Tuesday, April 17, 2007

Doctors for villages?

Why is nobody making any noise over this?

If you don't have the patience to read through the article, what the Government is proposing is this:

... for all new MBBS graduates to serve in a rural area for one year as a
precondition for being granted permanent registration...

It's the perfect socialist scheme. Government abdicates responsibility, puts clueless, young people on the spot by entrusting nation-building in their inexperienced hands and watches the fun while people squirm in their seats. It's a scam because our villages deserve better. It's a scam because our medical graduates deserve better than being asked to sweat their asses off, trying to clean up the Government's mess.

Here's why I think this is wrong -

1. It violates individual freedom and choice. Why should this be made compulsory? Does that not say something of its own? Why should social service be obligatory? People become doctors for their own reasons, some to save the world, some to make money. Why should the government assume that it has the right to tell doctors where to work? What next? Engineers being asked to compulsorily intern for a year, building generators and setting up communication networks in villages before they can graduate? If that's the case, why not bring in a minimum period of social service for politicians before they can contest elections? All I'm saying is leave it to the individual. He or she knows best. Starry-eyed idealism should not be forced down people's throats.

2. Why should the government have to introduce this scheme in the first place? Sixty years of fiddling around with the health-care system means (as the article says) "up to 40 per cent of the doctors posted in primary and community health centres fail to turn up". That's almost one in two. I wonder what happens when they do turn up. Maybe the patients are dead by then. Why doesn't the Government learn? It's simple labour economics. Make it worth their while. Invest money where it is needed. Establish a better network of clinics/hospitals with better equipment, hold the doctors and other paramedical staff responsible, bring accountability into the system. But no, they won't do that, they will continue to rob Peter to pay Paul, they will continue to squabble about Greg Chappell in parliament and wait for the next elections to come around. We so have our priorities in place.

3. Read this for more. You can see the situation already. Rookie doctors saddled with non-existent equipment, scratching their heads when required to make a speedy diagnosis. It's like taking someone from the junior Cricket leagues and dumping him right into the pressure-cooker scenario of a Test match. I'm not saying our medical graduates are dumb. Just that from a working knowledge of the present educational system, I'm very sceptical about their abilities to provide quality medical assistance, especially with zero experience. If anything, our villages need better doctors than our cities.

4. If you look at it from a corporate angle, our villages being customers would end up at the receiving end of very poor service. Why should they accept this scheme? Because the system is in such a sorry state they will be happy to get anything that comes their way, instead of rapping the government on the knuckles for suggesting this hare-brained scheme.

5. Why are the doctors and the medical associations keeping quiet? Why aren't they protesting? Where are all those placards and those marches? Because the medical profession is a "noble profession" and because if they say anything, they will be labelled "selfish". Damned if you do. Damned if you don't.
6. In fact the Government deserves more credit than we give it. Staffing community clinics with quality doctors and then retaining them will mean higher health-care costs and hence they can't swindle as much as they are swindling right now. So what do they do? Ensure an annual supply of low-cost personnel, who a) won't have the inclination to hold themselves accountable and b) will purely be looking forward to the end of their tenure so that they can get on with furthering their career aspirations. Brilliant solution for eliminating any worries about attrition.
7. And why is The Hindu sucking up to this scheme by calling it "commendable"? Later on in the article, there is a mention about the real problems, which are, to admit, quite obvious. So why isn't this scheme being judged in the face of these serious issues? But no, it talks about "systems in place for the graduates who are thus posted, not only to widen but also sharpen their knowledge and skillset through programmes for professional enhancement and continuing medical education." But of course! The Government would be very keen to do that now, won't it? I used to wonder why people called The Hindu "Leftist". I understand fully now. As a so-called "responsible newspaper" why is it not taking the opportunity to slam the government for taking the easy way out? Cop-out, if you ask me. Both government and media.
And then people ask me why I don't read newspapers.
Ignorance is bliss.
Update -
I'm posting my arguments on some positions as an update. Counter arguments can be posted on blogs and a link left in the comments here, or can be emailed (find email id on my profile page).
  1. The subsidy argument - "Government subsidizes medical education, so it has the right to force Doctors into one year of service in the rural areas". Assuming that a subsidy gives the Government the right to force the one-year stint, the radical free market stance would be to ask for zero subsidies and indulge in "richest will survive" rhetoric. Since that is not practical (India having a lot of poor people), I'm suggesting three things - a) Give a loan to cover the existing subsidy, b) Give students the chance to decide whether they want their education to be subsidized or not. That way, students who choose the subsidized education also agree to serve the one-year term, c) Provide the subsidy based on economic status, so that the students from the lower income groups get cheaper education and also serve the one-year stint.
  2. The one-year term is an additional subject/ It is just like an internship - I have problems with this on many fronts. First, the motive. That such an internship will provide valuable education is a baseless and flawed assumption. Is there any concrete evidence for this? Has a study been conducted by any medical education board to say such a stint will add value? No. On the other hand, given the existing facilities and the current educational scenario (as evidenced by the article from The Telegraph), it won't be wrong to say that any education that such a stint might provide would be of lesser value than one pursued by a doctor on his/ her own. So, there is no evidence to suggest that this stint will be a good "subject" to add to the syllabus and moreover, the Government does not have the authority to unilaterally add such a "subject". The motive is not one of education and learning, but to somehow tide over a problem, caused by the ineffectiveness of the Government, with cheap labour. Second, internships are again choice-based. The student decides where to do the internship. He/ She has the freedom to make that choice. As far as I know, no institute demands that internships should be done only at a place of their choice. Third, assuming that it is a valid additional subject and that it is just an internship and that it's good training, why make it compulsory? Why not make it optional? Fourth, the proposal (thus far) is for the freshers to work, with very little guidance. How can one call this a "subject" or an "internship"? Again, this argument simply doesn't make sense.
  3. Lassitude/ shirking responsibility - In a democracy, one has the right to employment, consequently the right to voluntary unemployment, and education. It is morally wrong, in a democratic public domain, to deny someone education, and hence discriminate against them, just because he/ she doesn't want to work. If a doctor doesn't want to treat a patient, it is still his/ her individual choice, one with negative consequences. You simply can't deny him/ her that right. You can't force them to treat patients. I will defend their right to not treat a patient but I will condemn their actions and insist that they pay the necessary penalty. That's the whole point of liberalism! And what is this about shirking responsibility? If at all anybody is shirking responsibility, it is the government! You elect a government, pay taxes to keep it running (which includes providing health-care to the rural areas) but you find it is not doing its job properly. So what do you do? You don't pull up the people concerned, you don't take them to task, you don't file RTI applications to find out where the money went, you don't ask why doctors don't turn up for work, you don't ask why facilities -- for which money was sanctioned -- are non-existent. You don't realize that the price of freedom is eternal vigilance. No sir, you won't do that. What will you do? Suggest that stringent measures be introduced for certain professions, including forcing unwilling doctors to serve a year in god-forsaken places. Brilliant. Heck, why have a government in place at all! Might as well run the country ourselves. In my opinion, the well-to-do citizens of this country are being sent on a guilt trip. People find they are doing well in life because of their own efforts but are being made to feel guilty about not doing enough for the country (what with movies like RDB). And what do they do? Instead of being active citizens participating in governance and making use of the RTI Act (which in my limited experience of working with it has yielded amazing results), they support such schemes. Why? Because, hey, participative governance and the RTI Act are just too much work and not as cool as asking doctors to sacrifice a year of their lives. Why be intelligent with my actions when I can be stupid with my sacrifices? Might as well support this scheme, go easy on individual rights and feel I'm patriotic. My stance is this: the citizens should focus on repairing the existing system, which can work provided the bureaucratic hassles and corruption are removed. We need to make sure that all has been done and the system is still not working before going around begging for people to spare some time for their country. Even then, it will have to be of their choice.
  4. This is an experiment and can be judged only after it's been tried out - If the motive is just to see if it works, why make it compulsory? Make it optional. I'm sure there will be certain service-minded doctors who would want to give it a try. We can still judge the concept by keeping it optional. I don't see the logical connection between judging this scheme as an experiment and making it compulsory.
  5. We are disgruntled anyway/ Choice and freedom are mirages - (Personally, being a participant in an almost free-market, my actions have been directed towards optimizing my happiness, and I'm happy with where I am) Even if choice is a mirage, I make that decision to consider choice a mirage. I choose to believe in that. Someone else can't tell me "hey, choice is an illusion, so you might as well come and work for me for minimum wage". And even if people are disgruntled, they have the right to choose to be disgruntled. Nobody else can force them into a choice they are disgruntled with.
  6. A couple of instances of strawman fallacies about how I'm advocating privatization of the health-care system make me reiterate my stance: I'm NOT asking for privatization of health-care. I'm purely asking for the Government to own up to its failure, clean up its act and restore the system to what it should have been in the first place.

Friday, April 06, 2007


Will you remember these minutes whiled away at the crossroads, amidst the melting tension of traffic? Will you remember waiting for the lights to turn favourable, surrounded by the futile rhythm of idling engines, choking us with the exhaust smoke of wasted time?
Will we remember this claustrophobic interval, spent silently navigating the schizophrenic hemispheres of our minds, confronting the abrupt ebb in the ambition of our journeys, contemplating destiny while it evaporates like fuel from the alkaline river beds of our lives?
Will you remember this agonizing countdown towards the resumption of motion and the comforting continuation of our obsession with petty notions?
Will our lives become less ordinary? Will we stop having to squeeze enthusiasm from the pores of our dried up souls? Will we ever ride out with hope singing in our hearts? Will we play slalom with the lane-markers?
Or will you continue to stand and gape while life passes by in the opposite direction, forever? Will you have the courage to turn off the ignition and reassess the shape of your destination? Are miles more important than milestones? Or is it the other way around?
Will you remember revelling in the paralysis that lack of self-belief is? Will you at least concede that you chose to not choose and that the choice picked you?
Or will you, when you see green, shed all these thoughts like uncomfortable clothing and drive away, spiritually naked in the searchlight of your fraudulent existence? And how much longer can you live like a chameleon, alternating identities between hopeful romantic and caustic cynic?