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Simple problems need simple & straightforward solutions. On the face that’s how the honorable health minister’s prescription for the ailing health of Indian rural Medical system. So, all medical students of India shall serve a one-year rural term before getting into any postgraduate specialist training. Lo and behold, all our villagers will brim with good health.

 

If the solution to this massive rural-urban healthcare disparity was so simple, why did it take so long to be thought of!

 

In all fairness to the medicos let’s examine the issue closely.

 

Unlike in the US, the average medical student enters medical school after class 12, meaning he (also could be a she, but forget about being politically correct, that’s not the issue here) is 16-17 years of age. MBBS is 5 years plus a year’s internship. Having gone through the mill, let me assure you that a majority of doctors who come out of medical school after MBBS are clueless about clinical practice. Our system teaches them how to examine patients, how to assist consultants in their surgeries and clinics, but fails to teach them how to prescribe medicines and worst of all, there is absolutely no training in interpersonal communication. A fairly large number of MBBS doctors would never have experienced how to discuss the pros and cons of let’s say undergoing HIV testing. Or how to declare to a family that a beloved one is dead.

 

Equipped with this kind of ability to practice, to deal with the illnesses of our rural kindred, look at what he is armed with. A large number primary health centers in the country function without adequate medicines, lab facilities, x-rays, nurses & technicians. In the absence of all these, how does our man diagnose the diseases? And in cases where he can, does the paper on which the prescription is written cure the patient. Remember, utter poverty prevents a great majority of patients in the villages from buying medicines.

 

If indeed shortage of doctors in rural areas is the reason for making rural tenure compulsory, why not make it universal. Why only sent PGs-in-training to the villages? This is where our honorable health minister has taken the easy way out: unlike the MBBS students, interns or practicing doctors, PGs are almost at the mercy of the authorities. If they are sent they better go, or else they won’t get the degree. Come on doctor, why don’t you send your in-service doctors to the villages? It is no secret that a large number of doctors in government service posted in rural areas are actually sitting in urban or semi-urban areas by hook or crook. Governments have realized that it is impossible to take corrective action against serving employees. Whereas PG students will have neither choice nor voice against this decision.

 

Is there an educational advantage for the PGs to be posted in villages? True, they get a closer look at the medical problems of rural India. The exposure to some of the third world problems such as rheumatic heart disease is so great in rural India that I know of doctors in US coming to India to study tropical medicine in this population. However, learning cannot happen in the absence of diagnostic aids. If clinical suspicion of disease cannot be confirmed by laboratory or imaging techniques, do you really learn something out of that case? Learning how to treat diseases merely on basis of clinical suspicion is not scientific medicine. Our rural doctors have no choice, but to allow PGs to learn this kind of medicine is certainly not on.

 

What about comparative economics? In a good number of cases, medicine is chosen as a career by the top students in the class. Having been brilliant throughout and for the six year toil, the salaries offered by most governments in the country are at best pathetic. Contrast a student who after 3 year BSc or 4 year BE earning 5-figure monthly salaries. And if there is a 2 year MBA thrown in, earnings could cross a lakh a month.

 

It is nobody’s case that a non-medical man should not earn comparatively larger amounts of money. But then, after any sort of education, most people are given the freedom to work where they want. In places where labor of any kind is difficult to obtain, financial incentives are given so as to compensate for the inconvenience caused. A PG cannot claim any of this and will become a hapless scapegoat of one more governmental scam.

 

Improvement of rural medical facilities is truly an important requirement. Invest in hospitals and well-equipped clinics in villages and towns, pay the doctors well enough and then rural medical service may improve. If building hospitals in non-urban areas is made a profitable business, private players will also come in. Strategies for these have to be thought of. But all these ideas need men of steel to think and execute. In the absence of such steel, people like the hapless PGs will suffer.

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