letter sent to IMA head quarters in protest of MCI proposed BRMS COURSE

From
Dr.srinivasa raju.c
JOINT SECRETARY-IMA H.Q.
CWC member ®
IMA-A.P. state.

To
The secretary general
IMA-H.Q.
DELHI.
SUB: suggestion regarding GOVT. Proposed “BRMS” course.

Respected sir,
Namaste.
These are my few observations and my humble suggestions regarding above subject.

Why we are opposing the GOVT. proposal of starting the rural BRMS Course?
What are the other viable alternatives to increase the skilled doctors to serve in the rural areas?
Why the allopathic medical education should comply with IMC act?
Is there any violation of Indian medical degrees act?
Is there any violation of right to quality health?
Is there any violation of human rights?
Is it serving the purpose?

The proposal in discussion:

Out of 2100 medical colleges in the world (71 countries) India has 300 (14%). In the last decade while the number of medical seats has doubled there has been no change in the PHC and CHC postings with 70% of them still lying vacant. Even if we increase the medical colleges to 1000 the PHC will not have doctors. So, we need a separate system” told by Dr.ketan Desai, chairman of the MCI.

A NEWLY DESIGNED MEDICAL COURSE TITLED "BACHELOR OF RURAL MEDICINE & SURGERY" HAVING THE SYLLABUS OF 13 MEDICAL SUBJECTS IN THE SPAN OF THREE AND HALF YEAR MODULAR STUDY & SIX MONTHS INTERNSHIP.
AIM:To Cater The Needs Of Basic Health Services Of Rural India,Where 70% Of Poplulation Resides and groping With Viral , Tropical , Vector Borne Diseases.
MODALITY :
1.Adapting The Existing District Hospitals Which Have 150 To 300 Bed Capacity.Enrolment Is 25 Students For 150 Beds And 50 Students For 300 Beds.
2.Enrolling The Inter / +2 Students Studied In Notified Rural Regions As Minimum Eligibility.
3.Restricting These "BRMS" Graduates To Work In Notified Rural Regions Only.
4. They Can’t Enroll In Regular Medical Registers. They Are Not Called As Doctors. They Can't Practice In Non Rural Areas. They Can’t Conduct Surgeries.
5. They will not be registered under "regular IMC register" but under a "separate register" and will need to get a yearly certification for the first five years after which they will be entitled for a permanent registration "under the rural register". For life they can only practice in a certified rural area only.
Some of the points raised in opposing this proposal are-
1. How can a doctor’s course be shorter than nurse’s course.
2. How can they be called “doctor” with a condensed course.
3. Who will be able to stop their migration to other countries.
4. How can one stop them from migrating to urban areas.
5. When the country can not check quacks how will they check migration of rural doctors to urban areas.
6. Why discriminate between rural and urban patients and give them doctors with condensed course.
7. Would it not amount to producing more quacks?
8. Will the govt. also think of bringing condensed crash degree courses for pilots, lawyers, charted accountants?
What we need to provide basic health care in rural areas apart from doctors?
Adequate infrastructure, including good roads, transport, schools, water,power supply, adequate medicines, and all types of trained nursing & paramedical staff.
What are the challenges crippling our rural health care?
1. Challenge Posed By Diseases:
2. Second challenge is financial and budgetary constraints under the economic constraints:
India Per capita health expenditure: 5000/- in 2009
and Public healthcare as percentage of GDP: 1.2 %
3. Segregation of doctors only in urban regions.-------- that the estimated density of all health workers (qualified and unqualified) in India is about 20% less than the WHO norm of 2.5 workers (doctors, nurses and midwifes) per 1000 population, meaning that there are substantial shortage of qualified health workers in the country.
4. Poverty and ill-health: The majority of illnesses Indians suffer - such as tuberculosis, respiratory infections, malaria and diarrhoeas -- are linked to poverty and poor living conditions.
5. The doctors are not interested to do service in rural areas. – Because lack of infrastructure, medicines, schools, trained nursing & paramedical staff.
The statistics on health manpower throughout India in the rural areas as published by the Ministry of Health and Family Welfare.
1. Only in 4 States - Uttar Pradesh, Maharashtra, Punjab and Assam the number of doctors are less in the PHCs and sub centers. In all other States there is surplus of doctors at the PHC level. 2. There is gross deficiency of Specialists at the Community Health Centers.
3. There is very gross deficiency of Health workers, Pharmacists and Lab Technicians.
VIOLATIONS : ITS BLATANT VIOLATION TO PROPOSE THIS TYPE OF MEDIOCRE ALLOPATHIC COURSE, as follows :
1. Violation of Article 21 of Indian Constitution which guarantees right for life for all people as serious threats would be posed upon the hapless patients of Indian villages

2. Violation of the mandatory provision in the “Medical Council Act” that no person other than a doctor having qualifications recognized by the MCI is allowed to practice Modern system of Medicine or Surgery anywhere in India;
3. Violation of the Article 14 of Indian Constitution that guarantees rights for equal treatment for all citizens of India;
· complications arise if we allow this BRMS course as follows :
The basic skill necessary for diagnosis of disease and provide minimal necessary treatment to an ailing patient cannot be compartmentalized or taught in a piece meal method. There can be no dispute that the proposed BRMS bill for a medical course of only three and half years would produce “half-baked” doctors who would be no more competent than the unlicensed “quacks” who are already practicing medicine illegally and causing needless deaths and injuries to countless number of innocent patients.

Ironically, the BRMS proposal has claimed that the medical practitioners from this abbreviated medical course would be treating patients only in the rural areas. One has to wonder how the Government would assure the new medical practitioners would be confined only in the villages and not relocate to practice medicine outside the rural India?. In any event, it is an atrocious claim by the authorities, that the half-baked medical practitioners would be utilized to treat only those patients who live in the rural areas. Such obnoxious reasoning in order to justify the substandard medical course as proposed brazenly tramples over the basic dignity for humanity and shock the conscience of ordinary people.
Do the lives of the poor villagers worth less than the lives of the city dwellers? Article 14 of the Indian Constitution provides fundamental rights for equal treatment of all citizens of India. This is clearly discriminatory against the patients in the rural areas and it violates the rights for equal protection under the law as guaranteed by the Constitution.

· The Hon’ble Supreme Court has made compelling observations as follows :
“A medical student requires grueling study and that can be done only if proper facilities are available in a medical college and the hospital attached to it has to be well equipped and the teaching faculty and doctors have to be competent enough that when a medical student comes out, he is perfect in the science of treatment of human beings and is not found wanting in any way. The country does not want half-baked medical professionals coming out of medical colleges when they did not have full facilities of teaching and were not exposed to the patients and their ailments during the course of their study…..”
Alternative suggestion to improve rural health care.
I. Raising the MBBS and PG seats by 25 % in existing medical colleges and allocating these seats exclusively to the students of notified rural regions.
Modality:
1. For the students studied in rural region with intermediate qualification through common PMT.
2. These students must work in rural areas for 10 yrs after completion of the course.
3. If they want to study higher education or research, they will be allowed only after completing 3 yrs.rural services. After completion of post graduation or research, they must have to work in rural areas for minimum 12 yrs.
4. They are not allowed to go out of the country. Not allowed to do practice/ employment in urban areas for 10 to 15 yrs.
ADVANTAGES of new suggestion:
· NO EXTRA INFRASTRUCTURE: when compared to establishing or strengthening the district hospitals with 60000 crores, it’s very much less expensive to raise the infrastructure of existing medical colleges to accommodate raised 25% seats.
· No violation of Indian medical degrees act.
· No dilution of quality health care.
· No violation of human rights- Freedom of migration to urban areas after 10 to 15 yrs. of rural service.
Suggestion II: increasing the salary and other emoluments to rural doctors from the existing Rs.25000/- to 50000/ -per month for MBBS doctors and 70000/- to specialist doctors.
Around 34,000 medical students are enrolled every year in India.
We need 1 lac basic MBBS doctors in 50000 PHC CENTERS.
We need MBBS doctors 10000 in 4000 CHC + 10000 in district hospitals + 20000 in 300 medical colleges.
* Total MBBS requirement : 140 000.
We need 25 000 specialist doctors in 4000 CHC centers.
We need another 20000 specialist doctors in 600 district hospitals.
We need 75000 clinical specialist doctors in 300 medical colleges.
We need 10000 pre & para clinical specialist doctors in 300 medical colleges.
*Total postgraduate degree doctors we need: 1 30 000.
AS PER THE IMC REGISTER WE HAVE 6 LAC DOCTORS IN INDIA.
WE NEED 1.3 LAC MBBS doctors and 1.4 PG doctors in public sector. Here we can use postgraduate diploma doctors as specialist doctors after fulfillment of certain stipulations.
So, we have to distribute the doctors evenly through the entire demographic area of our country by raising the salary and other emoluments to rural doctors.
Suggestion III : BRMS is not a solution to the need of the villagers. ASHA's and other trained nurses, midwifes, can do much more, can be trained in much more numbers to make primary healthcare more effective!
All in all, the Govt. needs to start a PINK REVOLUTION in healthcare by injecting a massive 12% of GDP in Govt healthcare system(from the measly 2% GDP)
With best regards
Dr.srinivasa raju.c
09490172569