Kerala   

Diagnosis and prescription for health care

— Photo: S. Mahinsha

Symptoms of weakness: Patients queueing up for tickets at Chittar Primary Health Centre in Pathanamthitta.

Catch them young

As a Plus Two student, I feel that the root of all these problems lies in our educational system. The students are locked up in a world of school and entrance coaching during the most crucial years of their life. Although one may find an excuse saying that all the buzz is only for two years, these two years are of utmost importance in one’s life and most of the opinion formation takes place during this period.

The students fail to take note of social issues and problems such as backwardness in the rural health-care system and the dearth in the number of doctors in the sector, because the time they spent for reading newspapers and journals is very little. The end result is a generation of doctors probing the pockets of the super-rich and willing to serve only in metros.

The key to solving these problems is the restructuring of our educational system. Let students from all sections of society study together. Care should also be taken to encourage rural youth to enter the fold as doctors since they are the ones most likely to face and sort out the problems in the right manner.

Balu G. Nair

Guruvayur

If we analyse the situation over the past 10 years carefully, there has been a steady exodus of doctors trained in Kerala medical colleges to the U.S., U.K., and Australia. The reason is quite simple: money. Doctors in the West are paid something like $4,000 a month during their residency (PG) training. This translates to roughly Rs.1,60,000 a month. Compare this with the stipend of Rs.10,000 that Government doctors get during PG. When India pays IT professionals salaries like Rs.7 lakh to Rs.10 lakh per annum and B.Com. graduates get a pay of Rs.25,000 a month, is it any surprise why no doctor wants to stay in India?

Doctors are very poorly paid because in successive budgets both Central and Kerala Governments sanction very little money for health care. The result is poor pay for doctors and pathetic infrastructure in Government hospitals. Only if the budget allocation for health is increased can we provide better facilities for poor patients and also give more salary to Government doctors. The salary for all PG doctors should be a minimum of Rs.40,000 a month.

Let us not forget that there are some consultants in Kerala who earn up to Rs.5 lakh a month in the private sector!

Dr. Joseph Kunnirickal

Kochi

Compulsory rural service for at least one year for all MBBS/PG (Medicine) students in Government medical colleges has been in practice for the last few years. But rural bond is not applicable to those who secure seat in medical colleges under all-India quota.

Now the Union Health Ministry is toying with the idea of making rural service for at least one year applicable to students coming under all-India quota, besides executing a bond to that effect. Now the students from the state list are executing a bond for rural service at the time of admission.

In Kerala there are seven self-financing medical colleges and two medical colleges in the cooperative sector. All these colleges are functioning under the control of the Medical Council of India and the universities concerned. The Government may make it compulsory for all the students of these medical colleges also to execute a band for rural service as a condition precedent to admission. In that case, the shortage of doctors in Government health-care institutions can be remedied.

V.P. Ramesan

Thripunithara

A useful reform will be to include a stint of rural service before award of the basic degree. Such service can be compulsory towards obtaining the degree, credited with marks, and rewarded with attractive stipends/salaries and all reasonable perquisites.

Obviously, ‘service first degree later’ will give better results than the other way round. The existing provision for ‘community medicine’ may be suitably augmented to accommodate this additional activity.

A related issue, if the idea can be implemented, is whether all doctors, training or trained, can be economically and conveniently utilised by the programme.

Also, focus on rural health will mean improving the condition of PHCs and reviving the old institution of the ‘family doctor.’ If this improvement is made possible, specialists can be where they need to be; in specialty centres where those needing them may be referred to.

Devraj Sambasivan

Alappuzha

There are so many reasons which persuade doctors to seek jobs in private hospitals in India and abroad. Inadequate facilities in Government quarters is one. One of my friends, a Government doctor, had a bitter experience. A mad stray dog entered his quarters and bit his three-year-old daughter. Now he is working in a private hospital where he is provided with all amenities. A doctor is a doctor. He has studied hard and there is no substitute for his hard work.

Apart from making some things compulsory for doctors, the Government machinery must improve. The doctors must feel like working in a Government hospital. A private hospital is the place for a just doctor to work under an unjust Government. The poor conditions of the Government hospitals keep the doctors away.

Sujith M.S.

Kothamangalam

Government has introduced new schemes in rural areas to improve the health of people. It seems to be a very good plan. But while examining recent events, we’ll come to the conclusion that lack of doctors was not the main cause of the increased death rate; there are so many unnoticed factors behind it.

Preventing diseases is better than curing them. Creating a healthy background can resist the entry of many diseases. The recent outbreak of diseases like chikunguniya, dengue fever, etc. is the result of an unhealthy environment. Bring out new schemes to create a healthy background not only for today but also for tomorrow.

Rural people are going to doctors only in the last stage of diseases. Some others do ‘self treatment.’ These activities have to be stopped by providing necessary knowledge. Researches have to be made to find new medicines, preventives, etc. Government has to look into the fact that medicines that go to villages are often old stock. Good facilities have to be provided to rural people. Like this, there are many unnoticed but serious factors which Keralites ignore; not because of lack of knowledge, but because of their attitude.

Meera M.L.

Thiruvananthapuram

Many private hospitals in the city are liberal in hiking the salaries and perks of doctors of all grades whether they are retired or youngsters. The cost of treatment in these hospitals is equally heavy. Many patients think that the treatment is good when the charges are heavy, with the result that many people who love their lives prefer to go to private hospitals whatever be the seriousness of the disease.

The managements of these hospitals provide all sorts of facilities and this is the reason doctors are committed to private hospitals.

It is not enough to have doctors and other para-medical staffs without adequate equipment and other facilities to perform their duties as physicians and surgeons. Many rural hospitals do not have even the minimum infrastructure.

The lack of schools to educate their children and lack of recreational facilities are constraints in rural areas. Unless panchayats and other self-governing institutions provide these facilities on par with urban areas, doctors will not be attracted to rural service even in violation of government rules. What is basically required is to provide educational and recreational facilities commensurate with their education and standard of life.

K.P. Karunakaran Nair

Thiruvananthapuram

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