Recently government planned for introduction of a new course in rural area, bachelor of rural medicine and surgery.. Indeed a very innovative step and government needs a big applause for this.. But what is disturbing is that Indian medical association has ab initio opposed this step and recently in paper I read about their call for strike to pressurize the government for abolishing this course..
I would like to bring attention to my fellow doctors by asking them how many of them have really served in the rural area for more than 10 years ? India still has population of about 33 % below poverty line and if we take national advisory committee recommendation for inclusion of people for subsidized food grain then it is 75 % these are not just numbers but a grim reality of problems faced by our nation and shows the abject poverty faced by people of my country… in such a scenario is it possible for a poor to pay the fees of doctors which is quite high..(go to any corporate hospital a normal vaginal delivery will be costing rs 30000) can a poor person pay this??
Problem faced by our country is multifaceted…
The reforms of L P G has infact increased rich poor divide..urban areas have gained more than rural areas… population pressure has worsened the condition added to this my fellow friends have infact lost their bit of morality and are preparing for exams such as USMLE ,PLAB , and what not..added to this now corporate culture has started to percolate medical field and infact has converted patients in to clients ,mushrooming corporate hospital is proof of the amount of profit which they earn..
Our experience with ASHA workers,educated dai, village health workers have shown that a small step can infact go a long way in reducing mortality and morbidity over a long period…
BRMS could be considered such a step in this direction. This project has small incubation period and results could be manifold..
Government still faces the problem of deploying doctors in rural area. Village posting is considered taboo even today. In such a circumstance these BRMS doctors can act as a link between village levels to district. The tag of rural doctors will give them legitimacy and also bind them to laws. These BRMS are in fact a better alternative to quacks..
IMR and MMR are still very high and we lack behind many developing countries. even Bhutan is ahead of us .our place is 134 in HDI ranking shows dismal performance despite a growth rate of 10 %.doctor population ratio is somewhere 1:2000 in India while if we compare with US or UK there it is 1:100 to 1:200..and still my friends are going to these countries.. What a paradox
Few of my friends and seniors are Doubting that there value will come down once BRMS doctors start practicing and they argue that village people have right of good health so they don’t need semi qualified or BRMS doctors who are basically for village scenario.. But my question to them is, is this situation worth when we have not been able to provided the medical facility for our poor people.. even the recommendation of BHORE COMMITTEE 1946 has not yet been adopted owing to multifaceted problems and in such a scenario when government wants to come out with the proposal of extended arm of medical field, it is being opposed
My humble request to them is to try to understand the grim reality of our time and see the real motive of government in such a noble step...it is infact a process of medical inclusion of society .. Government is already working for financial inclusion and wants health inclusion or medical inclusion
BRMS course and BRMS doctors are not to replace the MBBSdoctors but are to help MBBS or M D doctors for effective delivery of health care needs. To help doctors for effective decision making and saving their precious time...to keep doctors inform at PHC level. BRMS can act as a extended arm of doctors in rural setting …As we enter 21 century our country is preparing itself for a better and enhanced role in world politics and it becomes more eminent for us to ensure that health of our people remain in good spirit and we should ensure that no man-day is lost due to illness of our people.. Such steps are just a beginning and lot more need to be called for.
Why BRMS is need of time can be gauged from the fact 1)they will be well versed with local needs 2)in PHC a doctor has to look for population of 2000 and more which practically is not possible for a single doctor to do 3)there training requirements will be met in district hospital there by not putting burden on exchequer 4)for local people it will be blessing in disguise 5) historically speaking we have a culture of village vaidya they are in fact such vaidyas
My fellow doctors have gained from the concepts like health tourism . m tourism ,e health etc but all these are for elites staying in urban settlement what about the person who is living in far flung village of chattisgarh
Call of I M A to oppose this move indicates the narrow , parochial and self serving tendency of fellow doctors. Though BRMS is not a solution to all this but he can to some extend work to reduce the grievance of village folk.. Meanwhile our aim should be to ensure the dignity of our profession. Which infact is getting lost in this capitalist world.
Dr bhuvnesh pratap singh
