in the context of desert ecology. Accordingly, the scientific research programmes funded and conducted by DMRC should continue to aim to produce profound insights into health-related issues of people living in desert regions. Dynamic interactions between people, their environment and living conditions, which are changing rapidly and affecting trends in various communicable as well as non-communicable diseases besides behavioural problems, need to be explored further. Many of these insights may have great significance for the overall development of the desert region not only in the health sector but they may also have implications in economic and strategic terms.

Research Specific to the region          

  • Longitudinal studies on communicable and non-communicable diseases in desert regions, estimation of disease burden and transition of diseases in space and time, and identifying the desert-specific risk factors leading to the development of appropriate measures for intervention. To further strengthen its core areas, new research programmes and initiatives should evolve as circumstances and opportunities dictate.


  • DMRC, as part of the overall healthcare system, has a responsibility not only to conduct research but also to provide scientific and technical expertise for state and local health agencies as per its mandate. This knowledge shall not be limited to improving the quality of people's health but to protecting them against the increasing financial cost of illness by undertaking research projects to measure the burden of disease of various illnesses prevalent in the desert region. It is desirable to focus on 'Blending Clinical Practice and Research' specific to the region. The challenge is to create linkages between the production of scientific knowledge and its application as well as to avoid duplication or replication of research already reported from other centres.

Linkages          

In today's changing environment, no institute can work in isolation. The challenge for the Centre includes establishment of problem-based linkages with other ICMR research institutes and develop well-planned new links between different research organizations such as the Indian Council of Agricultural Research (ICAR) and its agencies, regional universities, medical colleges, defence organizations, Council of Scientific and Industrial Research (CSIR), oil and natural gas organizations located in the region. These linkages with national as well as local institutions should get priority in the evolution of the Centre so that it establishes itself as a leader to address the health problems of the desert region. Knowledge in the fields of geography, medicine and health issues, linked with defence-related areas need careful consideration for various strategic reasons. There is a need to develop linkages with other researchers and begin working towards a common research agenda for optimum utilization of infrastructure and resources.

However, to accomplish the institutional goals, it is necessary to find answers to some of the priority areas of health research to improve people's physical, social and mental well-being.

Futuristic Priority Research Directions          

The quality of a health research institute is gauged by its output indicators, particularly in terms of meaningful research. To meet the goals given in the mandate, it is desirable for DMRC to reprioritize its research areas and develop a new strategy by undertaking basic, clinical and operational research with a view to improving its effectiveness and efficiency, thus giving greater scientific visibility to DMRC.

After more than two decades of its existence, it was considered necessary that DMRC determines both its future direction as well as the contributions it can make keeping in view its given mandate:

  • Research programmes of DMRC need to focus on health-related issues of disasters linked with drought, which are common in desert regions. So far, these problems have been addressed by institutes of agricultural research.


  • Similarly, answers are required to address the health consequences of migration of both people and animals under difficult conditions. For this, it is necessary to move from traditional laboratories to social/field laboratories. There is a need to study, monitor and understand the life-style of the desert population, their food habits, rearing of children and other health-related issues.


  • The Centre needs to focus on specific diseases that have a strong association with the dry climate of deserts (less humidity and more exposure to sunlight). Adequate scientific information needs to be generated on heat-related health problems, such as heat syncope, heat stroke, solar radiation and dust-related diseases in the desert.


  • The relationship between a dry climate and social and environmental factors, and their effect on diseases such as tuberculosis, human immunodeficiency virus (HIV) infection, respiratory allergies/infections, etc. needs to be probed.


  • There is a need to know how rapidly the growing developmental activities influence the health and life of the desert people.

Specific Research Issues          

The use of opium from infancy to old age in certain select populations is unique to this region. Research findings emerging from this area will provide insights that will have an impact well beyond the field of drug abuse. They will provide exciting information that would be worth pursuing. Some clinical evidences suggest that the course of pulmonary tuberculosis and its prognosis in those addicted to opium is different from those not using opium. The relationships and mechanisms need to be investigated.

Interesting research findings include the cause of vitamin A deficiency in the region; reports suggest that this region has the highest milk output and Jodhpur is the biggest centre for trade in butter. One possible reason is the changing lifestyle of the people due to developmental activities. As a result, milk and milk products are exported out of the region and vitamin A tablets are imported for supplementation. Similarly, as Jodhpur is the biggest centre for trade in chilli, its usage and influence on the health of the people needs to be studied.

Thus, the Centre needs to focus on local and regional issues pertaining to social and behavioural aspects to provide a scientific foundation for interventions.

Thrust Areas          

Based on the needs and expectations, the Centre will use conventional clinical, epidemiological and laboratory methods as well as modern biological tools of genomics, proteomics and bioinformatics to focus on the following thrust areas. Proposed studies shall be expanded/modified/ augmented according to the leads and needs, with the aim of fulfilling the overall mandate of the Centre.

  • Human physiology: Studies to comprehend adaptations towards a desert environment and possible disorders caused due to these, including studies on the concentration and chemistry of urine of the desert vis-à-vis non-desert population. Establishing linkages with specific diseases, relation of urine physiology specific to the formation of renal calculi, osmotic research on salt intake and excretion as a risk/causative factor for hypertension and research related to endocrinological functional peculiarities among the desert population.


  • Geographical genomics: Studies on human genetics as well as other agents for diseases with a genetic component as a major factor in the context of stressful environmental conditions/adaptations.


  • Nutrition and associated morbidities/diseases: Studies on nutritional constituents of desert plants and their utilization for common ailments, development of nutritional packages from desert products, correlation of nutrition including micronutrients and associated morbidities among desert populations, especially vulnerable groups such as women, children and socially underprivileged sections.


  • Operational research: Studies on the healthcare delivery system encompassing availability, accessibility, adequacy, quality, sustainability of healthcare programmes in the region aimed at the development of affordable, effective and sustainable modules for improvement of service delivery by healthcare providers (both government and non-governmental organizations).


  • Vector-borne diseases: Vector-borne diseases and their vectors offer unique opportunities and challenges for the study of occurrence, distribution, behaviour and their transition in time and space in the desert environment. Determinants and predictors of diseases such as malaria and dengue for the development of area-specific strategic action plans for their control to support national control programmes.


  • Medicinal and insecticidal plants: Inventorization, distribution, biochemical analysis of useful medicinal plants; study of desert plants as alternative remedies; isolation of ingredients and the possible role of desert plants as anti-infective agents/insecticides.


  • Infectious diseases: Studies on tuberculosis, HIV and other prevalent infectious diseases for the development of improved diagnostic tools as well as intervention strategies.


  • Non-communicable diseases: Epidemiological studies on diabetes, hypertension, cancer, cardiovascular diseases and development of area-specific intervention strategies.


Capacity-building and optimal utilization of manpower        

Human resource is the most valuable part of any research institution. Scientists are intelligent but they have emotions too. There is a need to use their creativity in a well-directed manner by harnessing their talents and efforts in integrated and goal-directed research programmes.

Functional Groups          

It is a fact that collective and committed group-oriented efforts are effective in ensuring quality and quantity output. Hence, scientists in DMRC shall strive to function in group mode to provide optimal inputs of their creative abilities. The formation of groups is required for administrative and co-ordination purposes, and can be modified and expanded depending on the area of research. These should not affect the independence and accountability of individual scientists.

Leadership          

Lastly, the role of leadership in scientific institutions is usually not given its due attention. This is not a helpful policy. A good leader can build a climate where research growth and creativity are culturally induced by providing positive conditions, where good researchers can be attracted and retained, where people with ideas get encouragement, resources are procured and used intelligently, the research environment is cultivated and available resources are integrated to produce optimum effectiveness and growth. This has to happen if the Centre is to grow. Leadership has to be created and nurtured at all levels.