Dr Shyam Singh
Education and Medical Education is the most important and crucial for the quality growth and progress of a nation and investment in the twin sectors pay dividends though later in the form of well informed,educated ,lawabiding citizens who are physically , mentally, morally and spiritually healthy. Unfortunately, these sectors are the ones neglected most,especially in our state .Nobody has the political will to clean the mess and adhoc arrangements to tide over the crisis whenever it erupts has lead to the present impasse and it will carry on till some crazy politician or bureaucrat holds the bull by the horns and puts in a transparent,honest system in place that is doctor and patient friendly,teacher and taught friendly. Education institutions and medical institutes are great temples of learning and seats of giving back to society what it has given to you.These should be handled with great respect and care.
There are still sufficient honest and upright workers in these institutes that make these going.But our children need quality education and people need quality medical care which is their fundamental right . For quality medical education ,you need quality medical teachers.If you compromise on the recruitment of medical teachers you are destroying the medical education system of the country because medical teachers are responsible for guiding the undergraduate(M.B.B.S.) ,postgraduate(M.D./M.S), Postdoctoral (M.Ch/ D.M) medical students in their teaching and training , 24×7 because medical profession cannot afford to sleep. Besides he/she has to deliver quality medical care to the poor and rich alike.Not only this ,he/she has to undertake research in the clinical and basic sciences and teach and guide the students under his/her care in research projects. The recruitment agency for Government medical colleges in State, Public Service Commission has become a rehabilitation centre for most of the retirees. J&K Medical Education (Gazetted) Recruitment rules 1979 needs revision but who is going to revise ?——– The great task where the most experienced medical teachers/ professionals would fumble,is left to a poor clerk who even cannot spell correctly ” medicine”. Then there are some guys in the secretariat who manipulate these rules to their liking. This has happened in 2006 revision and will happen again and again till such elements are reigned in. The best way to put a fullstop on these malafide actions is to implement Medical Council Of India,Minimun Qualification for medical teachers in medical institutions,Regulations (Ammended 2009). The society expects quality medical care at the hands of qualified doctors, paramedical professionals and rightly so,as a matter of fundamental right. To produce a quality qualified doctor you need a stringent premedical, prepostgraduate and prepostdoctoral tests given by a board of masters in the field of medicine so that you can get in people who really deserve to be trained as M.B.,B.S ,M.S/M.D and M.Ch/D.M. The M.B.,B.S. , and M.D/M.S pretests are conducted by Board of competitive authority as J&K common entrance test but postdoctoral M.Ch/D.M pretest is not as yet standardized. The medical institutions in the state starting from subcentres to Sher-i-Kashmir institute of medical sciences are great assets of the state and the country.These need be equipped with not only machines and medicines(easily purchased) but quality machines and quality medicines and quality manpower.
Recruitment of paramedics and ancilliary staff should be done through a standardized procedure. Regularising adhoc/contractuals who were never seen working in these institutes for last so many years(working at officers houses at expense of common man’s money),are suddenly swarming the departmens on announcement of Govt policy, needs scrutiny as the welfare act of the Government in medical institutions could put patients’ lives in danger. Accountability needs to be fixed not only at the local level but the the highest level. The medical institutions at tehsil and district level must be strengthened so that unnecessary referrals to Government medical college hospitals is curtailed. Trasfer policy of doctors in health department needs prompt revision as there is no transfer policy in place.
The transfer policy in health department made in late 80’s in which region was divided into zones and first posting of a medical officer after M.B.B.S. would be in farthest zone and he/she would be compensated with 5 extra points for Postgraduation entrance examination Scheme needs a fresh look and strict implementation so that the poor citizens of faroff places like Nobra, Padder, Kunzer, Gurez,Lohran etc may not suffer for want of medical care. New superspeciality hospitals shouldnot be opened for the sake of cutting ribbons unless and until you have requisite trained and qualified medical professionals and paramedical staff in place and protocols in place.
The supporting services of qualified engineers for maintenance of buildings and engineering services are must.An experienced, honest, upright and dynamic administrator at helm of affairs who knows how to lead his team from the front, can make the difference. Superspeciality hospital should purely cater to patients who require superspecialist’s consultation or admission. Continued medical education for medical personnel should be made mandatory. In each department, the chair of the head of department must change every two years between the two seniormost faculty members. This will help implementation of new ideas /protocols for the betterment of patient care. All the health professionals working in tertiary care hospitals need be in campus. For this proper accommodation and facilities must be provided so that these institutions donot become factories with 10 A,M to 4 P.M timing. An inhouse highpower committee should be set up in each tertiary care hospital which makes inquiry and powered to take prompt and appropriate action. A review committee must review the progress and achievement of set targets every month and pinpoint bluntly the shortcomings and deficiencies of all the departments involved and dissect out the causes and suggest immediate remedial measures. OneTertiary care hospital is the need of hour in the Ladakh region for the citizens of this high mountainous tough terrains. You cannot quickfix the problems in medical profession in a way just to tide over the crisis and buy time.Recruitment of faculty and paramedics on academic basis for new superspeciality hospitals will create more confusion and chaos and will further decrease the medical teachers in GMCs’. It shall be like mopping the floor instead of closing the tap. Already there are cases where the Government has tried to shift faculty from departments of General Surgery,General Medicine to Departments of Cardiothoracic Surgery and Cardiology GMC Jammu,thereby decreasing the faculty strength in the parent departments of General Surgery and General Medicine on the cadre of which they were recruited.
This action is not only illegal but detrimental to the health of the parent and the new superspeciality departments. The Principals of medical colleges should be made ex-officio secretaries to Government so that red tapism of secretariat is avoided. Tansparency in purchase of quality drugs and equipments directly from Manufacturing Companies without involvement of middlemen (suppliers) should be ensured. Can a medical professional afford doing private practice while serving in a teaching tertiary care hospitals without compromising the quality of services,he/she is recruited for delivering? I have no doubt in my mind on this subject, one cannot justify doing private practice, infact cannot have time to do so if one performs his services of teaching,clinical practice and research. But they need to be compensated adequately. Doctors salaries and perks should be at par with standard institutes of the country.Sabbatical leave after some years of regular service is good option. Those who think they can flourish in private practice should go fulltime in private sector and help private medical sector to grow and progress as that is needed for competitive growth of medical services. Health Services and facilities must be charged however there should be Government sponsored Health insurance policy for underpriviledged.
It is heartening to learn that at last media has woken up but it is the common person who has to wake up,rise up to the occasion and make his genuine concerns noticed in the corridors of power and implementors for quality medical care at their doorsteps. Civil society has an important role to play in maintaining these assets of the nation and help the quality medical services going on for better patientcare. It is the clear conscience,zeal for selfless service to mankind which sets apart a medical professional from the rest . I have a firm belief that the medical education and healthcare in the state is going to change, and chage for the better because the system hasnot let the common man down ,it is the implementors who have found loopholes in it and never wanted to plug them for their petty material gains.
(The author is Associate Professor, Department of Cardiovascular &Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar)
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