90,000 Doctors Calling: WAKE UP Mr Health Minister
Guest article by Dr. Rita Pal.
Medical education in India has been plagued with a labyrinth of entrenched deep rooted corruption. Caught in the middle are the innocent unassuming public and the fragile careers of good doctors. Politicians appear to turn a blind eye while there are advertisements citing “medical seats for sale” appear for all to see. Recently, IBTL featured the $30 billion dollar Medical Seat Scam demonstrating the extent of the corruption. Private medical colleges have been under fire due to the allegations of corruption and poor standards. Examples include cash for seats, demands for payment to obtain pass marks, rigged assessments when spot checked, college accreditation obtained by payment, exam cheating etc. Dishonest behaviour appears to pervade the entire system. Essentially, medical training is becoming big business for some. Any threat to that big business will naturally be met with some objection.
Good doctors appear to have a small voice in a large country like India. Few appear to listen to their plight and others turn a blind eye – too busy being “busy”. The fact that good training makes good doctors, and good doctors maintain patient safety, appears to escape everyone's attention. Having failed to have their voices heard in the mainstream media, these brave doctors have taken their protest to social media. There we discover the plight of 90,000 doctors.
So what is Twitter hashtag #SaveNeetPG all about? It is not just about the $30 billion dollar scam affecting the medical fraternity, it is about careers of fledgling doctors ruined because a court case has effectively halted their lives. They have all been thrown into a pit of uncertainty.
We discover the origins of this hashtag and why it is an important cause to support in the war against medical corruption. For the uninitiated, a brief history is as follows:-
It essentially concerns the National Eligibility Entrance Test [NEET]. The two arms of NEET under controversy are an undergraduate [UG] and post-graduate exam [PG]. The first is taken on entry to medical school and the second on obtaining postgraduate placements. The Medical Council of India has full details of these exams.
Until 2012, the AIPGMEE [All India PG Entrance Exam] was a single exam taken for medical seats in government led medical colleges. In addition, each state had universities with their own exams – the intention being to fill up the rest of the government quota and private medical seats. Unfortunately, this system was plagued with corruption – including seat-selling and seat blocking.
In an endeavour to stop corruption, the NEET was introduced. Billed as the “one nation- one exam”, it was due to replace the AIPGE plus multiple state-wide exams.
The new and fairer NEET has been universally welcomed by students and their parents. Unfortunately, following its announcement, it was plagued with administrative problems and endless delays – the most recent one being a delay in one state due to a conflict with electoral poll dates. By December 2012, petitions were filed in the court by 76 colleges and heard by Chief Justice Altamas Kabir, SS Nijjar and J Chelameswar. Their argument was that being either religious or linguistic minority colleges, they were entitled to autonomy of administration of their educational institutions under Article 30 of the Constitution. The Times of India reported.
“However, hearing the pleas of opposing states and private medical colleges, the SC on December 13, 2012, permitted them to conduct their respective examinations for MBBS, BDS and postgraduate courses, but restrained them from publishing the results till the outcome of pending cases. The fate of such entrance examinations will depend on the final SC verdict”
So there we are. A rather puzzling decision since it appears to undermine the true spirit and intention of the NEET. Even more startling was the court's lack of foresight. They effectively placed the fate of 90,000 doctors in jeopardy. The doctors' interests being placed at the bottom of the pile while ultimate priority was to a handful of colleges.
Details of this complex case was eloquently summarised by this medical blogger. Read this here. Once read, the legal tangle appears to be exasperating with numerous laborious adjournments, delays, lengthy arguments and counter-arguments. These appear to occur more frequently than the repeated changes of female costume in an average Bollywood movie. Lawyers are making endless amounts of money pontificating and the system is still open to the endless corruption and money making schemes. Everyone is benefiting apart from the doctors and the public.
It is not entirely clear why the fate of 90,000 doctors have to remain in limbo while a set of lawyers argue and out argue each other. It appears to be the most outrageous if not catastrophic situation.
While the final decision of this case remains on ice indefinitely, neither the judiciary nor the Minister of Health appears the least bit concerned about the implications in reality. The lives of these junior doctors have been left in limbo courtesy of this bureaucratic legal fight that is lethargically lounging in the Supreme Court with no end in sight. The Department of Health has made no contingency plans AT ALL. If they cannot manage these relatively simple issues adequately, how can they manage the entire health of a nation?
It is clear that despite this unfair and impossible situation, the Department of Health and the rest of India appear to be asleep. While they have been asleep, the voices of the brave junior doctors can be heard on various social networking websites. Their anger and disenchantment with the system is understandable given the serious consequences to their lives. There appears to be no appreciation of the distressing impact of these significant delays. The risk of deskilling young doctors due to commence postgraduate training appears to have slipped the minds of India's esteemed establishment. Can this be a threat to future patient safety? Moreover, there is career, financial and psychological consequences of these significant delays. All of these disastrous personal consequences to hard working doctors have been forgotten or at least swept aside.
The NEET exam system is seen a positive way forward to decrease corruption, to maintain integrity and public confidence in a profession that has been scandal hit over the last few years. Many doctors see the current court case as a threat to the NEET system. Some also see it as a pointless challenge by medical colleges hell bent on preserving their cushy lucrative money-making schemes. The cynics amongst us would cite the arguments put forward by these colleges to be essentially moot since equality should be part and parcel of medical school admission. Therefore, NEET should be universally welcomed by everyone interested in a fairer system.
In my view, these colleges have broadly unconvincing and fairly laughable arguments. Their main aim is to abuse the legal system, spend endless amounts of money paying lawyers to take advantage of the law. Everyone knows that a lawyer who is paid enough can argue that the sky is polka dotted sari – they call this a mouth-piece for hire. I believe these colleges see NEET to be a threat to their status quo and an end to “big-money”. In order to protect their vested interests, they are now taking advantage of the minority ticket. If I was at the Department of Health, I would be looking at the integrity of those colleges challenging the NEET.
For all these reasons, there is a hash tag on Twitter by the name of #SaveNEETPG. Good doctors have taken it upon themselves to fight for the preservation of a corruption free medical system. Last year, the system took a step forward to prevent corruption. Sadly, the events after demonstrates that it is now taking three steps back.
Various peaceful protests have taken place over the last few weeks about this issue. Some distressing evidence of police man-handling of peaceful medical protesters has been collected. Hunger strikes are being held at Jantar Matar, New Delhi but these have not been featured by the mainstream media. Refusing to keep silent, the doctors carry on undeterred, raising their concerns throughout the Twitterspere and other social networking websites. The hash tag #SaveNeetPG is gaining momentum every day.
The sheer mismanagement of the issue of India's Department of Health [part of the Ministry of Health and Family Welfare] is self evident. The Minister of Health has failed miserably to place contingency plans in place to protect the livelihoods of these doctors. One doctor demanded an answer as to why this entire issue was mismanaged. This succinct list of points can be read here. Essentially, the authorities have been negligent and short-sighted. We can call it either human error, or the more cynical amongst us would state that this is a wider effort to scupper the NEET exams from ever seeing the light of day. Is Department of Health complicit in the corruption exposed recently?
It is clear that in the absence of the NEET exams, medical seats were big money. Those who benefited from the flaws in the old system will never let go without a fight. Then in my view, good doctors will never be deterred from standing by what will protect their patients and uphold public confidence in the medical system. A rather odd situation is evolving – where doctors are doing the job that the Department of Health is paid to do, that is to protect NEET.
The Health Minister appears not to have opened any dialogue with doctors. It is interesting that while #SaveNEETPG was trending on Twitter over the weekend, Mr Union Health Minister Ghulam Nabi Azad was speaking at the convocation ceremony of the first batch of the MBBS students of the Kerala University of Health Sciences at Mulankunnathukavu. While he crowed about how rosy the health system was under the glaring eye of the mainstream media, this successfully diverted attention from the real evolving issue – the catastrophe caused by his own department. Bravo for being a superb spin-master Mr Health Minister.
The Department of Health has washed its hands of the $30 billion dollar medical seat scam admitted by its previous Health Minister. It has not been forthright nor has it objected to the minority challenges in court to NEET. The Department continues to be tight-lipped and less than transparent relating to questions surrounding its conduct in this matter. Moreover, its negligence in mismanaging this entire issue while placing 90,000 doctor's careers in jeopardy demonstrates a catastrophic failure in management. If Mr Health Minister cannot do the job he is paid to do – then he should resign with immediate effect.
Dr Rita Pal is a freelance journalist based in the United Kingdom. She specialises in medical and medicolegal issues with occasional detours into horticulture and Bollywood gossip. Her background as a former psychiatrist provides insight into the human condition from both sides of the medical fence. She also writes on the Huffington Post. Her personal blog is Naman Astitva.
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