By Lamya Ibrahim:
In the aftermath of a calamity, we can only pick up what remains and move forward. Even with the best technology and our most ardent efforts, sometimes we just cannot see it coming. But can we allow ourselves that comfort when it comes to those disasters which are neither ‘natural’ nor ‘unpredictable’? Take India’s current healthcare scenario. Out of the 1.21 billion people that inhabit its land, almost 600 million people have little or no access to healthcare. With only one doctor for every 1700 patients, India’s shortage of doctors is a stark reality that is going nowhere soon.
To recompense, the Government of India has 2 go-to solutions every year that pacify the blissfully unaware population. First, recruitment of new MBBS graduates to rural areas for one year, before handing in their Bachelor’s degree; but the idea hasn’t come into effect yet due to students’ opposition to the extension of the 6 year course.
The real problem with rural healthcare isn’t truly a dearth of doctors. Every year, India produces 45000 fresh graduates who can either keep trying to get one among the 22,000 postgraduate slots, shell out a fortune for a PG seat, or take up the thankless job of being a primary health care physician. Meanwhile, 2012 Government data demonstrate that merely 2, 500 more basic doctors in PHCs would be adequate to make up for the scarcity. Why the gap then, despite significant unemployment rates among graduates?
“The issue with rural healthcare is not lack of doctors, but that of infrastructure,” laments Dr. Mudassir Azeez Khan, Head of the Department of Community Medicine, in one of India’s oldest colleges, Mysore Medical College & Research Institute. Apart from problems regarding medical supplies, facilities and electricity, “there is no security for doctors. Rural areas are under the command of local politicians, who come in the way of equitable distribution of services. Those who take up the job are neither paid fairly, nor are their families provided incentives like proper living quarters and school facilities. As long as the Government refuses to rectify these shortcomings, doctors will opt for better-rewarding jobs in well-planned villages, cities and in the private sector. Only when they have no other option would they resort to these areas and that is precisely why the Government forces interns into it.”
These doctors lack the experience and competency to deal with rural healthcare problems hassle-free and by bringing in a new crop of such doctors every year, the problem compounds further. Also, the lack of clarity regarding the rural stint puts the doctors in a fix. “If it is an internship, it needs to be supervised accordingly. If it is a full-time job, they should receive appropriate salaries and facilities as well. These doctors have undergone a much longer training than their peers, and are required constant updating and relicensing to continue practicing. The least that can be done is to provide payment on par with urban doctors.”
Unlike popular belief, doctors aren’t ignoring rural areas and would gladly foray into disease-stricken parts, if such matters would be taken care of. Two years ago, as part of a national ‘Save the Doctor’ campaign, a compromise was put forward by students to include few months of rural service within the one year compulsory internship during MBBS, or during the second year of post-graduation. Unfortunately, so far, these practical suggestions have all fallen to deaf ears.
The other ‘solution’ the Government has is to increase the number of undergraduate seats. This not only adds to the excess of graduates wandering aimlessly around the nation, but also undermines the quality of education. Many new colleges do not follow MCI guidelines, yet sustain on India’s fanatic demand for a medical degree. The universally known dirty secret is that medical education is a lucrative business and the ‘shortage of doctors’ is a highly convenient excuse. A better investment is to improve the quality of the existing system, address pressing concerns and increase the number of merit-based PG seats, stat. These steps would be more effective in motivating doctors to stay back in India, rather than restrictions on foreign education aspirants, which currently constitute less than 3 per cent yearly.
Amidst all that, the biggest losers are still the residents of rural India. The incidence of both infectious and lifestyle diseases keep rising: India is now the leading contender for diabetes, coronary heart disease and hypertension, still losing large numbers to illnesses like diarrhoea and pneumonia.“India’s problem is simply the lack of importance given to preventive medicine and the glamorization of curative medicine,” states Dr. Khan. “Prevention is no longer better than cure; it is the only cure. In 40-50 years, we are likely to lose all known antibiotics. It is every citizen’s right to be provided safe drinking water, decent living conditions, and be made aware of the critical importance of basic steps like simple hand washing and practice them religiously. Sounds silly? But the reality is, with these simple measures, we can greatly reduce the incidence of communicable diseases and focus on other health problems including lifestyle diseases. It is hard enough convincing the medical fraternity of its importance, so the challenge to shift the attitude of the entire nation is immense, but it has to be done. Nothing will change unless this fact is taken seriously. ”
The debate has been raging on for more than two decades now, and will continue, so long as the matter remains a tussle between the medical community and the Government. Exercising our democratic rights, it is time for the issue to venture into the public arena and reform, so that we may finally avert the failing of India’s collective health.