Some years back the Manmohan Singh government tried making rural postings mandatory for MBBS graduates, but the proposal was killed after opposition from doctors and medical students. The current government is mulling offering incentives for doctors to work in villages, which too might not produce the desired results. Often in the general public's eyes, that translates into opinions like "doctors always shirk their social responsibilities", or "it is so cruel of doctors to let our rural folk suffer." This is sad logic, and it is about time the intricacies of the whole issue were properly communicated to the public.
"Send doctors to villages" is the splendidly preposterous yet most commonly proffered answer to the burning socio-political question: How to ensure good quality healthcare in villages? A character aptly said in 3 Idiots that people often need to be shown "demos", and that is what I will try here. Using instances from some popular films, I will attempt to explain why exactly, in current circumstances, the knee-jerk "send doctors to villages" is an ineffective solution to rural healthcare challenges.
Things will be far more productive medically if, like good old Thakur, those who fund and administer rural health centres are highly committed and financially generous.
In Sholay, Jai and Veeru are sent to a village to fight wicked goons. What if they had received no financial or material support, no ammunition, and no strategic inputs from Thakur, and were made to fight with just their bare hands? Obviously Gabbar's men would have routed them (there was no Rajnikanth back then). The way the public health system in most Indian villages currently exists, asking doctors to run rural health centres is akin to that. Doctors too are no Rajnikanths.
Since our governments (central and state) make only miserly investments in rural health systems, there are regular stock-outs of everything from syringes to medicines to gloves to disinfectants, to add to already inadequate infrastructure. Asking well-qualified doctors to work in such a system not only doesn't cause any significant improvement in people's health, but also wastes doctors' education and skills. Things will be far more productive medically if, like good old Thakur, those who fund and administer rural health centres are highly committed and financially generous. Our governments, sadly, have yet to reach that state.
Jurassic Park showed how putting an extinct past in intimate contact with the present is foolish and potentially dangerous. Specialization in medical and surgical fields has reached pretty advanced sophistication, but the kinds of facilities, equipment and infrastructure (and even salaries) that the government provides specialists in non-urban settings still belong to an "extinct past". No wonder the most important personnel shortage rural areas face is a shortage of specialists -- surgeons, paediatricians, obstetricians, etc.
In many community health centres and district hospitals, for example, surgeons frequently cannot operate because surgical and radiological facilities are not modernized, and obstetricians are often compelled to refer patients elsewhere (generally expensive private hospitals) because modern facilities for neonatal care, emergency C-sections and blood transfusion are absent. Ironically, specialists in rural areas often end up looking at general ailments like common cold and backache, thus wasting their rare skills. Bringing specialist doctors to rural health centres is meaningless unless the administration makes concrete efforts (and not the usual Bharat sarkari half-baked ones) to upgrade those centres.
Contrary to popular perception, there are actually many doctors who desire to work in villages. They study hard, graduate from good medical colleges, ignore lucrative urban opportunities, follow their passion to serve underprivileged people, and migrate to a village despite opposition from friends and family. Then, just like in the second half of Sairat, reality strikes.
With respect to culture and sociopolitical context, most Indian villages and towns range from annoying to frankly dangerous for doctors (like for the young lovers of Sairat).
With respect to culture and sociopolitical context, most Indian villages and towns range from annoying to frankly dangerous for doctors (like for the young lovers of Sairat). Corruption and irrationality are rife, and so is political interference in doctors' duties. Often the consequences of not toeing the lines of local politicians are terrible. Besides, being a doctor in remote villages can be pretty devastating personally, what with frequent unprofessional demands from villagers and local goons, and scant support from the government. No wonder many young doctors equate compulsory rural posting requirements to administrative torture.
When Simran implores her father to let her go on a Europe tour, perhaps her last chance ever to do something like that, our heart goes out to her. We know how important friends and fun and frivolity are in life, especially at that age. Sadly we, and our entire health system, tend to ignore this when it comes to young doctors. In India, an individual enters medical education in late teenage (ages 18-19), and generally exits in late young adulthood. Life changes drastically for most, and hobbies, travel, etc take a backseat. The pressures of colossal readings, of rote-learning-dependent exams, and of a training culture characterized by horizontal violence, all make the realization of DDLJ's jee le apni zindagi mantra perpetually evasive for most doctors.
All in all, while the medical community is in no way exceptionally pro-poor or pro-rural, when it comes to the dismal state of health services in villages, the most important responsibility lies with our governments, not doctors. Sadly even the present central government has shied away from healthily investing in health. It is important for citizens to understand that for rural healthcare to improve, we first need to pressurize politicians to generously support rural health systems, instead of blaming doctors for "dodging their social responsibilities"; especially as in the latter case, citizens rarely apply the same standards to engineering and management graduates with respect to improving rural infrastructure and economy. Once robust health systems begin to thrive in villages, doctors and other health professionals will naturally follow -- and not for one-year or two-year mandatory bonds, but for much longer periods.
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