More doctors Ok; but we need more para-medical staff too

Considering that India ranks 67th in the doctor-population ratio among developing countries, (we have one doctor for every 2,000 patients ) this announcement can be welcomed as good news indeed. But, the MCI has failed to comprehend that a sprawling country such as ours with a population of over 1.2 billion needs a 1000-fold output of paramedical persons also who can treat ordinary ailments in primary health care centres rather than mere highly specialised doctors in rare disciplines.

According to the Centre's new liberalised policy regarding admission to post graduate studies in medicine, we will see medical colleges churning out more and more specialists who will not serve the nation’s interests even if they choose not to emigrate to other more developed countries which will probably be their preference.

The Rs1,350 crore expenditure planned to upgrade government medical colleges for this purpose is not in the country’s interest. We are training medical specialists in several disciplines at great cost to serve the interests of developed countries like the UK and USA which are the final destinations for them.

The Medical Council of India would do well to advise the Centre to strengthen other supporting medical disciplines such as nursing, pathology, physiotheraoy, occupational therapy and paramedics to serve the country’s interests first. Unless there a simultaneous output of specialists in such supporting disciplines, merely producing more specialised doctors will not be a tenable proposition.

Take the case of doctors and nurses. Can any doctor or hospital function effectively without a strong and competent nursing staff? Can a highly qualified surgeon operate successfully without the support of a team of nurses and anaesthesiologists? Or, can an orthopaedic surgeon do without a physiotherapist to complete his treatment?

Yet, the best of hospitals are deficient in these areas, especially in nursing care without which all other specialised treatment becomes a farce. As for government hospitals where nursing care is a myth, the situation is bleak.

Miserable nurse-patient ratio
With just 3.72 lakh nurses in the country, the nurse-patient ratio is a miserable 1:3,000. Whereas, according to medical norms, the ratio should be 1:1 in an operating theatre, 1:2 in an intensive care unit and 1:5 in a hospital ward. It is not that the state has not earmarked funds to train nurses. India can boast of thousands of nursing colleges which produce qualified nurses every year. But, even here, many of them are lured to richer countries after making use of their training here. India is said to be the largest exporter of nurses to the developed world! A truly sorry state of affairs.

The MCI and the Centre should devise ways to retain these trained persons who have cost the exchequer money for their training. If India’s ranking is 67th among 133 developing countries with regard to the doctor-patient ratio, her ranking with regard to nurses and doctors is a dismal 75th. Although we have nearly four lakh nurses in the country today, that still makes it one nurse for every 3,000 patients!

Just as it has been proved that there should be three technicians for every engineer we produce, there should be at least two nurses for every doctor we create. Unless this ratio is maintained, the medical profession will suffer in the long run. Even as the MCI sanctions more and more medical seats, it should increase the number of nursing institutions and make it mandarory for its alumni to serve in their own country first before emigrating to developed ones.

In order to do this however, it is necessary to provide sufficient incentives to motivate the qualified nurses to stay back. Nursing is largely a thankless profession in India in the present context. Meagre salaries added to uncertain working conditions added to inherent job risks, make nursing an unattractive career. The same applies to other paramedical professions.

Unless the government upgrades these professions and brings them on par with the medical profession itself, things will not improve. After all, the larger population needs these paramedics more than the super speciality doctors.

It cannot be reiterated enough that the MCI should revive the LMP (licentiated medical pro) diploma course in medical colleges. Students who cannot afford that prohibitively expensive medical seat but who have the aptitude to practise medicine will get an opportunity to take up a profession that will be used and appreciated by the vast majority in the country.

The LMP doctor should be a respected member of the fraternity, as it was at one time. He should be the one whom patients will seek for their day-to-day ailments.