The BRMS course has been misunderstood as an attempt to dilute and undermine medical education. It is actually about preventing needless loss of human lives in rural areas owing to lack of basic healthcare.
Those opposing the proposal should tell us whether women, infants, and other vulnerable sections should continue to die for want of medical care till new medical colleges are set up and the doctor-patient ratio increases to acceptable levels. Solutions which can be realistically implemented are better than ideal or perfect remedies, which may or may not materialise.
I would be hesitant to reject outright the MCI proposal to have a cadre of rural doctors. Increasing the number of MBBS seats may not meet the health needs of villagers. With the rapid advancement of medical technology and increasing pressure for specialisation and super-specialisation, most young medical graduates do not see family medicine and general practice as a viable option.
More MBBS seats will only produce more specialists who may not be suitable for rural areas where the needs are more preventive and basic. There are still large areas of our country where people die of malaria and gastroenteritis. A cadre of alternative health providers who are monitored — and a good system of referrals for problems they cannot handle — may still be an option that needs to be seriously considered.
Manoj C. Jacob,
Some doctors have argued that the BRMS course will produce half-baked medical practitioners who will not have the requisite skills to provide treatment. They seem to forget that even an ANM (Auxiliary Nurse & Midwife) can deliver a baby.
Increasing the number of medical colleges will serve little purpose. Since independence, the number of medical colleges and doctors has increased but the situation has remained the same. Doctors want returns on their five-and-a-half years of investment and hard work. Compulsory rural service for medical graduates is not a permanent solution either. Compulsion in work and temporary posting do not bring motivation. We cannot afford to wait for the mindset of MBBS doctors to change. The proposal to introduce BRMS course is a step in the right direction. It offers the hope that our villagers will lead a healthy life.
Kapil Kumar Singh,
While I am not taken up by the BRMS proposal, I nonetheless disagree with the editorial. Even a quick Internet search would show that Chhattisgrah has revived the three-year medical course and the diploma holders are being recruited in remote PHCs.
The need of the hour is to have a trained primary health care provider within half-an-hour’s walking distance of every village home. In many countries, care at this level is delivered not by doctors but by mid-level practitioners. They are not doctors but can diagnose and treat a range of primary health problems. Reviews and studies have found no problems with the quality of care they provide.
I have Indian friends who are doctors and I am aware of the concerns of creating partly trained doctors who may set themselves up as fully qualified doctors. So it would seem to be more a question of maintaining status. The problem can be solved by changing the name of the rural ‘doctors’ and, at the same time, ensuring that they cannot set themselves up in practice at a later date. They can be called Rural Para-Medics and trained for 18 months, instead of three-and-a-half years. If they wish to become qualified doctors at a later date, they can take the same route as any medical student.
You don’t need to spend two years studying anatomy, physiology and biochemistry to offer primary health care. I was a Special Forces medic. I didn’t have to use most of the training I was given. I lanced, stitched, took teeth out, dealt with a miscarriage and operated using nerve block injections. I am sure that with advances in compact diagnostic kits, the present forces medics are even more capable. In Afghanistan, more troops are surviving with injuries that would certainly have killed them in the past.