A dead body is treated by a corporate hospital, a tribal lady is demanded money by the government doctor. We hear a number of such controversies daily through media. All these controversies are inevitably linked with greed for money and negligence. In order to understand the origin of these problems let us first search for answers to the three questions viz., purpose of medical science, sections of the society most deserving this art, and the persons eligible to study and practice medicine. (Medicine in the context of this write up includes surgery).
Intention of Medicine
The twin questions of purpose of medicine and the persons who most deserve this art answer one another. Just as any other subject, modern medicine started as an art and over the last 2500 years of its evolution became a science. The need for an art of medicine originated from the illnesses and injuries affecting the mankind. Let us go back in time, divide an ancient village into different classes and examine who is entitled to this art. There exist different classes of people in the village viz., working classes (farmers, weavers, potters, etc.), the traders, the protectors, and the rulers. Working classes and the armed protectors form the majority population and the traders/rulers the minority of the village. The life of any village depends on its working classes successfully contributing to its economy. In order to decide which class should have the first claim lets take the following hypothetical case. There exists a village with one doctor. One day a farmer, carries a soldier, a trader and the village headman in his bullock cart back from the shandy of the adjacent village. By the time they travel half the distance its already dark. The farmer struggles driving through the dark pathway and suddenly finds his cart wheel fall in a huge ditch. The cart over turns and all the four persons receive serious injuries. They are brought to the village doctor. Unless each one is attended to immediately he is going to die. Who should the doctor treat first? Out of the four persons, the one who produces and contributes to the village is the farmer. Unless the farmer produces the headman wont have any food for his people, the trader anything to trade, or the protector to protect. Therefore the farmer should be the first to be treated. Of the remaining three unless the protector guards the village, the farmer wont be able to produce, so he should go next. Out of the remaining two the trader plays the role of exchanging the goods between various producers such as potters, farmers, weavers etc. a function more important than that of the headman. Therefore the headman should go last.
Thus we can safely say that the first claim to this art of medicine shall be made by the working classes, then the armed protectors of the village, then the traders and lastly the rulers who contribute the least to the village economy. The working classes/armed protectors are the most deserving of this medicinal art. Every village will now require a doctor to carry this art to those who deserve it. Even today a look at any of our tribal villages in the scheduled areas reveals that every 2-3 villages (around150-200 houses) have a 'bhuta vaidyudu' who will be treating the sick. These were the earliest people involved in this occupation of treating the unhealthy.
Coming to the present day, we have allopathic doctors almost replacing 'bhuta vaidyulu'. I will digress a bit to narrate an incident. Recently there was a conflict between the older generation bhuta vaidyam and todays science of medicine. One day a young boy from a Savara village near Palakonda town in North coastal Andhra Pradesh approached the police saying that his father was murdered. There were no property disputes or political/family disputes. On enquiry it was revealed that this boy had an elder sister who was a health worker in the village. This village had a hamlet of 20 houses adjacent to it where some people fell sick due to fevers. The health worker visited the village, gave some medicines and referred the sick to nearby PHC. This wasnt liked by the village 'bhuta vaidyudu' who understood it as an insult to his knowledge. He gathered the villagers who still had considerable faith in him, brainwashed them into believing that the health worker was in fact the cause for all the fevers in the village and that she was a sorceress. They ultimately decided that her father was the origin for all the black magic. This father was a poor old man of 70 yrs. One night while he was returning after answering his call of nature was attacked and hacked to death.
Do the same type of illness or injuries affect all the classes of people?
The diseases of the working classes are different from those of others. The inherent nature of the work of the working classes keeps their bodies physically fit till a very ripe old age. We very commonly come across persons above 80 years of age still engaged in farm work, employment guarantee works etc. in the villages. A talk with any villager will reveal that his primary objective of consulting a doctor is to get back to his work as quickly as possible. The illnesses of the working classes are confined to injuries and epidemic diseases.
The same age group persons from other non-working richer classes are usually found engaged in the sole work of prolonging their unproductive life with the help of doctors. The illnesses of these fellows are related to intemperate habits: sedentary life, indiscipline etc. The aim of a rich person consulting a doctor is to prolong the life of his unproductive body. There will arise a question as to whether all persons not engaged in manual work are useless. There are people such as engineers, scientists who lead a sedentary life but are productive. Such people are supposed to be contributing with their intellect, therefore supposed to be educated. Any educated person is supposed to have a proper knowledge of his body and the way in which it can be kept healthy with regular exercise and proper eating habits. If any educated man acts contrary then he doesnt deserve to live beyond what his habits dictate. Any effort to artificially prolong such a persons life will be a liability to the society.
In order to understand who deserves to use medical science for his benefit I have put in table 1 the desert from the stand point of contribution to the economy and usefulness of the person to the State. The entitlement of a citizen to medical science in the country is directly proportional to his contribution to the economy. Workers contribute the maximum to the economy hence they shall be the first rightful claimants to the use of medical science. The supervisors, professionals(lawyers, engineers, teachers etc.), traders, and owners of business follow next in that order. The affluent and unproductive persons of the country dont deserve the use of doctors of a State. Rulers though better than unproductive and affluent people should not use medical aid before a rich man only because they have a moral responsibility to take care of the health of all their citizens.
We can classify the diseases into those affecting the workers and others. Workers by nature of their work are prone to accidents and epidemics. The illnesses affecting the others can be sub-divided into either those due to a sedentary lifestyle or due to an indisciplined lifestyle. Diseases arising out of sedentary life and indisciplined life are preventable. The persons who are educated are not entitled to suffer from preventable diseases. They are supposed to prevent the diseases of pleasure and indiscipline with the help of their education. The epidemic diseases or accidental injuries therefore are entitled to medical science first, then come the sedentary lifestyle diseases. The diseases of pleasure or indiscipline come last.
Table 1: Purpose served by medical science in treating various sections of society.
Class of People(-->) | Workers | Professionals /supervisors | Kids | Aged | Traders | Affluent classes | Rulers |
Contribution to economy | V.Good | V.Good | N.A | N.A | Average | None | None |
Nature of work | Physically active | Sedentary | - | - | Sedentary | Sedentary | Sedentary |
Is this class supposed to have preventive knowledge of disease(Y/N)? | No | Yes | No | Yes | Yes | Yes | Yes |
Common cause of Illness | Accident/ Epidemic | Sedentary Life | Accident/ Disease | Age related | Sedentary Life | Indisciplined life | Sedentary life |
What does medical science do? | Quickly restores health | Quickly restores health | Quickly restores health | Maintains health | Restores health | Tries to restore health | Restores health |
Purpose served by medical science | Get back to productive work quickly | Get back to productive work quickly | Quickly resume school | Enable them to do their personal chores | Resume their business | None(to prolong a useless life of personal pleasure) | Resume rule |
Purpose served by individual | Get back to work quickly | Get back to work quickly | Get back to school quickly | Ability to attend to their own needs | Get back to business | To resume a life of pleasure | Resume rule |
Desert of medical study
The question of who deserves to study medicine from amongst our students has been a controversial one. In order to arrive at an answer to this we need to first understand the criticisms against Government.
1. It is the right of a doctor to practice where ever he wants in the country;
2. A talented doctor is not recognised in the Government sector;
3. The rural areas do not have sufficient doctors;
4. The government is not paying commensurate with the private sector;
5. A student pays a heavy fee of 40-50 lakhs to a private college to study medicine;
6. Medical seats in Government quota should be given based on merit alone;
The first issue: From the aforementioned discussion on purpose of medical science, it is clear that the doctors primary purpose is to treat the workers of the economy. It is the duty of the State to redistribute doctors as per the geographical distribution of the workers in the country. Whereever the workers go the doctors shall follow like a 'hutch dog'. It follows that the doctors then are not free to practice whereever they want. The location of the practice of their medical science is decided by the workers of a country.
The second issue: The talent in a doctor can be measured by the upkeep of the health of the workers in his jurisdiction. A comparison of the loss of working days of workers between the tenures of the previous doctors will give an indication of the effectiveness of the doctor. Similar other measures can certainly be worked out to recognise the best talent in the government doctors.
The third issue: Lets examine the distortions in todays medical sector.
Some figures: the average doctor population ratio in our country is around 1 doctor for every 2000 people; developed countries have 4-8 doctors per 2000 people; WHO prescribes 3.3 doctors per 2000 people; every 15000 persons in the rural areas of our State(AP) have access to only 1 doctor.
Facts we know: More than 70 % of India lives in rural areas; more than 90 percent families in rural areas are dependent on agriculture. The inference is that more than 60% of our population are workers and live exclusively in rural areas.
A look at the profile of the medical students indicates that a majority of them are those born and brought up in urban areas. It is highly likely that such a person will go back to an urban area after completion of his medicine. These facts and figures indicate that firstly, the availability of our doctors is a quarter of that prescribed by WHO and secondly, even the small number of doctors are available only in the urban areas. This shows that there is an urgent need to increase the production capacity and produce those doctors from the rural areas of the country . There are two remedies for this problem of shortage in rural areas, firstly to bring in a legislation making it mandatory for doctors either private or government to work only in locations decided under law or secondly to alter the intake ratio of students in such a way that the majority of medical seats go to those students born and brought up in rural areas. In the second case we have to see that the doctors produced from the rural areas are in proportion to the working class population in rural areas. More than 60% of our working classes are in rural areas, therefore more than 60% doctors produced every year shall be those who were born and brought up in those rural areas.
The fourth issue: Doctors in private sector treat diseases of the richer classes of the society. As we have seen the non-working classes suffer from diseases mostly arising out of indiscipline. The purpose of medical science is not served here because any treatment of the non-workers has very minimal contribution to the economy of the State. I interpret urban private medical care in the following way. The wealth of the State which is hard earned by our productive classes is squandered in prolonging the lives of unproductive persons who are a liability to the State. Therefore the Government shall always pay what the doctor deserves as a professional. Any gap in demand supply shall immediately be rectified by government by increasing production.
The fifth issue: The Hippocrates(father of medicine) oath taken by all the medical graduates runs like this.
"I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
But I will preserve the purity of my life and my arts.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."
The essence of this oath in the current context is free teaching by those who have already learnt it, to those who want to learn medicine. It will be the responsibility of the government therefore to impart free medical education to all those who deserve to learn. Teaching of medical science in return for money defeats the very purpose of medicine. It is said patients are the study material for a medical student. A private medical college which operates for the purpose of earning profits can never treat patients free of cost. This will exclude all the working classes and the poor from the private medical colleges. The students coming out from these colleges will therefore be half baked without exposure to the diseases of the poor and the workers. It is also the responsibility of the State to take care of all the medical needs of the productive citizens free of cost.
The sixth issue: Should the most talented students get all the medical seats? The desert of a student to study medicine depends on three things, 1.talent 2.love for medical knowledge 3.life long commitment to the purpose of medical science. Our entrance exams test the talent part alone. This is resulting in production of doctors who are deficient in knowledge and whose purpose of study of medicine is at variance with the purpose of medical science. Whereas the purpose of medicine is to treat the producers of the country free of cost, the current doctors end up treating the unproductive persons out of a love for money; whereas the ideal doctor should treat the workers out of love for medicine, the present day doctor treats him out of love for recognition in doing so.
No comments:
Post a Comment