Opinion - Letters to the Editor   

Rural service

The Government's decision to make it compulsory for new MBBS graduates to serve in a rural area for one year (editorial "Doctors for the villages," April 17) is laudable. But most MBBS graduates may not have the necessary skills to manage the surgical and obstetric emergencies in the rural setting. As most medical colleges rely on sophisticated technology and expensive laboratory tests to diagnose common conditions and practical clinical exposure during internship is limited to drawing blood samples, fresh graduates are likely to feel grossly inadequate in villages. It would be appropriate to conduct an orientation course aimed at equipping them in emergency care before posting them to rural areas.

Dr. Susheel Oommen,
New Delhi

* * *

Graduates passing out of infrastructure-laden environs of medical colleges will find it hard to work in rural health centres where a sphygmomanometer may be a rare commodity. A young enthusiastic doctor will end up feeling frustrated.

Also, what is wrong in doctors seeking competent salaries and regular jobs after spending the prime of their life acquiring skills? Why do politicians and bureaucrats expect doctors to work in the toughest of areas at oddest of hours but not seek any gains? How often do we see engineers posted in inferior set-ups? Will the Government make it mandatory for IIT graduates to stay back and serve the country?

Dr. Harsh Chopra,
Chandigarh

* * *

Wielding the stick is not a healthy way to bring about change. Doctors will go to the rural areas reluctantly. Many will try their best to shirk the postings (fall sick, prepare for other examinations, etc.). Instead, incentives such as preference to doctors who take up rural postings for a year in admissions to higher studies, priority in scholarships, commendation certificate from the MCI and the like will attract the right kind of doctors to work in the villages.

D. Gopal,
Bangalore

* * *

It is only fair that a year or two of a doctor's service be set apart for the rural population. But fresh graduates are ill-equipped to do the job in primary health centres where one has to diagnose on the basis of clinical observation, often without laboratory investigations. Instead, the graduates should be drafted in secondary health centres and taluk hospitals under the guidance of a senior doctor for a year. That will equip them for useful rural service for another year.

Dr. M.J. Kuruvilla,
Kochi

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It is the failure of governments to provide basic healthcare that is being camouflaged as the outcome of doctors' selfishness.

Dr. S. Rajesh,
Tiruchi

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Huge public funds are spent on doctors. They must, therefore, be compelled to serve our people even if they are reluctant. This is an economic obligation, not just a moral one. But while sending fresh graduates with minimum experience to rural areas may be good training for doctors, is it good for the villagers?

In his widely regarded book Medical Nemesis, Ivan Illich presciently says: "the medical establishment has become a major threat to health." Until there is universal access to health insurance provided by the state, even building a hospital in every village will not bring about better healthcare.

Dr. Prem Chandran John,
Chennai

* * *

Generally, doctors posted in primary and community health centres lack the commitment to serve. Since the stipulated tenure is only one year and new doctors will be posted every year, I think the level of frustration will be low.

M. Aruna Sahithi,
Hyderabad

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