The potential role of Interprofessional Education (IPE) to kindle the one health approach among students: a perspective from Indonesia

This article was exclusively written for The European Sting by Muhammad Mikail Athif Zhafir Asyura and Muhammad Afif Naufal, two second year medical students at Universitas Indonesia, in West Java, Indonesia. They are affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

During the mid-19th century, a series of cholera outbreaks occurred. John Snow, the father of modern epidemiology, observed that most of the infected lived-in proximity to the Broad Street water pump. Knowing this, he then persuaded the local authorities to disable the pump, which resulted in the outbreak diminishing in due time. This simple recount demonstrated two valuable lessons; (1) human health depends heavily on their environment, and (2) involving other sectors is paramount in putting the bigger picture into the equation.¹ The second point briefly describes the One Health Approach, which consists of people, environment, and animal health.

Now enter Indonesia. Brimming with biodiversity and a bustling society, it is one of the biggest developing countries. Situated in the tropical hemisphere, stable climate and ‘perfect’ weather are usually present. Despite its nurturing environment, Indonesia still faces a plethora of public health problems, one of them being Neglected Tropical Diseases (NTDs). Diseases such as leprosy and Soil-transmitted helminth infections are still commonly found, despite efforts from the government to eradicate them. Reflecting from Dr. John’s story, environment (and fauna) plays a pivotal role in disease transmission. This motion was well-received by the government, which is now spending 3.8 billion dollars on sanitary programs especially in lower-hygiene regions. However, even with a constant decline in prevalence, Indonesia has failed to meet its eradication target, indicating inefficiency.

Inefficiency in the system was predominantly caused by the minimal efforts in instigating cooperation between experts of different disciplines and even corruption to some extent. To truly adopt the One Health System, interprofessional collaboration should be more emphasized. Looking back, credits should be given as Indonesia is starting to move towards that goal, with the most recent action being the implementation of One Health in halting the pandemic.³ Ironically, this consequential mindset has not yet been included (or even considered) in our medical education curricula.

However, The recent introduction of Interprofessional education (IPE) has been a successful addition in our curriculum. IPE is a “curriculum approach in which students from various backgrounds collaborate in one setting.⁴ To some extent, IPE could be considered as a kindle for One Health, but in retrospect, the potential to improve and expand are there. There are very little-known examples of IPE which incorporated other sectors connected to health such as agricultural and environmental studies. Although one might argue about the difficulty of executing such collaborations at an undergraduate level, several points should be considered, with one of them being the prospective future of these undergraduates growing into future leaders in healthcare.

To summarize, the One Health system is monumental in tackling several global health issues. Sufficient focus on One Health approach has been initiated, although with varying results. The introduction of One Health via education is considerably lacking, thus raising the importance of non-healthcare collaborations within these modules. Hence with this approach, we are investing in the possibility of future ‘John Snows’ to tackle more complex healthcare issues.

1. Tulchinsky TH. John Snow, Cholera, the Broad Street Pump; Waterborne Diseases Then and Now. Case Studies in Public Health [internet]. 2018 [cited 2021 Aug 26]:77–99. doi: 10.1016/B978-0-12-804571-8.00017-2. Epub 2018 Mar 30. PMCID: PMC7150208. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150208/
2. Biro Komunikasi Publik Kementerian PUPR. Pagu Anggaran Tahun 2020 Sebesar Rp 120,21 Triliun : Pembangunan Infrastruktur Dasar Permukiman Menjadi Prioritas Kementerian PUPR (Bagian 3) [internet]. Indonesia: Kementerian Pekerjaan Umum dan Perumahan Rakyat; 2019 Aug 30 [cited 2021 Aug 25]. Available from: https://pu.go.id/berita/pagu-anggaran-tahun-2020-sebesar-rp-120-21-triliun-pembangunan-infrastruktur-dasar-permukiman-menjadi-prioritas-kementerian-pupr-bagian-3-
3. Ramadayanti E. COVID-19 dalam perspektif one health approach dan law enforcement [internet]. Bandung: Universitas Padjadjaran; Mar 26 [cited 2021 Aug 25]. Available from: https://fh.unpad.ac.id/covid-19-dalam-perspektif-one-health-approach-dan-law-enforcement/
4. Findyartini A, Kambey DR, Yusra RY, Timor AB, Khairani CD, Setyorini D, Soemantri D. Interprofessional collaborative practice in primary healthcare settings in Indonesia: A mixed-methods study. Journal of Interprofessional Education & Practice [internet]. 2019 Dec [cited 2021 Aug 25]; 100279. Available from: https://www.sciencedirect.com/science/article/abs/pii/S2405452619300035?via%3Dihub

About the authors

Muhammad Mikail Athif Zhafir Asyura and Muhammad Afif Naufal are currently second year medical students at Universitas Indonesia, in West Java, Indonesia. They are members of the Center for Indonesian Medical Students Activities Indonesia (CIMSA Indonesia), an affiliated NMO of International Federation of Medical Students Associations (IFMSA). Currently serving as members of SCORE, they possess a monumental interest in youth involvement and medical student empowerment in tackling global health problems for the betterment of society.