Mandatory rural service for doctors seems to be an idea that is gaining strength in India. The Union Health Minister has reportedly said that soon, medical students would have to spend a year in rural areas. Already, students in Telengana and Andhra Pradesh are being asked to work in rural areas for a year – this is mandatory, not voluntary. The students have gone on strike protesting this, and who knows how this will ultimately turn out.
At first glance, mandatory rural postings seem like a good way to solve the shortage of medical care in rural areas. But I have several doubts and questions on this.
1. Care cannot be forced – If a doctor is forced to provide care unwillingly – because it is a mandatory posting and seen as some sort of punishment, what is the level of care that the doctor would provide? Would he/ she have a half-hearted approach to treating patients? Would the quality of patient care (and the enthusiasm of the doctor) be better if the doctor had volunteered for the rural posting ?
2. What is the plan to beef up rural medical infrastructure ? Sure, you can force medical students to work in rural areas, but how effective are they going to be without nurses and trained support staff ? Will there be a mandatory nursing service too ? What about medical supplies ? Who ensures that rural clinics have sterilized needles and cotton, vaccines, anti-venom, antibiotics and all that stuff ?
3. What is the plan to ensure doctors’ safety ? We have seen how relatives of patients besiege doctors when their loved ones don’t respond to treatment, or even die. This happens in the best hospitals in the cities – like say AIIMS. Of course it will happen in rural areas. Who protects the doctors then ?
3. What is the plan to protect women doctors ? Who protects the women doctors from harassment and molestation ? They may have to treat patients at all hours of the day, travel alone to patients’ homes etc. How do we ensure their safety?
Years ago, I studied in a college town where the female students (who were few to begin with) were all considered to be of loose morals because we dressed in jeans and spent time with the other male students in the class after sun down (on group projects and classwork, but still..) Now, once a person is considered to be of loose morals, anyone can decide to molest her and no bystander would come to her rescue. We had to always travel in groups. That particular college town has very likely changed its attitudes since then but I am sure many villages in India still would share this attitude.
4. Caste politics and other issues – Most urban Indians don’t have much idea of the intricacies of caste hierarchies and customs that govern rural India. This is all the more so if the rural doctor does not hail from that region. How do our khap panchayats deal with unintended transgressions by the doctors?
5. The rule will still not apply to every one – The Central government’s proposal, as I understand it, only applies to post graduate medical students. So anyone who can afford it, will try to complete postgraduate studies abroad. It is only the students who cannot afford to go abroad who will end up working in rural areas, and this will add to the resentment.
I am sure there are many more such issues and people who have worked in rural areas would have a lot more to say. I am also sure that governments at the State and Central level would have thought through these issues. But if they are already imposing such a mandatory rule on medical students (as in Andhra Pradesh and Telengana), surely the public needs to know more details on what the thinking behind this measure is?