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An Open Letter To The Medical Students Of India

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By Md. Uzair Belgami:

The following words are addressed especially to you, those who hope to realize the ‘Great Dream’ of entering a medical college. The following words are also addressed to you, those who are studying or have finished your Medical degrees, and are now living the ‘Great Dream’ of studying/having graduated from a medical college (though, of course, I presume most of you, by now, have come to realize that the “Great” in the above expression, mainly signifies the “great” volume of the syllabus, rather than the “dream” itself!)

famineI would like to convey to you something very important, something which you, of all people, should be well aware of and anxious over, and yet it appears, are pathetically & woefully ignorant and apathetic of. I would like to tell you very briefly, about the health situation in India:

Today, India is considered around the world as a rapidly developing country posting economic growth rates of around 8-9 percent consistently over the last several years. Along with China, which is much further ahead, India is seen as a powerhouse of the global economy in the decades to come and already it is home to a very large number of dollar billionaires, perhaps the largest such number in Asia.

If you take a look around this vast and populated country though, the picture that one sees is not as rosy as it is made out to be. India is also home to the world’s largest number of people living in absolute poverty. In 2007, a study on the unorganized sector in India, based on government data for the period between 1993-94 and 2004-05, found that an overwhelming 83.6 crore people in India live on a per capita consumption of less than Rs.20 or O.50 US cents a day.

In 2010 a UNDP/Oxford University study, using a new Multi-dimensional Poverty Index (MPI), said that eight Indian provinces alone have more poor than 26 African nations put together. The report said that acute poverty prevails in Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and West Bengal which together account for 42.1 crore people, 11 million more “MPI poor” than in the 26 poorest African countries!

India, today, is harboring a major health disaster, which can be described quite accurately as a “genocide”. There is a specific technical reason for using the word genocide and it is not wielded in a rhetorical manner.

The Indian National Nutrition Monitoring Bureau (NNMB) tells us that over 33% of the adult population of India has a Body Mass Index of less than 18.5, and can be considered as suffering from chronic under nutrition. If we dis-aggregate the data, we find that over 50% of the scheduled tribes (Adivasis), and over 60% of the scheduled castes (Dalits) have a BMI below 18.5.

The WHO says that any community with more than 40% of its members with a BMI below 18.5 may be regarded as being in a state of famine. I hope you realize, that by this criterion, there are various subsets of the population of India – the scheduled tribes, scheduled castes etc. which may be regarded as being permanently in a state of famine!

So, it is not any general population that is suffering the consequences of poverty-induced malnutrition but specific ethnic groups and hence the use of the term ‘genocide’ as per the United Nations definition. All this is, of course, in addition to the mundane reality, to which we have become habituated, of 43% of children under 5 in India being malnourished by weight for age criteria. India has the world’s largest number of malnourished children and according to the UNICEF, over 20 lakh Indian children die every year due to malnutrition related diseases.

The salt in the wounds, is the scarcely known fact that it is precisely these sections of the population, the tribals, scheduled castes & tribes living in malnourishment and famine, are being subject to ruthless land displacement policies and exhortation of their natural resources, for the development of industrial power-houses and factories, the benefits of which the victimized people scarcely receive. It is ruthless and pitiless genocide — and shockingly, with the primary responsible being the Indian State.

In our country, the “future superpower” of the world, under-nourishment kills around 25,00,000 people annually, malaria kills 9,00,000, air pollution kills 5,27,700, tuberculosis kills 4,00,000, and road accidents kill over 1,00,00 people annually! These are all preventable causes of death! It approximates to around 12,000 Indians dying every single day. There is no conflict in the world, no terrorist, or no President, because of whom the daily toll of lives reaches such catastrophic peaks!

The country you live in is one in which even the silent genocide of millions every year due to neglect and poverty, does not touch the conscience of the rulers, or the conscience of the public at large, or most pitiably the conscience of most of the medical practitioners & students. Nobody is deemed punishable or accountable for these deaths due to disease as they happen without a single shot being fired or any explicit form of violence used.

Nowhere else in the entire world will so many people be allowed to die like this every year without sparking off a revolution!

So, amidst this deluge of misery and injustice, the question now lies heavily on your shoulders, why are YOU studying medicine? The question was posed to some of my classmates at the Bangalore Medical College, and their answers (I am sure they would be similar among any other students in any college, across India) ranged from:

Well, because it was the most prestigious career choice, and there’s lots of money involved while we’re also helping people

to, “My father is a doctor, so I too became one

and, “I want to study medicine here, then go to the United States. Doctors earn so much money there!

also “I don’t know, I guess I kinda like wearing white coats”

Amidst the entire situation I have described above, this, for me, is the most frustrating and depressing! The medical students in India, who are most apt to arm themselves with the knowledge and know-how to make a meaningful contribution in the health situation in this country, are some of the most apathetic and insensitive. The medical students whose voice would be respected and listened to keenly if only they chose to lend their voices to those that need them, instead are too busy studying for entrance exams and the like. The knowledge of ‘medicine’, which could be used to effect a great change in this horrendous environment in which we are living in with our eyes closed, is instead treated as just another career and livelihood by doctors and medicos. Our system of medical education is such that, it creates people who gain a lot of knowledge on medicine – but, it seems, lose their conscience along the way.

So, my advice to all medical students is this: widen your horizons, do not be just another one of the cattle in the herd. Start reading whatever you can find, in books, in websites, in magazines, even on facebook — about the repulsive health conditions in the country we live in. I promise you, the more you read and learn, the more shocked and appalled you will be. Go on a trip with your friends to Chattisgarh, to Bihar, even to the nearby village just outside your town/city, or at the least, the slum which I am sure you will find not more than 5 kilometres from your house. Pull your head out of the ground that you have unconsciously stuck your head, ostrich-like, into. Explore Indian society in its comprehensiveness and reality — not just the upper 5-10 percent of society that we comfortably, happily live & dream in. Do this, and you can take my word, you will not be the same. Do this, and you will not look at ‘medicine’ in the same selfish, apathetic and oblivious manner. Do this, and I very much believe & hope, you will be inspired and extolled by your conscience onto a journey towards a meaningful and serious contribution to health, to humanity in this country.

How exactly you will set about on this revolutionary path, how you & I can change these repressive & depressing state of affairs? this is the subject for another discussion, which will be very soon I hope. For now, let us start thinking and understanding the why, rather than the how. Let us start reading, travelling and understanding the situation here in India, outside of our comfortable little lives. Let us learn what we so criminally and unfortunately are not taught in our seminar halls, but which is so absolutely necessary for us, as medical students and doctors to know. The challenge and urgent necessity for us today, is to connect our medical knowledge and courses — with humanity, with the society (not just the small percentage of society we live in, through which our eyes are never able to see, but the whole Indian society). This situation will not be tackled by a host of speeches and ‘thakreer’, but through youth who will strive with their lives and their ‘career’. I hope we can discuss & explore this further and share ideas in the future. Until then, keep pondering, and keep wandering.

Perhaps your reading this, will inspire you to think about the large majority of this society who are isolated and ignored, and not just the upper fortunate few among whom we so proudly serve, with the prestige & status of the ‘white coat’. Perhaps you may begin to hear the silent voices of the millions, who are calling for your help, whose future you can change. Perhaps, this may inspire you to a new beginning.

By
Md. Uzair Belgami
House Surgeon,
Bangalore Medical College & Research Institute

Large Excerpts & Data taken from
(1) the speech of Dr. Binayak Sen at Gwangju, 2011
(2) The Editorial, “Health & Society/Sehat aur Samaj” journal, issue 1, by Satya Sivaram

You must be to comment.
  1. Arushi Kumar

    You can’t enforce compassion. We live in a society where respect is measured by how much money we have and all the pretentious things that come with the money are indicators of success. Your parents teach you to be competitive instead of compassionate. It really comes from within if you want to make a change and you will only then teach your sons and daughters and siblings to think that way.

  2. rizwandurrani

    we must stop thinking of the individual and start thinking about what is the best for society.we (youth) want to change the system bt we don’t want to become the part of the system.problem is within us.we have to fight within us then only we can understand the problem of others.this is the way we can make a change in society and country as well.

  3. subrata guha thakurta

    typically you post questions that trouble us – but then the medical community doesnt decide hoe the future of this country is going to be shaped – the unfairness is obvious to everyone – but then with out being avaracious am i not allowed a decent life – without feeling guilty ?

  4. A Raving Mind

    Sir,
    As an MBBS student i am rather hurt at the insinuation that we are oblivious to the conditions in the country. Here at MAMC we are witness to the thousands who daily seek the healthcare services provided by the govt. at minimum cost to them. Our PSM posting has a compulsary FHAP part where we follow up a family living in a slum for a couple of months to assess and advice them on how to improve their health. Internship involves a compulsary rotation in a rural setting. We go as a part of the pulse polio teams specially to the underserved areas of the community. In fact I doubt such exposure to the real problems of commuity are a part of any other curriculum other than MBBS.

    As for malnutrition, you as a medical graduate yourself would know better than most that it is not an isolated problem from an isolated cause. The causes are as diverse as the community in which they are prevelant. And while we as doctors try our best to prevent and treat it, the solution lies in education of masses about proper feeding practices and govt. policies to ensure food security.

    This is of course my humble opinion on the matter

    Yours Sincerely
    Suman Pal

  5. harish

    Why single out the doctors? They are trying to make a living just like engineers and lawyers.

  6. Aditi Thakker

    I think it is rather unfair that doctors are being targeted like this. If you think logically, someone who doesn’t have much money becomes a doctor to earn money. Someone who does have a lot of money, either buys the seat at medical college or gets in on merit, but has to recover the money spend or keep making more money.

    It is not easy being a doctor in this country. I have seen patients come to doctors at the last stage of their cancer, addicted to tobacco. When the doctors tell them that there isn’t much that can be done, they question the credibility of the doctor. They say he is not a real doctor. This problem is rampant in rural India, and of course it needs to be addressed, but how many individual doctors do you think want to be called murderers in villages they serve in? Why not use the same knowledge to work at a good recognised hospital, make money and even get fame.

    Also, the responsibility of making healthcare available in the rural areas, is the responsibility of the government. They have the power to make medical service for doctors compulsory.

    Why does this accountability not extend lawyers, for legal empowerment, to engineers for infrastructural development, and to teachers for educational development of the country?

  7. Prerna Godara

    Dr Uzair

    You, yourself being a doctor would understand the hardships gone into being one. after studying in MBBS for 5.5years, we start studying for a specialised degree, which we get via entrances, as you may no, there is no value of only MBBS as a degree. If we even think of working somewhere, we are asked about our specialisation, an MD/MS degree is a must. I have tried to find a job in MSF India and even they require he doctor to be a specialist with a MD/MS degree most of the time. Also due to the various reservations in India, its quite hard for a general person to pass the exam at one go (i myself facing this problem) keeping in mind how some people even end up buying these seats. After putting in about 10 years of your life into this profession in just becoming a doctor, how can u expect us to forget all that and dedicate our lives to the society. We have a responsibility to our family first. Our parents who have waited patiently for 10 years in order for us to study, and to be able to earn the bread and butter for our family, how can we not think about them. Engineer and Lawyers too live in this society. there are so many cases in the courts that are just there with no one taking responsibility. a decision is never given on time by the court, and this way, lawyers keep making money, no matter the client is poor or rich, or a handful of students who have collected the money after so much efforts (this being in reference to the court cases going on for pre pg exams), only to get another date with more money required. why dont the engineers and architecture students come and help built better houses for these people, and educate them to become literate. only being provided by medicine and health care wont improve their health, a hygienic house and literacy is also required. I think targeting only one strata of the society,the doctors, will not help this scenario and we have to work as a whole team bringing together all the professionals.

    Another reason why i would hesitate to help someone at one go is this. Having worked in government hospitals, i have noticed one thing. when the patient is very sick, you are god to him and his relatives. they demand your full attention to the patient. but being loaded with so many patients, you need to divide your time. on not being able to do so, the attendants never think twice in calling upon your senior consultant to blame you for ignorance. after being treated and as soon the the patient is healthy, they start treating you as their slave, and start demanding things like even a discharge sheet, which if not given on time, is again complained about. why this difference of behavior, being compared to god at one second and to a mere nobody at the other. why would i want to help them again in the future if i was not respected. i have not dedicated my life to medicine to get this response. so why should’nt i be greedy and think about my and my families future instead of thinking about someone elses.

    I hope you understand my feelings, and im sorry if i have hurt anyones sentiments.
    thank you!

    Dr Prerna Godara

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