Interpreting India’s medical maladies
By Pratik Deb
The medical students of the country took to the street last month in the capital of the nation against the impending imposition of rural posting upon them. The Medical Council of India, the governing body of the medical education of the nation, is yet to make this official and already the ire, the uncertainty and the precariousness of the medical students of the country along with the rest of the medical community is being vociferated against the forthcoming mandate that would compel the MBBS pass outs to work in a rural centre for a year in order to be deemed as eligible to pursue higher study and specialisation. The decision itself is somewhat consistent considering the path the government was willing to take for last decade or so, when they initially proposed a separate three and a half year course of medical training for a band of health care workers who would be stationed in the rural part of the country to specifically provide health care to the populace of the hinterlands. Though that plan could not take shape as the Supreme Court ruled against it, the method of deliberation on the part of the government seems to be remaining same: putting a health care work-force on the rural sphere be it somewhat untrained or inexperienced.
Without fearing to sound like a naïve idealist, let us see what is wrong with this proposition. First of all, just like its predecessor’s attempt of putting semi-qualified individuals in the helm of affairs in the rural settings, the government, once again, seems to be not moving further from their original assumptions: the health care of rural areas does not require the same expertise as that in the urban realm. Even if we overlook the utterly undemocratic essence that this assumption transpires, we have to accept and admit that the truth is quite the contrary. In rural settings, when a physician is entrusted upon with general practice and is expected to diagnose diseases without the aid of a USG or X-ray or laboratory tests that was more or less routine in the tertiary health care centre where he was taught and trained, he needs to have more clinical experience than that a one year rotational internship at the end of his study provides. Contrary to what the common notion is, general medical practice is not trite, rather it is the backbone of any efficacious health care system. True we have not ‘specialised’ it the way the first world did in the form of family medicine, but that does not render it insignificant.
By making the rural service mandatory, the government renders it off-putting. While the rural posting was never meant to be sounding as if a persecution, a very little was done on the part of almost all the state governments throughout India to ensure the rural community a healthy infrastructure on the first place. Currently most of the rural postings for the doctors take place on ad-hoc basis (by National Rural Health Mission) as temporary job without any job security or future benefit. How can a government eradicating job security off its doctors even in the governmental sphere expect better commitment of them? Working on the infrastructure and increasing incentives for the rural posting works wonder in alleviating the so-called apathy of the doctors to go to rural settings: Gujarat provided a perfect example of that.
So the only ground of such a decision on the part of the government can be found in the argument of pragmatism. But let us ask ourselves, is it the only thing that could have been done? Is it the best alternative that is at hand to improve the health care of the rural populace? And the answers, to both the cases are: a resounding no. The path towards a holistic and wholesome health-care system in the rural section of the country is not a mandatory one year service of the fledgling health care professionals who would rather see this as a condemnation rather than an opportunity to work for the people or to learn. Putting the rural health service in the map of one’s career as a purgatory that one must bear with for a year in order to return to the heaven to super-specialized posh hospitals of the urban regions is neither a vigorous nor an ethical measure. Hopefully it won’t be too late to confront that inconvenient truth. Rather, a sincere attempt is required to equilibrate the inequity present in the urban to rural ratio of health centers and infrastructure. The dissonance between the urban to rural population and their representation in the medical student community is worsening every year. The burden of technology and investigation is augmenting while the reliance on good old clinical skills is being marginalized in the medical education by each passing moment. Unless a health care system can be bolstered keeping all these conditions in mind, it would be hard if not impossible to see the forthcoming step as anything more than an eyewash on the part of a government reluctant to take the matter of the health of its own people seriously. (IPA Service)