Location: Hyderabad, Andhra Pradesh, India

Thursday, July 06, 2006

A Correct Prescription?

Here's an article by Dr. Kaveri Nambisan on Rural Health in India:

Wrong prescription, doctor

The recent interview with Dr Devi Shetty by Shekhar Gupta ( Click here) has spurred me to write this. I admire Dr Shetty for starting an excellent hospital in Bangalore, and for giving up his lucrative job in the UK to work in India. I appreciate his concern for the health of our rural communities and for the future of young medics. But I do not agree though with his prescription for our health sector.

He advocates, like many others, that increasing medical college seats so as to produce specialists and super-specialists is essential. Since very few such doctors go to rural areas, I presume he expects the 700 million rural Indians to head for city hospitals when they need treatment, or to be happy with telemedicine where, as Dr Shetty explains, there is no need to touch the patient. Specialists and super-specialists will be busy attracting medical tourism, which is set to escalate by 25 per cent annually. The majority of them come from developed countries and will further deplete our medical resources.

In the midst of overwhelming economic disparity, super-technology and telemedicine can make a small change if any. Such advances will not ensure that the 50,000 who die of TB every year and the 60,000 who die of diarrhoeal diseases and the 400,000 who die of AIDS are saved. It will not ensure that the myriad preventable diseases that beset our people will be tackled. He adds that the additional college seats will not cost money, because education is .technically free.! Then why do colleges take lakhs in capitation fees?

Doctors working in rural areas do not need the wisdom of their city counterparts to tell them how to deliver health. Daily power cuts of 4 to 12 hours, untrained staff, scarcity of equipment, drugs and oxygen are obstacles that rural doctors face every day. Add to this unfair government laws about blood banks, hospital equipment and trained staff, and it is very difficult to deliver good medical care in villages. I speak from my own experience and that of my colleagues. I have performed all major surgeries during my career (including 76 gun-shot wounds in Bihar) with the help of so-called untrained staff who learnt by in-house training.

As per the law, it is mandatory for any hospital giving blood transfusions to have a blood bank, with air-conditioned rooms, highly qualified staff and expensive equipment. Few rural hospitals can afford it. And with daily power cuts, it would be a hazard. Instead rural doctors resort to unbanked direct blood transfusion, which is the giving of fresh blood, after following all the WHO rules mandatory for safe transfusion. We do it in defiance of an unjust law. Why is it illegal to save a life? If rural doctors did not give blood transfusions, the mortality rate in villages
would increase manifold.

The frustration we rural doctors face was one reason for forming the Association of Rural Surgeons of India in 1992. It has 500 members from all over the country and holds annual conferences to exchange ideas and experiences. They are more useful and stimulating than the farce of specialists. medical conferences in five-star hotels, sponsored by the drug industry. I could give you a story every month for the next five years of marvellous work being done in rural India.

Dr Shetty.s enthusiasm for the Yashaswani insurance scheme in Karnataka is misplaced. First, it is beneficial only to the landed (you have to possess at least half an acre to enrol). Rich farmers are likely to avail themselves of the scheme. Many hospitals which joined the scheme and performed free surgeries were not paid by the government. And how much will it cost to actually collect Rs 10 as insurance coverage from every farmer? Dr Shetty rightly says that the medical lobby is very powerful. I would put it differently. We are a strong minority who have failed to use our voice for the good of the people whose health is in our hands. We protest only for selfish reasons like a pay-hike or more medical seats.This would be justified if we showed equal concern for the appalling health problems besetting people.

If Dr Shetty truly aspires to make an impact on the nation.s health, he should couple his organisational skills with wisdom garnered from those with experience. He should work towards providing clean drinking water, hygienic latrines, healthy food and clean air to every citizen. Any doctor worth her or his stethoscope knows that our health lies in these simple requirements and not in telemedicine and (for God.s sake) not in more doctors perpetuating the same madness.

(The writer, a novelist and surgeon, has spent most of her working life in rural India. Her latest novel,.The Hills of Angheri. is about a village surgeon)

My Comments: Dr. Kaveri Nambisan might have been harsh on Dr. Devi Shetty on certain statements that he made, of course in a different context that Shekhar Gupta made - in the wake of the Reservations Issue, but the point on telemedicine or for that matter Health Insurance Schemes - is bang on target.

Telemedicine or Health Insurance Schemes claim to be a "BY-PASS" route for bettering the health of the rural population - but certainly the BY-PASS route cannot be the way forward for a country's better health. The claim of whether they are a By Pass route can itself be questioned.


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