For Reya Sharma Thakur, her Dibrugarh home, with its quiet moments, has been a refuge in the past few days. But when she thinks back to the days leading up to March 3, she feels uneasy.
“I try not to think about it,” she says.
Reya is a second year medical student at Vinnitsia National Pirogov Memorial Medical University in Ukraine. And as the war broke out, she says, several students stayed back after the dean of her college assured them that no harm would come to the students. Once the hostilities began, they made their way to the Romanian border. An eight-hour bus journey followed by a 13-kilometre trek amidst snow and shelling led them to the border.
“To cross a length of 10 metres, we stood in the biting cold for two days,” she recalls.
The harrowing experience has shaken her.
Reya is one among 18,095 students who were suddenly out of college as hostilities by Russian soldiers in Ukraine began. A majority of these students study medicine. As Indian authorities scramble to bring them back home safely, there is a renewed focus on the phenomena of Indian students heading to countries in East Europe for a medical degree.
Czech Republic, Romania, Hungary, Nepal, China, and in some cases Kyrgyzstan are some countries that students head to.
At a webinar on February 26, Prime Minister Narendra Modi wondered why Indian students were going to “small countries for study, especially in medical education”.
“Our children today are going to small countries to study, especially in medical education. Language is a problem there. They are still going… Can our private sector not enter this field in a big way? Can our state governments not frame good policies for land allotment regarding this?” he said.
So why do Indian students head to countries which are not the usual preferred destinations to study medicine?
The answer, experts as well as students say, is money — the difference in the cost of a medical degree in these countries — as well as the paucity of medical seats in India.
In India, a medical degree in a private college can cost anywhere between Rs 30 lakh and upwards of Rs 1 crore for a four-year degree. In countries like Ukraine, Russia and China, it costs a fraction of this. A six-year course costs between Rs 10 and Rs 35 lakh.
It was the affordable cost of a medical degree that led Sneha Issac to move from Kochi all the way to the Bukovinian State Medical University in Chernivtsi in 2017. In the fifth year of her six-year course, Sneha left for the Romanian border 40 km away on February 25, a day after the war broke out.
She considers herself lucky, as she did not have to face any difficulty in reaching India.
Dr Shiv Kumar Sarin, Director of the Institute of Liver and Biliary Sciences, who has previously served as the Chairman of the Board of Governors of the Medical Council of India (now known as the National Medical Commission) says that the lack of seats in medical colleges in India is one of the primary reasons for this trend.
“Every seat in a medical college in India has 16 or more aspirants vying for it. Passing the tough entrance exam is not enough, you will have to be good enough to get into a good college,” Dr Sarin says.
In 2021, 16 lakh students appeared for the National Eligibility cum Entrance Test - NEET (Undergraduate) for 90,000 seats across government and private colleges in India. Of these, just over half the students (8.7 lakh) made the cut.
Students who have scored above 50 percentile in the NEET are technically eligible to apply to colleges in India. In reality, the cut-off percentage for Indian medical seats is much higher. But the eligibility also lets them apply to courses in other countries. Since 2018, NEET has been made mandatory for students seeking admission abroad.
Former All India Institute of Medical Sciences (AIIMS) Director Dr RC Mishra says that since there are so many aspirants in India, NEET is a “process of elimination, not of selection.”
In India, unlike in the US or UK where anyone can appear for a medical course, the NEET serves as the qualifier. In these countries, a student has to study a four-year undergraduate course as a precursor to a medical degree.
Issac says that in Ukraine, unlike in China, students are taught in English. She now plans to sit for the Foreign Medical Graduates Examination (FMGE) which allows those with foreign medical degrees to practise in India. The FMGE is notoriously difficult, and has a bleak pass percentage.
In 2021, the success rate was only 23.83%. Among the 41,739 who sat for the exam, 9,948 got through. In 2020, only 5,897 of the 35,774 who appeared managed a licence.
Dr Mishra says that the dearth of faculty in medical colleges is a factor too. While there has been debate about the exact number of medical faculty in India, the Medical Council of India’s database has 2.6 lakh faculty till 2019.
“The Ukrainian crisis has prompted an emergency relook at India’s medical education. We need to have flexibility in admissions without diluting quality,” he says.
Following the crisis, the Indian Medical Association (IMA) has written to the Centre saying that the students returning from Ukraine should be adjusted as “a one-time measure” across medical schools in India in “an appropriate dispersed distribution”, keeping in mind geographical constraints.
Dr Jayesh M Lele, secretary general of the IMA, says that these 18,000 students can help India plug the gap in shortage of medical staff. “The last two years, under Covid, have shown us the shortage in our system. The government should take steps to accommodate these children, and perhaps give them temporary certification,” he says.
Dr Lele says that long-term planning is the need of the hour. “Medical colleges come with infrastructure and hospitals, and there is a strong need for these, especially in rural areas where adequate healthcare is missing,” he says.
Over the years, there have been measures to increase medical seats. In July 2021, data provided by the health ministry showed that in the last three years, the government had established 90 new medical colleges, and 157 new colleges have been approved.
On Friday, the National Medical Council issued a circular stating that foreign medical graduates nearing completion of their courses can apply for year-long internships in state medical colleges, under certain restrictions, and state colleges can reserve up to 7.5% of their total seats for these students.
Dr Mishra says that one of the challenges of allowing foreign medical graduates is that smaller countries do not have the same teaching methods as India. “In many of these countries, exposure to patients is limited. Our experience with many students from these countries is not very encouraging; their basic understanding of clinical medicine is not ideal,” he says.
Rajiv Chhibber, Joint Coordinator Policy and Government Affairs at Association of Indian Manufacturers of Medical Devices, says these students could be given opportunities in the Health and Wellness Centres (HWCs) under the Ayushman Bharat scheme through tailor-made courses.
“A mapping of these students, looking at their core competency should be done immediately,” Chhibber says. He says that unlike in countries like the US, UK and Israel where paramedical professionals are an interdependent cadre recognised professionally, in India, the apathy towards nurses and technicians is appalling.
Dr Sarin says that like in the system of chartered accountants, India can look at a system in medical education where it allows people to study medicine but has an exit exam for licensing.
“We should allow more people to read, but not all to pass. New ideas have to come in to make a real change,” Dr Sarin says.
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