The government recently proposed starting a shortened medical course to train doctors for our villages. This move has been criticised by the National Human Rights Commission (NHRC) and many branches of the Indian Medical Association (IMA) as being ‘discriminatory’ to the rural population. Such a truncated medical course, they fear, will produce more quacks.
I do not know any NHRC member, but I do know doctors in various state- and district-level branches of the IMA. Their sudden concern for the well-being of our villages is surprising, for most of them do not understand medical issues that fall beyond the narrow boundaries they set for themselves. Associations like the IMA have failed miserably in crisis situations and rarely have anything positive to offer. Their fear that quackery will flourish in rural areas is more stupidity. Quacks come in two forms: those with an MBBS degree and those without. When a medical practitioner ditches ethics, there is not much to choose between these two varieties.
With a few reservations, I’m all for the initiative of a shortened medical course, because those who do the six-year grind look pointedly away from the villages ever afterwards. The number of medical colleges in India rose more than tenfold after Independence; the number of doctors in India is over six lakh. They have concentrated in the cities, since money always speaks more passionately than social considerations. Almost 80 per cent of hospital beds are in the cities when more Indians live outside them. Having discriminated against the rural sector for so long, doctors have no right to protest against a drive to make up for the deficiency.
Moreover, no doctors group has objected to the unstoppable growth of mega hospitals in the cities. Thanks to our media, these dazzlingly vulgar institutions have acquired a sanctimonious service-to-mankind image when the truth is anything but. They offer expensive medical care which only 15 per cent of our people can afford. Many such institutions are eager to set up satellite centres, telemedicine networks and vague insurance schemes for the villages and semi-urban areas. Such schemes have largely proved to be more hype than service and are often a ploy to lure rural patients towards expensive medical care.
We doctors have let our rural folk down very badly. Having learnt the art and science of medicine, we ditch those who need us the most. Our IMAs and the NHRC do not protest.
Let someone more worthy fill the gap we’ve left in these 60 years. The basic tenets of medical treatment are not complex. A three-and-a-half year course can certainly produce doctors capable of curing 85 per cent of ailments that commonly affect humans, no matter where they live. No multi-speciality hospital anywhere can boast of a doctor who can do more. A cardiologist won’t treat an ingrown nail, an orthopaedician won’t cure an itchy lesion, a nephrologist won’t tackle a broken ankle. Our villages need doctors with all-round competency and affordability.
The Medical Council of India quickly responded to the IMA and NHRC protests by calling a meeting of all medical college deans, state health secretaries and the office-bearers of various medical associations. Their views and suggestions will be listened to before the final decision is made. One only hopes that instead of going about it in haste, they will work out a suitable syllabus, identify the right institutions and select a committed faculty. India has many learned experts who have worked for decades in our villages and have shown that health can be vastly improved using simple measures. Their work is recognised and followed in other countries. Their suggestions on the curriculum and teaching methods would make a significant difference.
The ‘rural’ medical seats are being offered to students who have lived and studied in villages with less than 10,000 population. It would be sensible to also consider students from poorer peri-urban and tribal areas where medical facilities are dismal.
My own experience of working for over two decades in rural India has taught me that the art of medicine and healing is really quite simple: You must understand the body and its functions in proper detail; you must know the conditions that cause disease and have the knowledge to treat them; and most importantly, you must understand the cause so you can show people how not to fall sick.
Democracy in India has failed to provide social justice. Now, at a time when the words ‘economic superpower’ ring sweetly in our ears, for 500 million Indians (mostly from the villages), even basic health is unaffordable. Most of them live in rural or semi-urban areas or in the slums in our big cities. To block any attempt to reach out to them is cruel.
(Kavery Nambisan is a surgeon and has worked mostly in rural India. She is also a novelist.)