MEDICAL EDUCATION IN HARYANA

 

MEDICAL EDUCAITON IN HARYANA

                        Medical education and its curriculum is basically dependent upon general education system and type of health care system in a country as a whole. The medical education status of a state will depend upon general policies which are framed at national level.

A. GENERAL EDUCATION IN HARYANA

The existing system of general education in our country has developed to a great extent but it has failed to deliver the desired effects of education. As a result of this a large number of people in Haryana are deprived from getting education. The literacy rate of 55.85% is the testimony to the above statement. On the other hand the economic development has been still faster, but the gainers are few.

The education that is being taught in the institutions has little connection with the day to day functioning of life. It is not helpful for greater number of people in making them self confident and self reliant to lead a better life. In such circumstance it is not surprising that scientific awareness is very much lacking which in turn becomes a great rider for new scientific innovations to be adopted for the development of the society. Continuance of higher education in non-professional stream has become mostly an alternative for unemployment. Even the science subjects are loosing their hopes. New subjects like computers, commerce and M.B.A. have limited number of seats though they have a temporary career for students.

In the present system of education there is little scope for assessing the aptitude of students which could direct their choice for vocational training or professional education. For higher studies merit has become synonymous to money. It depends upon the paying capacity of the parents that which area the student will follow.

Because of various reasons, most of the students cannot continue their studies beyond eighth, so very few of them get the eligibility to complete for vocational, professional or higher education. Even if a student quality he cannot compete with students coming from an affluent family and trained in better institutes. Even the competition is becoming stronger amongst the latter. Corruption and manipulations are being reported in newspapers as the major mode of getting into a carrier. Admissions, examinations and services in Haryana are reported to be manipulated through all petty means.

B.  HEALTH CARE

Every country has got its own health culture. The present system of health care which was introduced by our foreign rules didn’t care of the health needs of our people in general because they wanted only to impart some treatment to their own people and to those who could some to their proximity. The Indian system of medicine was made to stagnate as there were prejudices against it. Ultimately it got perverted also. Obviously such a neglected system could not compete with the modern medicine.

PRESENT HEALTH DELIVARY INFRASTRUCTURE OF HARYANA

 If we compare the health infrastructure at the time of independence and now, one can say that lot of progress has been made but a lot more is desired to be done. The following tables give some insights of health care delivery system in Haryana.

TABLE NO. 1

Administrative setup (1996-97)
Area (sq. km.) Villages Towns Blocks Tehsils Subtehsils Divisions Subdivisions Districts	42212 6759 94 111 65 31 4 45 17

 

 

 

 

 

TABLE NO. 2

Population of Haryana

1991                        1996-97 Rural                                           1,24,08,904              1,42,05,135 Urban                                    40,54,744                 46,42,065 Total                                      1,64,63,648              1,88,47,200

 

 

            TABLE NO. 3

 

Parameters                                 Haryana                   India
Percentage of scheduled	19.75	16.48
caste population
Sex ratio	865	927
Density of population	372	274

 

 

 

                        TABLE NO. 4

Vital Rates (1995 SRS)
		Haryana
	Rural	Urban	Total
Birth Rate	31.2	25.4	29.9
Death Rate	8.5	6.8	8.1
Infant mortality Rate	70	65	69

 

 

 

 

TABLE NO. 5

Female age effective marriage (1991 SRS) in years
	Haryana	India
Rural	18.9	19.2
Urban	20.3	20.6
Total	19.2	19.5

 

TABLE NO. 6

Allopathic Medical Institution as on 31.3.97
1.   Hospitals	Number	No. of Beds
a.       State Public	43	4341
b.      State Special	12	202
c.       Private	20	2232
d.      ESI	4	405
Total	79	7180
2.   Community Health Centers	63	1890
3.   Primary health Centers	398	1690
4.   Dispensaries a.       State Public	30	63
b.      State Special	27	24
c.       Private	5	-
d.      ESI	69	36
Total	131	126
5.   Urban Health Posts	16	-
6.   Postmortem Centers	37	276
7.   District T.B. Centers/ T.B. Clinic	15	141
8.   MCH Centers	32	-
9.   Others	1	-
10.              Sub Centers	2299	-

 

 

TABLE NO. 7

Sub Centers, PHC’s and CHC’s required as per 1991 population and in position as on 30.06.97

 

Sub Centers			Primary Health Centers			Community Health Centers
Reqd. In position Short Fall			Reqd. In Position Short Fall			Reqd. In Position Short Fall
2482	2299	183	414	397	17	103	64	39

 

TABLE NO. 8

Specialist Doctors and other Paramedical Staff as on 30.06.97 for CHC’s PHC’s and Sub Centers
Category	Required	Sanctioned	In Position	Vacant	Short Fall
Surgeons	64	63	14	49	50
Gynecologists	64	63	04	49	60
Physicians	64	63	05	58	59
Pediatricians	64	63	09	54	55
Radiographers	64	56	32	33	32
Pharmacists	461	553	517	36	-
Lab Technicians	461	213	132	81	329
Nurse Midwife	845	781	593	188	252
Block Extension	-	90	50	40	-
education
LHV / Health Asst. (F)	397	540	430	110	-
Health Asst. (M)	397	590	552	38	-
Doctors at PHC’s	397	674	486	188	-

 

TABLE NO.9

Position of buildings for Sub Centers, PHC’s and CHC’s
Category	Functioning	Govt. Building	Rented	Under construction	To be Constructed
Sub Centers	2299	914	N.A	194	1191
PHS’s	397	165	N.A	45	187
CHC’s	64	59	N.A	22	-

 

 

 

 

            The present medicare system has given triple benefit to the vested interests.

1.       It has distracted the attention of the people at large from demanding the basic prerequisites of good health which is food, shelter, potable water, disposition of human and animal excreta and education. In other words of social justice is being denied. This has become very clear from effects of new economic policy in health sector.

 

2.      It has helped the vested interests in using these institutions to keep social and political control over the weaker sections making them subservient to the stronger section to beg relief which otherwise should have been their right to obtain.

3.      It has helped them in using this scientific and technological advance for their commercial benefit i.e. enormous profit at the cost of human health and life.

To achieve this sociopolitical and economic benefit the dominant social classes have introduced a type of medical education which is bound to serve the interests of these classes at the cost of people’s health at large. This is the story of the last 50 years. 

 

PRESENT STATUS OF MEDICAL EDUCATION IN HARYANA

            There are two medical colleges, four dental colleges and three ayurvedic colleges in Haryana. Few more are being opened. Students coming from upper strata of society get admission in medical colleges. Naturally they shouldn’t have social orientation and commitment to serve the society at large. Students are not selected on the basis of aptitude because of the commercial benefit paradigm.

            Present medical education is institutionalized and is dependant on sophisticated investigations and therapies. The approach towards health problems is predominantly unifactorial although it is a reality that health and disease are basically multifactorial. The irony is that people are aware of the ill effects of the unifactorial approach but don’t dare to change it because:

a.    those who are entrusted to change it and are capable of doing so are the products of these institutions and also the beneficiaries.

b.   training itself is misdirected and actively obstructs the scope of viewing the patient in totality i.e denying the multifactorial approach of medicare. Doctors and paramedical personnels thus become agents of commercial benefits of the planners. The planners have introduced the recipients in order to create a market so that persons responsible for medicare don’t rise against this system because of their competitive interests.

POLICY LEVEL CHANGES

1. Change in the general education:      

            It is suggested that to implement a people oriented, need based medical education, one should change the present system of general education. The opportunity must be opened to all sections of our society so that the children from the lower strata get an opportunity to qualify of higher education (General, Vocational and Professional). For this the change in the timings of the schools, creative and innovative methods of teaching, change in the curriculum of general education, well oriented teachers etc are some of the essential components.

PROPER SCREENING OF STUDENTS

            There must be screening to divert the students to different streams depending on their aptitude and performance by continuous assessments by the teachers and the parents as well. This will need a reorientation of outlook of the teachers and also the parents. This is again very much dependent upon the job opportunities and scope of employment in respective fields. It is understandable that in mixed society like India this is difficult to implement but it is time that we demand for it and change the direction of present system of medical education.

               LOPSIDED PRIORITIES SHOULD CHANGE

            Present policy has created a situation in Haryana where more doctors are being produced in medical institutions without giving proper attention to the training of paramedical staff such as nurses, anganwadi workers, lab technicians and pharmacists. We need nurses and paramedics in large numbers. We need specialists for our community health centres which are starving because of lack of specialists. Medical colleges which are being planned to be opened in private sector will increase this disparity further as the seats for nurses courses are being reduced.

            Thrust areas in special reference to specific health problems in Haryana e.g. residual effects of pesticides on human beings, urinary system stones, psychiatric problems, infant mortality rate, maternal health and gender problems are some of the areas which need more attention.

EFFICIENT MANAFEMENT OF THE INFRASTRUCTURE

            Health care is primarily the responsibility of the state. Individuals have a role to play for care of his health but the individual can’t go beyond the influence of their cultural, socio-political and economic environment.

            The staff in CHC’s PHC’s and Sub centres should be adequate. The necessary software and hardware should be made available in these centres. Public accountability of the persons working should be fixed. Required infrastructure should be provided as per the norms laid down.

            There should be properly regulatory law for private nursing homes in Haryana.

            The burden on PGIMS, Rohtak is mainly from Rohtak district (about 60%). The serious and problematic cases referred from the other districts may not get required attention because of increased work load. PGIMS, Rohtak is having CHC Dighal, Civil Hospital Beri, CHC Kathura (Chiri) and CHC Chhara under its direct administrative control. A bilateral referral system can be started on experimental basis between Rohtak District and PGIMS, Rohtak. The patients from Rohtak city first should go to Civil Hospital Rohtak and from there they can be referred to PGIMS, Rohtak. This may improve the functioning at PGIMS, Rohtak also.

            REORIENTATION OF MEDICAL EDUCATION IS REQUIRED

            Students must be selected purely on basis of aptitude and performance assessed during general education through continuous assessments. The objective of medical education should be to prepare:

A.    Basic doctor who will form the base for health care for the people.

B.     Medical Specialists

C.     Medical Scientists

D.    For optimal use of new technological advancements by the medical institutions to avoid exploitation of the poor patients by private sector and to teach students.

E.     Nurses and paramedical staff as per the required norms.

There shouldn’t be any capitation fee.

TRAINING CURRICULUM

A.    Selected students should be posted for 6 months in primary health centers to reorient them to the socioeconomic and cultural needs of Haryana. There itself they will learn basic anatomy, physiology and pathology.

 

B.      After 6 months they should go to sub divisional / district / regional hospitals for further one year under specialists of different disciplines to get training. Further detail of anatomy, physiology and pathology in relation to the disease under treatment will be taught.

 

C.     After eighteen months of training the students will be taught in medical institutions for next three years to learn basic science and clinical disciplines through intensive and extensive teaching with well adjusted curriculum so that the course will be for and a half years as it is at present.

 

D.    There should be continuous assessment and monitoring of the students. This will help them screen for basic doctors, medical specialists or medical scientists. Students are also mature enough to plan their future at this stage. Medical scientists for basic sciences need not get intensive training for clinical medicare after obtaining their degrees. Medical specialists will be trained extensively in their respective specialties. Internship after graduation should be there for one year at CHC level.

 

The three years extensive training at medical colleges should be there to strengthen to conceptual basic of different specialties. Specialist training after A, B and C should be encouraged depending upon the requirements of Haryana.

 

WHAT SHOULD BE THE CURRICULUM

 

In context of present scenario, there is globalization with open market economy which has created a group of people (about 10 crores in India and twenty laksh in Haryana), who can complete U.S.A, U.K and Japan in all aspects and their expectations are definitely very different than rest of the people (about 85 crores) who either can’t make their both ends meet or are surviving with great difficulty.

More rational approach will be to plan the curriculum of medical education which can respond to the needs and expectations of the people at large. Keeping in above things in mind, the curriculum can have following elements:

1.      Standard text books on all subjects authored by Indian doctors must be prescribed.

2.      Applied aspects of basic science – 18 months – should be scheduled for the field for which a new curriculum should be developed.

a.       First aid management in general and of particular diseases should get required emphasis.

b.      Basic knowledge about these problems should be imparted.

c.       Area specific diseases should be taught.

3.         Theoretical details should be taken up at PGIMS Rohtak in next three years.

4.         Honours course ( extra paper ) for those who want to become medical specialists or medical scientists should be undertaken ( computer course should be part of this curriculum ).

5.         In undergraduate period emphasis on social and preventive medicine should form a major part.

6.         Learning by doing alongside the bed of the patient in the field should be the approach of teaching. Rational portions of other system of medicines should become part of curriculum with a concept of “modern medicine”

7.         Region specific curriculum:

a.       Farm accidents and road accidents.

b.      Residual effects of pesticides in human beings.

c.       Disturbing trends in sex ratio and its implications.

d.      Urinary tract stones etc.

8.      Exposure to super specialties:

The basic principles of super specialties should be undertaken.

 

EXAMINATION SYSTEM

 

A.    Uniform pattern

B.     Major credit should be given to continuous assessment.

C.     More emphasis should be given to clinical diagnosis and treatment.

D.    Theoretical knowledge may be assessed by written and practical exams at the time of final examinations.

E.     For advance courses separate examinations should be held.

The conscious efforts should be made in this direction so that some concrete policy level decision can be taken.

 

 

Dr. R.S. Dahiya

Associate Professor

PGIMS Rohtak

2003-2004