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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.
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