Within 24 hours of each other, the media had reported two ghastly incidents which have probably faded from public memory by the time this appears in print. However the ramifications of these incidents are such that we would be well advised to be fully aware of the implications.
In the first incident, a 15-day-old baby stopped breast feeding and was crying continuously. She was taken to a quack who branded the baby on the stomach with a hot bangle. The baby died a few days later from the resultant severe infection at the Nabarangpur District Hospital in Odisha. In the second incident, three young girls at the S.V.S.YOGA and Naturopathy Medical College at Villupuram in Tamil Nadu committed suicide by jumping into a well following harassment by the management who were demanding exorbitant fees in addition to the Rs 7-8 lakhs paid for admission. Linking these two incidents is the whole spectrum of quackery; the first demonstrates the damage a quack can do to human life, and the second illustrates the existing illegal infrastructure that churns out quacks with the connivance of our “leaders”.
Branding in Goa has mercifully faded out though I still see numerous patients with coincidental telltale scars on their forearms or calves inflicted to supposedly cure jaundice. Education and awareness has improved sanitation and reduced the incidence of hepatitis that caused the jaundice. The Odisha incident occurred in one of the poorest tribal districts of the country, with little or no regulatory mechanisms in place. Attempts to reign in quacks, is thwarted by political patronage which ensures that they get away, as happened in Goa a few years back. Politicians are also involved in the running of dubious “medical” colleges which churn out “graduates” with little or no training in allopathy.
Of the 422 recognized medical colleges in India, 224 or 53% are in private hands, invariably with direct involvement or the “blessings” of politicians. With every cycle of admissions for undergraduate and post-graduate courses, an estimated Rs 12, 000 crores changes hands, most of which is unaccounted for. Institutions have the temerity to even advertise the sale of such seats without attracting punitive action. “Entrance examinations” are a farce. Attempts to create a central common entrance examination (NEET) are fiercely resisted by vested interests. Inspections are an even bigger joke. The SVS College where the three girls committed suicide was recently “inspected” by officials of the Dr. MGR Medical University and given a clean chit. Even as you read this, there are telephone numbers available of fixers who can arrange ghost faculty for such medical colleges. One can earn anywhere between Rs 50,000 to 5 lakhs for a three-day appearance all expenses paid, to pose as faculty during inspections which are meant to be surprise affairs. The rates depend on whether one poses as senior lecturer, asst. professor or HOD. The SVS College had “rooms” marked as O.T. and other such euphemistic labels; the very naming of the institution as a “medical college” was itself a fraud. At best it could be described as an institution of alternative medicine without recognition from any council for Indian systems of medicine.
Setting aside for a moment the SC definition of quacks and quackery, in practical terms they come in various shades. There are those who possess no recognized qualifications; indeed sometimes even their basic education is questionable. They flaunt “degrees” and certificates from institutions like the SVS Yoga College without any academic or official sanction. In Goa a few years ago some of these quacks were shut down following raids by the law enforcement agencies including the GMC, only to resurrect again once the heat was off. A researcher interviewed 20 such quacks in West Bengal to find out what makes them tick. Two of the various issues that came to light were that firstly, they are the darlings of the pharmaceutical companies because of the sheer volume of high-end drugs they prescribe. Secondly, there was often a healthy “understanding” between quacks and qualified specialists by way of kickbacks for referred patients. I have yet to come across any pathologist or radiologist refusing to carry out an investigation because it was requested by any unqualified quack.
Then there are those who are qualified in a system of medicine from the AYUSH stream, who then claim expertise in the allopathic system. This is described as cross practice and declared illegal by the SC. In my opinion it still falls within the realms of quackery in commonsense usage of the term, because a quack is also defined “a person who does not have knowledge of a particular system of medicine but practices in that system.”
India is short of 600,000 doctors. The average government allopathic doctor patient ratio is estimated to be 1:11528. There are about four times the numbers of doctors in urban areas compared to rural districts. This situation is predicted to continue at least till 2020 largely as a result of the budget allocation of a puny 0.8-1.2% of GDP. The disparity can be rectified by simply improving the working conditions in the rural areas and villages, as Kerala did. Instead, the authorities chose to abdicate their responsibilities in a short-sighted and misguided venture using the NRHM program to bring AYUSH practitioners into the mainstream of healthcare. This ignores the stark differences in the philosophies of the various systems. Some states have even legislated to permit AYUSH practitioners prescribe allopathic drugs thereby giving legal sanction to cross practice. Compounding this is the growing practice of corporate allopathic hospitals employing AYUSH practitioners as RMOs in defiance of the SC directives, and ignoring the inherent risks, on the grounds that they perform under the directions of the specialists. The real reason being that qualified personnel are expensive.
In short, healthcare in India is headed for a period of tremendous confusion from shortsighted, ill-advised and half-baked measures proposed by the government.
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member,
Executive Committee, Goa Medical Council.)
