Friday, June 14, 2024

Medical education – views of a medical teacher


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By Prof. (Dr.) Mihir  Kumar Goswami

After decades of stagnation the health care delivery system in Meghalaya has seen a significant change in the last few years. Whether it is in the NEIGHRIHMS or in the State run medical service sector, the change is visible. Credit goes to the Government policy for improvement and upgradation of health services. But at the crux is the dynamism of the Chief Minister who undoubtedly played a pivotal role in ushering in this change.

The first, and only national level health institute run by the central government in Meghalaya started functioning from a rented house in Shillong from 2001 and was shifted to the present site at Maw Diang Diang on the outskirts of the city in 2007. It took almost two decades since its conception in late seventies of the last century for NEIGHRIHMS to happen. Then there was a gestation period of two decades before the announcement to start two medical colleges simultaneously by the Chief Minister of Meghalaya. It is well known that dozens of meritorious students from Meghalaya in the meantime had to go out of the state and also out of the country to fulfill their cherished dreams of becoming a doctor. Unfortunately people at the helm of affairs were not serious about exploring the possibilities of opening new medical colleges to check this exodus and also to meet the demand for doctors in Meghalaya. Only recently, have attempts been made, by some private parties to start medical colleges in some states of North-East, like Assam and Tripura. But for various reasons these institutes did not take off. In contrast there are scores of medical colleges in other states ( especially in South India and one even in the tiny state of Sikkim) although infrastructure of many of them fall short of MCI specifications.

Immediately after taking charge as Chief Minister, Dr. Mukul Sangma announced that medical colleges are coming up at Shillong and Tura. Perhaps this is aimed at appeasing the people of Meghalaya rather than serving any purpose. Establishment of two medical colleges is no mean task. So the million dollar question is – will this venture ever happen? Will the vision be translated into reality or remain a vision only? Will the benefits be reaped by the people of the State, mainly the needy and unfortunate whose last succor is the state health care delivery system? It may sound ridiculous to question the future of such noble and ambitious ventures but if one goes deep into the heart of the matter, it may not appear so. Because to open medical colleges with modern infrastructure is one thing but to run it efficiently to attain the desired results is another. As things stand, there is a gap between the two.

It is a fact that even the NEIGHRIHMS is not fully staffed. There is shortage of teachers in many departments. Some department even after having post graduate courses, are yet to have a full team. I faced unpleasant experiences during my three-year tenure as Associate Professor & H.O.D of Medicine in the Institute. As I was serving in the state of Assam I was not even allowed to appear in the interviews for the aforesaid post. But so intense was my desire to serve the Institute that I fought a hard battle in the High Court to allow me to appear in the interview. Later on, due to changed circumstances, I was able to join the Institute. Though, I tried very hard to start the Post Graduate Course in my subject and the Ministry of Health and Family Welfare (Government of India) expert group also recommended it there were several bottle necks. I noticed that some junior level officers in the administration could not rise above their pettiness and they are harming the future growth of the Institute.

Patient turn-out both at the OPD and indoor wards of the Department of Medicine were also unexpectedly high which was an indicator of the trust reposed upon the doctors of the department by the people of Meghalaya. Unfortunately those at the helm of the affairs of the Institute were reluctant to request the Government of Assam ( as I served in NEIGHRIHMS on lien) for extension of my services or for my permanent absorption, for reasons best known to them. On the contrary they were eager to send me back to Assam. So eager, in fact that the staff at the Directors office worked late till 1 AM in the morning to prepare the papers for my departure. They even sent a special messenger to the Medical Education Branch of Assam Secretariat with those papers the very next day! Had they worked with such sincerity for the upliftment of the Institute it would have been in much better shape now.

Graham Bell once said, “When one door closes, another door opens, but we so often look so long and so regretfully upon a closed door that we do not see the one which is open for us.” The same thing was prophetically true for me. Immediately after I joined my parent institution, Assam Medical College Hospital at Dibrugarh the Government of Assam promoted me as Professor and also allowed me to head the department.

So whose loss is it? NEIGHRIHMS is the loser here. I would have loved to serve the Institute. Currently there is still shortage of faculties in the department of Medicine to which I belong. The myopic vision of the policy makers of the Institute is responsible for this. The earlier Director who served for a short while also cannot shirk his responsibility for the mess in which the NEIGHRIHMS is presently in.

In recent years the private medical sector has flourished with state of the art infrastructure, the latest medical gadgets and brilliant doctors who choose to join them in large number even leaving secured jobs in government institutions and public sector. Moreover, the government policy of reservation even in Medical Science where merit should have been the sole criteria for recruitment or promotion is a major deterrent for good and brilliant candidates to join the government institutions. It is a fact that there is more financial returns in the private sector when compared to the government sector (except by dishonest means through various scams).

As a senior medical faculty member with an experience of more than 2 decades of teaching in various medical institutions I can boldly say these words. Going by the current statistics there is no dearth of doctors in the cities and towns in all states of India including North-East. Rather there are more than expected. The shortage is in villages where the real India exists. Now the question is how many of these surplus (?) doctors produced by the medical colleges or those coming out of the existing ones would like to go to rural areas to serve the people? My students said that even many of those coming from rural areas with an aim to serve their own people after becoming doctors never ever returned to their place of birth to serve their kith and kin and fellow villagers. They all prefer to embrace the urban life. Recently the Government of Meghalaya had to claim the compensation of rupees twenty five lakhs from each doctor who availed seats in various medical colleges of the country and later failed to serve the rural population of Meghalaya as per the bond signed during the time of admission.

Although medical education is a highly specialized subject there is urgent need to broad base it. This is the call of the hour. Hence, our policy makers both at the central and state level should awaken themselves to this crying need so that the health of the people at mass level takes a better shape.

(The author is Professor & Head Department of TB & Chest Diseases Assam Medical College, Dibrugarh)


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