Peregrinations of an Indian medical student

The war between Russia and Ukraine is raging unabated for more than 20 days now. It has brought in its wake,  death, injuries, terror and wide spread destruction rarely  experienced by Europe in recent times. After almost 80 years, Ukraine is once again revisiting  the horrors of war. Any signs of the conflict  abating  is not forthcoming despite intervention of many world leaders, including Indian PM as well as bodies like the EU Parliament and UN. The specter of Third World War is looming large. This time round, it portends to be nuclear. The miseries of the effected people seem to be unending. In spite of numerous calls to cease operations, Russia stands defiant. Facing  death, injury, loss of hearth and home without seemingly plausible reasons, civilians are simply bewildered. They can’t believe that when things were going so well, a terrifying calamity has come a visiting.  For many senior Ukraine citizens, it’s a painful reminder of the  last great war and holocaust. It’s also  ironical that a country which has witnessed in the past, large scale  persecution of Jews and is  today headed by a Jew is being accused of sheltering Neo Nazis. The entire  Europe is astounded beyond comprehension. They have been rudely awakened from their slumber by the full fledged war raging in the neighborhood. The comfort zone of this part of Europe suddenly very make believe and second world war bunkers a new reality. By now,  it’s clear that the EU, Britain and US  have no answer to the Russian aggression. Russia with its familiar scorched earth policy is hell bent upon bombing Ukraine into submission. NATO is wary of engaging Russia and is simply making  appropriate noises. Russia seems to have planned the gambit meticulously. There is an uncanny resemblance to Hitler’s actions  just before the Second World War. Russia annexed Crimea in February 2014 much like Germany did Austria in March 1938. Russia has also recognized Donetsk and Luhansk as independent countries just like  Sudetenland,  the regions that bordered Czechoslovakia to the north and west were forced to be handed over by the Czech government in March 1939 to the Germans. All this  has really set loose the Russian cat amongst the European pigeons.

Russia  has  taken a position that Western powers and Nato by stealthily consolidating their position in Eastern Europe were trying to severely contain Russia and revive the cold war. While Russia may have been seething for some time, the actual priming  may have been the ignominious exit of USA from Afghanistan. Putin hailing from a country of astute chess players, appears to have prepared a failsafe game plan of bringing back Soviet era glory to Russia. Biden on the other hand, with all his eye in the sky, snoop technology and CIA braggadocio has been totally KOed. US State Dept. seems to have run out of options. Economic and other sanctions have failed to have the desired impact. Russia as well as its oligarchs have not even paused,  let alone  halt the assault. The capital city of  Kiev and other major towns of Ukraine are being pulverized. As a counter to the sanctions,  Russia has threatened to turn off the tap on its Gas and Oil supplies to Europe. This has resulted in a great divide between US and Europe.  Crude Oil touched 139 Dollars a Barrel with OPEC countries not promising any action at easing of prices the world is confronted with an uncertain future. Needless to mention, the impact is already being felt in diverse areas like economy, ecology, refugee influx,  violation of human rights, racial tensions, fear of trafficking and  other human rights concerns. The lack of any effective retort and mere fulminations of USA, Britain, France, Germany and EU has made most countries sit up and do some serious geopolitical rethink. Countries like Sweden and Finland want to examine their independent status while Japan can consider nuclearization. Of course, on the flip side, many armaments companies and related industries stocks have gone up considerably.

Though the theatre of war is Eastern Europe, India has not escaped  its fallouts. In the midst of imminent threats of soaring inflation, critical national security concerns,  nuclear fallout and ecological disaster; India has suddenly woken up to a  peculiar phenomena of presence of large number of Indian medical students in Ukraine who required immediate evacuation from war zones.  Now, like most Indians I would also not have scratched my head over a motley crowd of medical students caught at the wrong place at the wrong time. However, a  purported  tweet of  Mr.  Anand Mahindra that he did not know about the lack of medical colleges in India set the ball rolling. Be that as it may, every Indian  obviously had to stand up and take notice as Mr Mahindra is no ordinary soul. Lo and behold, politicians, educationists, corporate honchos and society conscience keepers  have started waxing eloquent on the need to swiftly set up medical colleges in India. Of course, common Indians are acutely aware of the almost nonexistent medical care in India. The Covid pandemic underscored this so vividly. Much is said about the lack of PHCs, Hospitals and trained  medical and para medical staff but the situation hardly changes. Some statistics show that in India, the doctor: patient (D:P) ratio  is  0.74:1000, for a population of 1.40 billion (140 crores) as of December 2021. The WHO recommendation is a minimum D:P ratio of 1:1000. Many pundits and minions of Government think tanks like to suggest that WHO targets have already been achieved or will be achieved by 2024. Fact is that authorities may not even be really aware how many doctors are there in India therefore  much of the statistics is, at best, guesstimates. In any case, some  Medical Council experts notwithstanding, there is a huge felt need for increasing the number of doctors, paramedical staff  and nurses. Of course,  it has taken an European War to bring home facts tellingly that there is a dire need of qualified medical staff and consequently medical colleges in India. Who knows, if we had adequate seats, India could have been spared the heartbreaking deaths of two of its citizens;  Naveen Shekharappa G  a fourth-year student at Kharkiv National Medical University who was hurt in shelling and Chandan  Jindal again a medical student at Vinnytsia National Pyrogov, who suffered an Ischemic stroke and died. Maybe they would have been alive today if they had pursued medical studies in India. It’s being said that Government of India will have to pay the Airline Companies  about Rs 70 Crores for getting back the Indian citizens from the war zone. It is ironical that as per a draft Ministry of Health & Family Welfare Guidelines Document, a  Medical College Hospital can be set up for Rs 189 Crores, the amount spent for bringing back students from Ukraine could well have gone into making of one such college.

Medical education in India is a quagmire of sorts. Exceptional colleges imparting quality theoretical medical knowledge and surgical skills  exist cheek by jowl with run down teaching shops with scant staff and nonexistent labs. An  attached hospital  is a sine qua non for requisite hands on training and practice of medicine but many colleges do not boast of the same. Government Colleges, reputed Universities and shady Societies are all in the fray of imparting medical education. Due to the prestige and earning potential of a medical graduate there is intense competition amongst students for the appallingly limited seats available. A recent article affirmed that as many as 15,44,275 students appeared for the NEET 2021 exam for a total of  83,075 MBBS; 26,949 BDS; 50,720 AYUSH and 525 B. VSc & AH seats. The fees for medical course is another formidable barrier for aspirants. Fees  can swing drastically from Rupees 1 Lakh  for entire five years course in a govt. run institution to Rupees 1.5 Crores a year in certain private institutions. The phenomenon  of Capitation Fees or Donations on various pretexts is also rampant in private medical colleges.   Parents and students are caught in a pincer of greed and unfulfilled promises on one hand and hopes and aspirations of young Indian students, on the other. In such circumstances, can one really blame the massive exodus of Indian students to countries like Russia, China, Poland, Croatia, Ukraine etc.? In these countries, it may be slightly easy to get through the entrance formalities and the fee structure can also be pocket friendly. The trappings of a developed country with better living conditions can provide additional reasons. The acceptance of the qualifications both in India and abroad make it worthy of an attempt to those desperate to get a seat in any medical college. This is all  very hunky dory till the cookie crumbles like it has in Ukraine.

The mass exodus of Indian citizens and medical students from Ukraine and their arrival back in India has created a massive emotional outburst. Scores are now concerned about the future of these medical student. Incorporation of the returnee medical students into Indian medical colleges midstream may pose issues. Laid down principles may come in way. Powers to be  have also almost overnight become  champions of affordable, quality medical education in India. Countless promises are being made with politicians taking the lead. One will of course have to wait and see how many of them fructify. Setting up a model medical college and then successfully running it,  is not at all easy. There are many hurdles on the way, even if the requisite finances can be organized, softer issues of getting competent faculty, stranglehold of medical councils, embedded corruption and red tape smothers the best of intentions. Despite all this,  the Indian human capital is  waiting to be tapped. Just like the success story of Indian IT Industry; Indian Medical education and practice is waiting to be unleashed on this world. Just imagine the potential world market which exists. Already many nations like the UK and some in Middle East depend heavily on staff of Indian/ Asian origin. One is often tempted to observe that the foundation of any sound  medical services system is actually quite labour intensive. India as we all know is ideally  placed with its demographic dividend. Before China takes a lead in this arena too, Indian should pull out all stops  to ensure that it is a go to destination for medical education and medical tourism. It leads one to wonder whether the New Education Policy announced with much fanfare even contemplated such situations in their scenario building exercises. But most Indians have, by now, realized that policy making and implementation if left entirely to babus, can scant stand up to real life situations.

Centre and various State Governments, Private Corporate Heads, Individuals and Societies in the wake of the Ukraine exodus  may have declared their intentions quite sincerely regarding medical education; still one will have to see whether money is put where the mouth is. After the devastating Tsunami of Covid pandemic,  it has taken a mere 24 Hours of war in Europe for the world to turn topsy -turvy again. So India can hardly wait any longer for this vital need. Is there any practical answer to the issue regarding rapid expansion of medical education in India? Many private institutions may not like to be bound by requirements  of correcting regional imbalances while setting up  institutes. Further, running these institutions  strictly on a not for profit principle may not find  takers. Centre/State Governments have restricted Project Management Manpower, Administrative procedures can be a hindrance and  quick turnarounds not in their DNA. Are we then staring at a situation where immediate do able solutions are not practical ? Luckily there is a silever lining in the dark clouds. Remember the instances  of Hon’ble Prime Minister’s Swachh Bharat Mission, Ujjwala Scheme, call for production and supply of Medical Oxygen during Covid crisis ? There were some select  PSUs which had been tasked with these missions and they quickly assessed situations, planned and executed them with minimum turned around time. Their records are  there for all of us to see.  There are several advantages for a PSU when it come to executing mission mode tasks.  With a corporate mindset, project planning & execution experience and adequate funds; profitable PSUs make an ideal platform for undertaking rapid development of Medical Education In India. In fact some of these PSUs have sizeable Annual CSR Budgets;  a portion of which would suffice to set up a Medical College and Hospital. They also have some experience in running of medical establishments. Most PSUs have excellent in house hospitals for  employees and in certain occasions are known to treat locals, especially in remote areas. To cite two PSU examples  in the Oil & Gas sector who traditionally have hospitals catering to locals is : 1)  ONGC which  has Sivasagar Hospital in Shib Sagar district of Assam which is being expanded to a multi specialty hospital at an expenditure of Rs 313 Crores;  2)  IOCL has amongst others a Hospital and Nursing School in Digboi, Assam. This Nursing School is a boon to local students who want to take up a career in nursing. In fact this Nursing School is ideal for up scaling  to a Medical College.  While ONGC had a  CSR Spend of  Rs  552.98   Crores in 2020- 21, IndianOil CSR Budget for 2020- 21 was Rs 460.37 Crores. Selected PSUs or an umbrella organization/trust consisting of several PSUs can set up Medical Colleges with attached Hospitals. SPVs can be another route for a speedy execution of such projects. They can carry out the activities after due consultation and seek assistance from bodies like National Medical Council and National Board of Examinations. Another advantage which these PSUs have is their geographical reach and access to remote locations. IndianOil is the largest customer facing organization in India with a phenomenal reach to  the country’s citizens . ONGC is used to working in On Shore & Off Shore sites with  manpower which is fully equipped, trained and ready  to tackle the most remote area operations. These PSUs are used to facing emergencies and have provided admirable service during War and  Natural Calamities. They make an all terrain, mixed skills force which are used to strategic and tactical operations in their Corporate assignments. They are also used to executing large scale and capital intensive projects from the drawing board to commissioning  level.  These PSUs also have Territorial Army Contingents  which if called upon can act as a force in uniform. What is the relevance ? Well India has to re think its border areas strategy carefully in light of Russia Ukraine war,  both in terms of defense and development. Else, India can  become as vulnerable in NE, Kashmir,  Leh- Ladakh or even the Naxalite prone areas as Ukraine is today due to its border areas siding with Russia.  Therefore,  the approach has to be two pronged;  set up Medical Institutions all over India but have a quota for border states. It again helps that  most border areas are familiar territory for PSUs.  Another factor which goes in  favour of PSUs  is their inclusive nature of personal policies. They have in place equitable principles like reservation for weaker sections with scope for amelioration of injustices, if any. These soft factors become crucial for an educational institution too. Greater transparency of PSUs may also serve to the advantage of the institutions set up by them. Private sector companies with their confidential pay rolls (CPRs) are antithetical to transparency. PSUs are amenable to Acts like the RTI and Prevention of Corruption Act. Private Corporates/Societies etc. do not have these checks and balances, they are more or less answerable to their Boards along with a few financial institutions. They are not encumbered with many social responsibilities nor are they specifically tasked with improvement of underdeveloped areas in India or the inhabitants. In any endeavour of a private body, profit is often the ultimate aim and it applies to Corporate Health Set Ups as well. Therefore, the cost of education and treatment in a private medical institution would  necessarily have to take this factor into account.

PSUs are organs of the state and therefore in this hour of deterministic necessity of setting up inexpensive, quality medical institutions and development of border &  backward areas they have to stand up to the clarion call of the nation..(–By Sidhartha Mukherjee)