Author: amkr

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The proposal for compulsory rural service by graduating medicos has long been in the pipeline. It is already being implemented by some states with variety of carrots and sticks attached. In a move by the parliament all newly minted doctors will be required to spend one year in rural areas in compulsory manner. They will not be accompanied by any support staff as per the proposal. Students are certainly not happy about it

“How can you extend the already long five-and-half-year tenure of the course? With this one-year mandatory rural service and the post-graduation after that, the total medical education becomes of nearly 11 years,” said Anil Sharma, spokesman of the resident doctors’ association (RDA) of AIIMS.

One thing I can say for sure- the amount of ill will in general population towards medicos is increasing. Do your think the targeted population will be benefited? I wouldn’t bet on it. forum discussion at IBN

As for our esteemed Minister- this is what he had to say

“the MBBS degree was not being extended by a year. The students were only being asked to do a year of rural service.”

“This is not a new scheme, as compulsory rural service was in force in the country 30 years ago. Even now, this is in practice in states like Kerala and Maharashtra. This will be only a temporary scheme for a few years to bring down the infant and maternal mortality rates in rural areas”

It is not just the health minister who is of this opinion. Even the mandarins at the planning commission see medicos as cheap plug for the gaping hole that health services is in India; especially in rural areas. In trying to make amends they plan to offer Medicos as the sacrificial goat at the electoral altar. So what do the esteemed gentlemen (&ladies)  propose? well-

The Planning Commission has made a strong case to make a few years of public service compulsory for all graduates from government medical colleges.

This should be at least three years, the apex planning body has recommended in the draft Eleventh Plan that aims to improve government’s health care services to the public.

The idea is to enable students who get state-subsidised education to contribute to the society by serving the tax payer for a few years. The Commission has also recommended that the pay structure of doctors should be improved. read the news here

You might notice that the proposed posting is just for students from government medical colleges. I am sure that the rules will be tweaked in future to include those passing out from private colleges and also provide an escape route for “political proteges.” It will be further tweaked to ensure that the brightest and the most selfless suffer the most.

The commission further notes –

Sources said quoting various national sample surveys that people do not go to public health facilities because medical and para-medical staff, diagnostic services and medicines are not available there. The scene is pathetic in some states. As per a recent government survey, Bihar and Jharkhand have just 0.48 health care professionals per 1,000 people, while the norm is 2.25/1,000 people.

I mean they had to do a sample survey for that! Any medical student knows that the country has been unable to achieve goals for public health set 60 years back!

update I see that the issue has already been well covered by catscanman

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Sometime back a patient presented in emergency with complaint of bleeding from an ulcer in breast and severe backache. As is typical she was referred from community health center in nearby town coming to us at 2:00 A.M. She appeared not to be worried about the lump in her breast or the multiple swellings in her axilla and other areas in her body ( she had metastasis and satellite nodules as well) but about the bleed from her ulcer. The surprising thing was that she is from well to do family and quite educated. In fact she did consult a doctor three years back who had advised mammogram and FNAC which had been inconclusive. She was asked to undergo a biopsy which she found bothersome and turned to home remedies/ ayurveda/ unani for treatment till now.

The sad part is that even her relatives are under the impression that she is fine. Her appetite is good; hasn’t lost weight hence must be healthy. “Doctor just give her some glucose (i.v. fluids) and blood and she will be fine” is what they say.

This is not the first time i have seen case of terminal cancer, but to go this way without trying is sad.

In our hospital (and i suppose in India in general) a large proportion of patients of Breast cancer present very late in the disease process. Mostly this is due to lack of awareness and access to medical facilities. The patients comes to the doctor only when the lump or discharge is noticed by friend or family member and forced to seek medical care. there is astonishing amount of ignorance and shame associated with the disease. This is the case not just in cancer but even more so in gynecological malignancies. I find patients are much more prompt in seeking care for abdominal or respiratory complaints.

According to the latest ORG survey Diclofenac painkiller brand Voveran is the most used drug in India displacing cough medications which till now were the topmost brand. This has already been the trend in other markets. One not so surprising drug in the topmost brand is Liv 52 an ayurvedic preparation from Himalaya. As reported in the Times of India.

Last year, cough syrup Phensydyl marketed by Nicholas Piramal, was the top brand, followed by another cough syrup Corex. The second largest brand for the January-July period is Corex (Pfizer), followed by ayurvedic liver tonic Liv-52 (Himalaya), anti-diabetic Human Mixtard (Abbott) and lastly, Phensydyl.

Industry experts attribute the spurt in sales of Voveran due to rise in viral fever this year. Doctors often prescribe pain medications to address bodyache, a common phenomenon of viral infections.

Last year, growth in therapeutic segments such as anti-infectives was robust on the backdrop of episodes like chikungunya, scares of bird flu and dengue, while this year cases of viral infections have been more rampant.

I think this trend will continue. As for the use of ayurvedic preparations like candy by allopathic practitioners the less said the better..

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