Our take on Rural Medical Officership

The Times of India of September 14, 2006 carried a story about rural MO-ship after MBBS, in which several parts of the situation were neglected/wrongly represented. Sumedh and I wrote this to set the record straight.

The Government Resolution (GR) issued by the state Government in the month of July this year dictates that medical graduates of Government and Municipal colleges must serve for a year (possibly two) in a rural area, as per the bond signed by them while joining the course. The timing of such a GR follows close on the heels of the chikungunya epidemic in interior Maharashtra and, more importantly, the intense media coverage of the same. Suddenly, questions are being asked as to why the healthcare machinery isn’t functioning well enough in the villages. So, arbitrarily, it was decided to do a patch up job (akin to the pre-monsoon road strengthening frenzy, which we know too well, doesn’t last long). The Government finds the softest targets possible – the fresh, just out of college, medical graduate.

Now, to clear a little history. The Government of Maharashtra and the Municipal Corporation of Mumbai take a bond from the medical students at the time of admission that the students will serve the respective bodies for a period of two years if required; else they are liable to pay Rs. 1 lakh. Under the bond, medical graduates were posted in rural health centres. But this was arbitrarily scrapped in 2001. Has anyone examined why this happened? Were any interviews conducted for the same since 2001? And, why not? Why was this situation allowed to develop in the first place? Will these postings also arbitrarily be stopped sometime in the future? And, yes, who will man the rural health centres then?

The underlying problem is the unwillingness of successive Governments to tackle the root of the matter. A doctor is not synonymous with health. Reaching a doctor to the village doesn’t mean that health has reached the village. To cite the most pertinent example, chikungunya is a disease caused by a virus carried by mosquitoes. Is it the doctor’s responsibility to spray pesticide? Is it the doctor’s responsibility to give mosquito-nets? Is it the doctor’s responsibility to eliminate stagnant water and other breeding sites? As a doctor, the only management at a primary level would be to dole out anti-fever and painkiller drugs. This is the Government’s ‘healthcare plan’ to curb the epidemic. Where the focus and thrust should be prevention, the employed strategy seems to be ‘treatment’, which, as you read above, isn’t even curing the disease!

Okay, so the Government didn’t do its job in preventing this epidemic well enough; but that’s not where their shortcomings end. Nothing has ever been done to attract doctors to the rural set-up! If a young doctor decides to work as an MO in a village, he faces several hurdles along the way. He cannot send his kids to a good school, lives with the anxiety of being transferred and, of course, there’s the remuneration package. Are these too much to expect? That’s not all; there are more immediate concerns. Some of us will be posted in tribal/Naxal areas. Can the Government even assure us personal safety? The simple fact is that they can’t. A good system can sustain itself only if it is win-win for all concerned parties. Doctors are normal people with normal aspirations. It isn’t possible to live on ‘respect for being in a noble profession’ in these times. This is where public perception needs to change.

People must decide exactly how they view a doctor. On one-hand we can be tried under laws such as the Consumer Protection Act, which effectively makes us your baniya of Healthcare General Stores. On the other hand, altruism is expected of (even forced upon) us. So it’s only too easy for non-medicos to sit in the comforts of their homes in Mumbai and berate the ‘selfish young doctors’. It’s socially convenient to blame a variegated group that goes by the name of ‘the young generation’. We are seen as being too spoilt to give anything back to the nation and are a favourite target to flog. It doesn’t matter if anything is being done to really change the healthcare (or any other) facilities in rural areas, or not.

There exists another twist to this tale. The GR also prevents students of Government and Municipal hospitals from appearing for the post-graduate entrances if the year of service is not completed. Even if they pay the bond, they are expected to sit idle at home for a year and can only take the next CET. Students of private medical colleges have no such problems, they can take the entrance right after getting their degree. So how can the same entrance exam have different eligibility criteria for students of different institutions? Is it just a coincidence that several private medical colleges are owned by politicians? The text of the bond we signed includes no clause about eligibility for post-graduate entrance examinations. By making MOship a criterion for eligibility to take these exams, the Government is adopting a strategy better known to most as blackmail.

Whether or not the public may understand the finer nuances of this matter, we are fairly certain that there are numerous political vested interests behind this move. If there are motives to be questioned, they are solely those of the Government!