Outsourcing education: Malaysian doctors will be made in Belgaum

While organisations are known to outsource IT projects and various works to other countries, here is a case you might not have heard of: University of Science Malaysia (USM) has outsourced the entire process of education to a medical college in Belgaum, which caters exclusively to students from the south-east Asian nation.KLE Group of Institutions has set up a college on a 10-acre campus in Belgaum that imparts medical education exclusively to students from south-east Asian countries, mainly Malaysia. Prabhakar Kore, chairman of the group, told DNA that they started the college after USM approached them in this regard. “We will provide good teaching along with infrastructure but the examination and curriculum is as per their (USM) syllabus,” Kore said.He informed that USM would select the students. The five-year course, called MD, is different from Indian syllabus.How it happenedKore said USM wanted to start a college in Malaysia itself but could not do so because of various hurdles posed by local rules. He said Malaysia has few teachers for medical stream and hiring Indian teachers is not practical either because getting a local licence for it is tough.Further, he said, even his group cannot set up a college there because of the rules.However, he said the KLE Group could cater to the needs of the foreign students with their existing infrastructure in India. He said they have been getting students from other countries since 1965. Shifting his attention to the college that is being started in association with USM, he said from this academic year they would be getting 100 students in every batch.About fees, Kore said it was not finalised yet and a call on it would be taken after considering expenditures on lab, faculty, building, hostel and other infrastructure.Link: Original Article

Top U.K. award for Indian doctors

Two teams of medical professionals from India were awarded top honours at the British Medical Journal Group Awards distributed on Wednesday.

The award for ‘Medical Team in a Crisis Zone' went to ‘Doctors for You' for their flood relief work in Bihar in 2008; and the award for ‘Innovation in Health Care' went to Professor Subhashchandra Daga and his team at the Maharashtra Institute of Medical Education and Research Medical College for their work in neo-natal health.

The ‘Doctors for You' team, about 110-strong, worked over six months, complemented by social workers and other support staff, to mitigate the effects of the disaster caused by the rising flood waters of the Kosi river in Bihar in 2008. Beginning with delivering emergency and resuscitation care, they stayed on to treat 1,30,000 patients in 300 mobile health clinics, district hospitals and relief camps.

Award a boost

Vivek Chhabra, International Coordinator, ‘Doctors for You,' said: “The award will boost membership, community support, and motivation for the team's work and help in raising a Medical Humanitarian Disaster Team for South East Asia.”

Professor Daga and his team had to work around the reality of frequent power cuts and figure out how to keep newborn babies warm. They adapted polystyrene foam boxes that were used to transport vaccines to do the job.

They went on to use the boxes to transport sick babies to hospital. The team found that not only were the boxes easy to use for families, and traditional birth attendants, but also that they were safe and effective.

Low-cost device

“The BMJ Group Award will raise awareness of a simple and a low-cost device, the styrofoam box that keeps babies warm without using electricity. This device holds hope of survival for thousands of low birth weight babies born at home, in harsh weather conditions, and in poor and remote areas of the world,” Professor Daga said.

The BMJ Group Awards, held in association with the Medical and Dental Defence Union of Scotland recognise and celebrate excellence in healthcare across the globe. This year, over 650 entries were received from across the globe for the 13 award categories, according to information posted on the website.

Link: Original Article

Doctors for You - Desire to serve still drives some doctors in India

In these days of crass commercialisation of healthcare, it may be hard to believe that a band of dedicated young doctors is giving up lucrative assignments and even risking their lives to serve in rural areas on a voluntary basis.

You may have never heard of a group called 'Doctors for You' (DFY), but this group created ripples in international medical circles this past week by winning the best 'Medical team in a crisis zone' award leaving behind strong contenders such as Medecins Sans Frontieres and Save the Children. The group got the award for medical relief it offered during the 2008 Kosi floods in Bihar. The award, instituted by publishers of the British Medical Journal celebrates an individual or team that has had an exceptional impact on a crisis situation.

The group deployed 110 of its members who treated 130,000 patients over six months through 300 mobile clinics, district hospitals and camps.

Interestingly, this group of mostly young doctors and medical students from government hospitals and medical colleges was born out of a necessity in August 2007.

It is not a typical NGO looking for opportunities for social work. During the monsoon season, government hospitals face shortage of blood and platelets when they are flooded with cases of malaria and dengue. In order to deal with such shortages, some medicos in Mumbai formed a group to promote voluntary donation of blood and platelets.

When Bihar faced the flood situation, Dr Ravikant Singh - who hails from the state and had founded the voluntary blood donation group - decided to take a small medical team there in August 2008. This slowly grew into a larger engagement over the next six months with several teams providing medical relief in flood- affected villages in rotation.

One young member of the team, Chandrakant Patil, lost his life when he was struck by lightning while sleeping in the open in a medical camp. Because of his pre-occupation in Bihar, Singh had to lose one full term of his post graduate training and an attractive offer to work for the WHO. DFY continues to prepare itself for future emergencies through constant training and by forging alliances with organisations all over the globe.

'A snakebite and a heart attack are both medical emergencies but you need different skill sets to handle them', pointed out Dr Vivek Chhabra, an active member. The group has set up maternal and child health centres - one in Biratpur in Saharsa district and another one in a Mumbai slum. Since March 2009, the Biratpur centre has treated over 50,000 patients and conducted over 100 hospital deliveries without charging any fee. The centre, manned by two doctors and nurses each, has six beds and provides round- theclock emergency services to pregnant women. The plan is to replicate this model in other districts of Bihar and other states like Uttar Pradesh and Jharkhand.

It is the dream and determination of groups like DFY which offers some hope for the health system in India.

If this isn't world class then what is?

For the likes of Jairam Ramesh who think that IIT faculty does not do any ' world class' research, here is a piece of information - a scientist at IIT Kanpur has solved the mystery behind dynamic processes in the earth's inner core. This is a fundamental discovery which was announced in Nature last week. Researchers from the University of Leeds collaborated with the IIT scientist for this research.

It is a different matter that instead of celebrating such successes, our policy makers take pleasure in running our researchers down.

It was so far believed that the inner core is freezing everywhere and is growing out gradually. But Binod Sreenivasan has found that it is melting and freezing simultaneously due to circulation of heat in the overlaying mantle being transferred to it. Over billions of years, the earth has cooled from the inside out causing the molten iron core to partly freeze and solidify. The inner core has been growing as iron crystals freeze and solidify. The heat generated is transferred to the mantle and the crust through convection.

The computer model developed by researchers simulates the outer core, using data from seismic measurements. This showed that variations in heat flow at the coremantle boundary can be transferred to the inner core boundary.

Sreenivasan, a mechanical engineering graduate from NIT Calicut and MS from IIT Madras, initially joined ISRO. But he decided to pursue research and went on to do a PhD at Cambridge. He then moved on to Exeter and Leeds for postdoctoral work on magneto hydro dynamics. In between, he had one year stint at CNRS in France. Finally he joined IIT Kanpur. If faculty like Sreenivasan are not world class, then what is, Mr Ramesh?


Box to save newborns

India has one of the highest rates of neonatal deaths in the world. Many babies die because rural hospitals do not have incubators ( or electricity supply to use them, if they have one) to keep new born babies sufficiently warm soon after birth. Since a large number of deliveries still take place in homes, the incubator is not a solution for rural India. There are instances of babies getting burnt due to faulty incubators or when crude heaters are used to keep them warm.

To overcome such problems, a Mumbai doctor, Subhash Chandra Daga, has developed a simple low cost device - a styrofoam box with four breathing holes - which can be used as a home incubator and a transporting device to keep babies warm. The box is inexpensive, reusable and washable.

It prevents bacterial growth, being a non- vegetative material. Oxygen can also be administered to a baby in the box at a predictable concentration. Over the years, a number of studies have proved that the box performs well in home and hospital settings as well as a transportation device for high risk newborns who require continuing special care while being shifted from one hospital or another. Dr Daga's innovation has been recognised in the category of ' innovation in healthcare' in the BMJ awards. The device, he says, holds hope of survival for thousands of low birth weight babies that are born at home, in harsh weather conditions, and in poor and remote areas of the world. Hopefully the award will lead to greater use of this innovative technology.

Link: Original Article

86% of all medical trips are made by rural Indians

The story of India's international medical tourism industry is now well known, but the first ever figures on domestic medical tourism are simply staggering. Indians made 126 million domestic trips for medical purposes, spending over Rs 23,000 crore on such trips, over the span of one year (2008-9) alone. That, incidentally, is about 30% more than the Union health budget for the same year.

But just as international migration into India largely reflects a choice of greener pastures while domestic migration is more as a result of the lack of economic opportunity in rural areas, domestic medical tourism too is largely the outcome of poor health infrastructure in rural areas and small towns. 86% of all trips taken for medical purposes are by rural Indians and the poorest spend much more proportionally.

The data is part of the National Sample Survey Organisation's (NSSO) 65th round on tourism which estimates the number and purpose of "trips" taken by persons in its representative sample of seven lakh persons as well as the expenditure on them. The survey defines a "trip" as the movement - for a period of not more than six months - by one or more household members traveling to a place outside their usual environment and return to their usual place of residence for purposes other than migration or employment and which is outside their regular routine of life.

The survey data shows that trips for 'health and medical purposes' form 7% of overnight trips for the rural population and about 3.5% for the urban population. While "social" purposes were the main reason for travel for both rural and urban residents, holidaying and leisure accounted for even less than medical travel - 2% and 5% for rural and urban India respectively. Similarly, 17% of same-day trips for in rural India and 8% in urban India were for health reasons.

While calculating the expenditure on a trip, the NSSO includes all goods and services bought or consumed by the traveler. The high cost of healthcare is borne out by the fact that trips for health and medical purposes were four times as expensive as the average trip for both rural and urban populations. Medical trips were much more expensive for the family than even shopping trips, where the money spent on purchasing goods is included in the total cost of the trip. Trips for health and medical purposes were the most expensive of all types of trips in both urban and rural sectors.

Expenditure on medical trips accounted for 30% of all overnight trip expenditure for rural India and 15% for urban. In addition, a breakdown of expenditure by Monthly Per Capita Expenditure (MPCE) classes shows that in rural India, the poorer the person, the higher the proportion of all travel expenditure that goes to medical trips.

A visit to Delhi's public hospitals only bears out these statistics. On Tuesday and Wednesday mornings, hundreds of people from all over the country thronged the two hospitals' OPDs, with ailments ranging from tuberculosis to cancerous tumours. Subhash Majhi (52) and his wife came here from Orissa's Sambalpur district last week, seeking treatment for a tumour on his back. "I did not get good treatment in Bhubaneshwar and the problem recurred. Our relatives told us that we would have to go to AIIMS," said Majhi, who is living in west Delhi with acquaintances. AIIMS alone receives 10,000 patients every day, the bulk of them from outside Delhi, AIIMS officials said.

Others have come here with no place to stay. Kanti Devi and her husband Gyanchand Kumar, both in their 30s, have left their children in the custody of their relatives in western UP's Muzaffarnagar district. "It is harvest season at home and we are losing work, but I was not getting better, so we had to come to Delhi," says Kumar, an agricultural labourer, who has come here with respiratory problems. The couple, who were in Safdarjung's OPD having just arrived in the city, planned to sleep on the streets.

Unlike in international medical tourism, where transport and accommodation expenditures also form a significant proportion of the trip's cost, three-fourth of the expenditure on a domestic medical trip is on medical expenses alone.

There were roughly 300,000 international visits into India for health treatments in 2009 and the size of the industry is estimated at Rs 8,500 crore, less than a third of domestic 'medical tourism' spending.

Link: Original Article

Revenue Recovery Looms Over Rural Posting Defaulting Doctors

Doctors who have not served the one-year Compulsory Rural Service (CRS) will have to pay the government at least Rs. 30 lakhs each, according to National Rural Health Mission (NRHM) officials.

Plans are under way to also cancel the Medical Council Registration of these doctors.

These punitive measures are being chalked out to make sure that students who complete the MBBS/Medical PG degree/DNB or Diploma from government-run medical colleges serve in the rural areas to fulfil a contractual obligation to the government.

Primary reports show each defaulting doctor has to pay not less than Rs. 30 lakh, which includes the bond amount and the amount spent by the government on each doctor during the course of studies and the interest on this amount.

In Kerala last year, 528 doctors were sent for CRS out of which 201 have discontinued without giving proper reasons. “We have sent notification to 160 of them asking them to resume service. Notifications for the rest are in process. And if they don’t turn up, revenue recovery by the government will happen without any compromise,” says a senior official at the NRHM in Trivandrum.

Students are given admission for MBBS, only after they sign a contract with the government for serving in rural areas for one year soon after completion of their course. There is also a provision to discontinue their service if they get admission for higher studies but they should resume service after the course.

But the practice now is that many of these doctors refuse to do rural service but join private hospitals or go abroad soon after the completion of their course. Also, junior doctors go on leave for preparing for PG admissions. This creates a dearth of doctors to attend to the poor and needy in the rural areas.

One of the reasons the doctors give for not taking up rural service is the low remuneration.

“It has become a regular practise by the doctors to not take up the rural service. These young doctors complete their MBBS at an age of 23 or 24 when students in other professional streams like engineering start earning at 22. By the time these engineers are 24 or 25 they become rather settled in life with a good job in hand and probably even a marriage, whereas an MBBS student has to go for higher studies. It makes it difficult for them to take up another year of rural service due to their personal commitments. Hence the defaulters,” says a senior doctor from Trivandrum Medical College, who doesn’t want to reveal his identity.

The NRHM now offers Rs. 15,000 per month as salary for the doctors who take up rural service. Also, they can avail 20 casual leaves and one leave every week. In addition to all this, doctors who are posted in interior rural areas such as Attapadi and Parambikulam are given an extra allowance of Rs. 3,000 to Rs. 5,000.
Pay-back Time

The students who pass out of government medical colleges owe it to the government to pay back in some form. “I think the government is right in their decision. The rural posting is the government's way of reclaiming the money that they spend on each student in a government medical college. If you look at the figures, a student in a government medical college pays an annual fee of around Rs. 12,500 as against about Rs. 5 lakh paid by a student in a private medical college. The rest of the amount is borne by the government,” says a student of Jubilee Mission Medical College & Research Institute, Trichur.

One year of rural service is not much in terms of a junior doctor’s pay-back to the government. Besides, a doctor who does rural service gets preference when he or she applies for PG courses.

“There is also another side to this story. Most of the students who get into the government medical colleges are repeaters at the entrance. Hence, most of them would be 24 to 25-years old when they graduate. And then they have their PG to do. So, obviously, they don’t want to ‘waste’ another year in rural service.”

“But rural service is a humanitarian service that a doctor owes to the society and there shouldn't be defaulters. Even we (students of private medical colleges) have something called ‘community service’ wherein we will have to visit rural areas on a regular basis,” he adds.

Reasons To Bunk

A house surgeon at the Alappuzha Medical College has a different take on the whole issue. “Though I would not support this practise by doctors, we have valid reasons for doing this.”

He blames the government’s erratic administrative behaviour for doctors being in a precarious situation. “It’s the government that decides who will be posted where and when the posting must be made. Most of the time what happens is that no decisions will be made by the time we complete our course. The next thing we would like to do is to go for a PG or take up a posting somewhere we will be paid a decent salary. But we can’t take up a job because we will be waiting for our rural postings,” he says.

“The rural posting comes when we least expect it. It becomes practically impossible for us to plan our lives with such erratic behaviour from the government.”

Another issue that he points out is that two batches complete their courses at nearly the same time with the results of the previous batch coming late. And there are rumours that the NRHM doesn’t have enough funds to pay the doctors of two batches if they get posted at the same time. “The latest batch would get a posting at a later time and no one gives us any assurance when this posting happens. Hence it becomes most likely that some of us would try to evade the rural posting,” says he.

But the officials at the NRHM office near the General Hospital here wouldn’t buy these arguments. “It’s not true that the doctors can’t choose where they would like to get a posting. We give postings strictly on merit basis. Those who pass the course with top ranks can choose where they’d like to do their CRS. Obviously, those who come last in the rank list will be left with not many options,” says a top official at the NRHM.

He says the department doesn’t delay postings. “Doctors usually complete their course by October-November every year and we send them posting notifications by December or by the end of November itself. There is no question of them having to wait for long. If there are late postings, it is only because some of them would have papers to clear and they finish the course after the others,” he adds.

He also rubbishes the rumours that the NRHM is running out of funds. “I’m not aware of anything like that. The NRHM is a fully state-run institution funded by the central government. We currently pay Rs. 15,000 for each doctor, Rs. 3,000 extra for those posted in ‘difficult rural areas’ and Rs. 5,000 for those posted in ‘most difficult rural areas’. And we have always been prompt in paying the salaries. About the pay being less, I’ve no comments. It’s the state government that decides the remuneration,” he says.

Doctors who go for rural service don’t have many good experiences to share. Most of the time, the senior doctors would dump all the responsibilities on the junior doctors. This is also a reason for some of them not returning once they get a chance to step out to do a PG course.

Having listened to all sides of this issue, Yentha believes that it’s a matter of professional ethics Vs practicality. The government’s decision of revenue recovery is something that can be justified in many ways and yet, one can’t be oblivious to the issues raised by the doctors.

A senior doctor of Trivandrum Medical College says: “Someone taking up medicine as a career has to be aware of these professional hazards rather than running away from responsibilities.”

Unlike in other professions, an irresponsible medical practitioner puts the life of common man at stake. Medicine is a profession where one’s priority should be the welfare of the people rather than any personal benefits.

An excerpt from the modern version of Hippocratic Oath: I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

Link: Original Article