Basic Doctors for Rural Indians -- Stop this madness

 

Many Indians including our President are suddenly concerned with rural India's health. They have already started formulating projects to flush young doctors out of cities and flood rural India with them. Medical Council of India is steps ahead by planning to open new Medical Colleges to mass-produce rural doctors. An article published in The Hindu daily, dated 5.11.09 and a Public Interest Petition filed in Delhi High Court by the author Dr. Meenakshi Gautham, triggered this outbreak  http://www.hinduonnet.com/2009/11/05/stories/2009110554760800.htm

It is unfortunate to note that some self-proclaimed "Think Tanks" and philanthropists having "Godfathers" in the Eastern Bloc countries are very unhappy with the achievements of India during the last sixty years. Now India could produce professionals like doctors and engineers acceptable for the whole world. The ulterior motive of these Intellectual Terrorists (see last para) is to reduce India to the level of the Eastern Bloc countries and they have taken the whole of India for a ride with compassion and benevolence ending in a write-up and a Public Interest Petition! Instead of being proud of our achievements this group wants to drive us back to the 15th century! All those concerned should be on guard. Before going into the mentioned article, a brief history will help normal people to have a better idea on the subject.

117 AD

In 117 AD legal councillors of the Emperor Hadrian headed by Salvius Julianus, an African by birth, categorised people into four to give different punishments for the same crime -- Roman Citizens with voting right to get away for murder by just admonishment, Romans without voting rights to get away by paying fine, free men (former slaves) to undergo varying terms of imprisonment and the slaves to be hanged till death.

500 AD

Persian King of 5th century AD, at the height of his glory declared -- 'without army no King; without revenue no army; without taxes no revenue; without agriculture no taxes; and without a just Government no agriculture.'

Agriculture is the foundation of civilization. Mesopotamia, one of the cradles of civilization disintegrated when farmers were not cared for by the conquerors. Importance of our farmers is not realised by the wise authors or governments yet.

1700 AD

 Elihu Yale, the British Governor of Madras amassed wealth in India, even by murdering to steal. When he was to return home with the loot, he came to know he would be arrested in UK. Therefore, he changed his destination to America.

Planning to have a College in New Haven, Connecticut, Sir Jeremiah Dummer, the colonial agent wrote to Yale who had just arrived there with a fortune from India -- "... business of noble men is to spread religion and learning among mankind..." (Kelley 24).

Yale agreed to help and the trustees thanked him by renaming the college as 'Yale College'. Overnight, the criminal became a great philanthropist in USA. Many Presidents and Senators including Bush Sr. and Jr., John Kerry, etc., are products of the famous Yale University.

1850 AD

Prof. Louis Agassiz of Harvard University's Lawrence Scientific School postulated that God created different ethnic humans. Anglo-Saxon whites are the superior and Negroes the lowest. Anybody who tried even to educate Negroes are to be considered criminals.

2000 AD

In 1946, Health Commission recommended a 6 year-course of M.B.B.S. as the basis for registration in Indian Medical Council. In 1946, no antibiotics (other than penicillin available to defence services), were present. Vaccinations and immunisations beside that for small pox were not discovered. Diagnostic imaging, ultrasound, etc., were unheard. Nobody dared to operate on heart. The famous surgeon of Vienna, Prof. Billroth decreed -- any surgeon who touched the heart was a medical fool.

By 1950, the amount of medical knowledge doubled. By 1975, the growth was astronomical and no single doctor could master all its branches. So doctors started to study more and more about less and less. This is specialisation, which doctors and patients equally became fond of. It is proposed now that all doctors including specialists need 're-registration' after attending the stipulated hours of classes to keep pace with the advances in their fields of study.

 A team of specialists is needed now for 'proper' health care. Even normal physiological process like childbirth entails an array of specialists. They are supposed to reduce morbidity and mortality of the mother and child. Besides the primary physician, it is advised to have a sonologist to evaluate the growth and abnormalities if any of foetus. Qualified technicians are needed to monitor various parameters and body functions of mother and the baby inside. Specialist doctors do complicated operations on the baby even inside the uterus. At time of delivery, an anaesthetist to relieve her pain and resuscitate the baby is a must. In addition, an army of specialist doctors of varied paediatric disciplines thereafter to cater all sorts of treatments to the newborn have come to stay. Social workers, nutrition experts and many other unheard of until now players waiting in the wings add to the ever-swelling medical cast and spiralling medical cost.

The plot

The Authors suggest Governments' failure in health care can be contained by introducing a new version of caste system based on wealth and habitat of patients. There will be lower caste poor rural people and higher caste affluent city dwellers. It will worsen the discrimination of patients already present.

Political bigwigs have access to the latest medical treatment of New York or London with taxpayer's money. The proletarian leader opposed to tractors and computers could go to UK for his lung problem. However, a poor citizen can only dream about such treatments.

The authors of the article think that affluent city dwellers are superior and rural farmers, inferior. Therefore, a rural patient needs only sham medical care delivered by a 'basic doctor'. They picture health care systems of old Nazi Germany and present China, where not even 17% of 'doctors' have education or qualification, as the ideal thing for rural India.

Doctors from ancient times glorified their profession by treating patients without discrimination. Patients were equal. Illness, like time is a great leveller. A thick wallet or respectable address was not needed to get adequate treatment. Doctor, not only cured, but also was a friend, philosopher and guide. Pauper and prince were equally welcome. There was no discrimination. Now, only the 'jihadis' and human bombs practise such lofty ideals of equality.

In India, before the battle of Plassy, illiteracy was unknown and when British left, India's literacy stood at 17%. It was a British policy. However, our governments under dumb politicians still continue them and damage our education and industry. Maintaining the scarcity of doctors is such a policy.

Medical education and doctors were the monopoly of 'Sarkar' and politicians, as was our industry, which could not produce a good razor blade or motorcar under them. We used to export a shipload of cotton in exchange of a Benz. After sixty years of 'glorious rule' by our politicians and bureaucrats, we still cannot produce even one microchip, though we are the largest consumers of cell phones and computers. They advised our economist prime minister to purchase 200 tonnes of gold at inflated rate instead of investing in shares of major American companies at rock bottom prizes.

Forty percent of engineers running American companies are Indians. Indian scientists and doctors become great in their emigrated countries and chosen subjects once they are free from our politicians and bureaucrats (? DHRITHARASTRA ALINGANAM or embrace). It is a pity that People who have no formal education become education ministers in India. They turn to bureaucrats considered the best brains and the only patriots in the country, for advice and help. (Seshan and Sam Pitroda are exceptions rather than the rule.) Those people are the main cause of our pitiable state of affairs.

Education should be entrusted with statutory bodies like the University Grants Commission and Indian Medical Council. What an autonomous body like the Telephone Regulatory Authority could do to our telecommunication must be a revelation. We had nearly 10 million telephones, which after deregulation jumped to 400 million, not to mention the manifold increase in quality of service.

If education is free from the clutches of politicians and bureaucrats, our institutions will be again on par with Takshasila and Nalanda where people like Pythagoras (300 BC) studied. Good education can be given with better standards and lower costs if the constraints and caveats of government are eliminated. Healthy competition will ensure better standards and number of experts including doctors. Cellular telephone companies offering services through IIM trained executives in remote villages are no news, nowadays. Doctors will have no option but go to rural areas to practise. In Kerala, the State that pioneered the 'Kerala model health care', qualified private practitioners not based in cities provide 70% of medical care. If the authors and like-minded people care to spend their energies to free our education from politicians, it will be a great help.

In 1984-85, Indian Medical Association and left politicians thwarted an attempt to start private medical colleges in Kerala claiming the anti-people reform will cause doctors to go unemployed. The same people now lament that vacancies in Health Services and Govt. Medical Colleges cannot be filled for want of applicants. Where did all the doctors go?

People, whether technically qualified or not, will migrate to prosperous parts of world to have a better life. Unskilled workers and qualified people migrate to Bombay against wishes of cheeky politicians. Were they powerful enough, they would have stopped it by a resident permit system, like in China. The authors seem to want that also.

In India, a criminal case will take at least ten years for a proper disposal in a court while civil case may take decades. Do we also need 'Basic Judges' to cure such ills of judiciary? Only 15% of Judges in China has university degrees, let alone degrees in law. Improper treatment by basic doctors (also called quacks) led to the recent emergence of multi-drug resistant TB, which cannot be cured even by qualified (non-basic) doctors.

The requirement

It is necessary to have at least one Medical College per million of population. All District Hospitals must be converted to Medical Colleges by allowing private parties to invest and upgrade them. The Indian Medical Council or equivalent bodies should conduct National Entrance Examinations and admit students. Fees should be charged from patients and students. Treatment to poor can be subsidised by government if politicians really care for them instead of shedding crocodile tears.

Fresh medical graduates do not like to go to villages. Why should they? Do all our MPs work as members of village panchayaths before seeking election? Do IAS and IFS officers serve as village officers before posted? Does Supreme Court or High Court Judges serve as bench clerks before accepting their exalted position? It is only natural for young doctors hoping to enjoy city life like other young people. Moreover, they can get good experience of the profession in crowded city hospitals before starting a one-man show practice in villages. Actually, it is a serious mistake to send an inexperienced young doctor to village unless our government considers the poor villager, a guinea pig. Imagine the mayhem, if a law is passed somehow in the parliament, that hereafter all our MLAs, MPs and Ministers, are only to be treated by fresh medical graduates! Let us hope that the Delhi High Court Judges will include this point in their final judgment.

It is more prudent and practical to ask government doctors, to serve five years before retirement, in villages. Most doctors by then will have their children settled and will appreciate a quiet life in villages. Let young doctors, starting their career and family, live in cities for employment, experience and educating their children. In addition, as time passes they will become mature, experienced and be prepared to serve our villages.

Funding

We have many Indian 'Yales' who help sustain the Swiss economy. What prevents India -- one of the most corrupt countries of the world -- from honouring them a la Yale. There is money to finance our education, health care and infrastructure if only we are willing. Corruption, India's major industry, has produced trillions of dollars as black money. If it is given amnesty from laws of the land, its custodians will bring it back from Swiss vaults. If those politicians are also to be honoured with incentives like Padmavibhushan, what dramatic changes will not happen to our education and health care scenario? Only moralists (an endangered species) will object.

If Switzerland can become the first country in the UN Human Development Index Survey by protecting looted money from all parts of world, what prevents India -- the biggest contributor to Swiss Banks, from patronising the looters and go up the ladder of Human Development Index herself (now with a ranking of 138 she is at the bottom)? The affluence of America and Europe owe much to looting of Asia and Africa (the honourable word is 'Free Market').

India also needs to be practical. In 1700, America honoured Sir Yale and the Yale University was born. Still they do it. A person named Mr. Obiyang, the corrupt minister for Forest and Agriculture of Equatorial Guyana (and the son of that country's President) has a 35 million dollar estate, a fleet of luxury cars, yachts, etc., in US while US laws strictly forbids anyone who had enriched himself by corrupt practices from being granted entry visas, even if not convicted. The reason why Obiyang is welcome is US Corporates like Exxon and Mobile have stakes in the 400,000 barrels of oil of Guyana. The recent economic recession due to the collapse of US Banks resulted from banker's corrupt practises. The consequent bailout (by US government) with one trillion dollars paid to the same criminals is called 'rescuing free market'! Why cannot Indian government also do our 'patriotic criminals' such favours instead of begging to World Bank for money?

If politicians are serious, they must make our health care, tax and levy free. Medical equipment must be free of import duties. That is the correct way to bring down medical costs to affordable levels. Instead, they search for avenues to add more taxes and controls.

Integration of all systems of medicine

All systems of medicine, like Ayurveda, Unani and Homeopathy can be integrated in a scientific manner by making MBBS the basic medical qualification. Other systems are to be made postgraduate specialities. All teaching institutions in Ayurveda and Homeopathy must immediately be upgraded for MBBS course. This will make all systems truly scientific. If it is done, every doctor, whether practising Homeopathy, Ayurveda or Allopathy, will have a uniform basic knowledge. He will be the real 'basic doctor', not the one politicians and our think tanks dream about.

The exercise by the authors is an example of 'Intellectual Terrorism' as said by Mrs. Radha Rajan, Editor  Vigil Online in 2006 at Kozhikode -- http://video.google.com/videoplay?docid=-6864335520571762844#

 Considering the above kindly join me stop this madness by our masters.

By: Dr. K. Kishore Kumar, State Secretary, QPMPA, Kerala

Details of the authors of the 5.11.09 article in The Hindu daily.

Meenakshi Gautham, PhD, is a public health specialist (gautham.meenakshi@gmail.com); K. M. Shyamprasad, M.Ch., FRCS, is a former vice president of the National Board of Examinations, MoHFW, India (shyamprasad@nlhmb.in). Legal inputs have been received from Indira Unninayar, Supreme Court Advocate.)