Need a thorough review of medical education after the Ukraine crisis

By Dr Arun Mitra

That the students from Sumy have been evacuated and are on their way to western Ukraine is a great satisfaction not only for the family but for the whole country. Better late than never; Eventually, the Indian government woke up and took effective steps to plan for this evacuation. The war between Russia and Ukraine threatens the lives of innocent citizens and the destruction of resources. The danger of the use of nuclear weapons in the event of an escalation of war cannot be ruled out.
The evacuation of citizens from war zones is an extremely difficult task. Foreign nationals who want to return to their families are put to the test. Indian citizens, especially students, most of whom are studying medicine, have gone through a difficult time. While most countries sent their Ukrainian citizens home, the Indian government failed to act in time. This despite several requests from students to the embassy in Kiev. When the war broke out, instead of arranging the evacuation of students, the Indian Embassy in Ukraine kept issuing notices to students to reach the borders of Poland or Romania.
It was a daunting task for the students since from some places these borders are more than 1500 kilometers away. Several young boys and girls braved bad weather and bombardments to reach the borders. The Prime Minister and his Cabinet colleagues, patting each other on the back, however, spared no effort to take credit for what they had failed to do. Evacuation consists of getting a person out of the crisis area. But here, students walked several miles or paid exorbitant sums to hire vehicles to reach the borders from where they could return home safely.
It is unfortunate that instead of praising students for showing bravery in crossing borders, the question asked is about their education, ability, level of knowledge, etc. So much is the lack of empathy in this hour of crisis that Union Minister for Parliamentary Affairs Pralhad Joshi, instead of helping, castigated students that 90% of Indians who study abroad fail not the qualifications in India. He does not know that even to go abroad for MBBS studies, students must pass the NEET.
The pertinent question that is now at the forefront is why should Indian students opt for admission to overseas medical colleges in such large numbers? They study not only in Ukraine, but in much larger numbers in the United States, Canada and China. Many are found in the Philippines, Kazakhstan, Kyrgyzstan and Bangladesh.
According to the National Medical Commission (NMC) website, India currently has 605 medical colleges with 90,825 places for the undergraduate course. Of these, 306 colleges with 45,035 seats belong to the public sector. The number of private sector colleges is 289 with 43,965 places and another 10 colleges with 1825 places. Tuition fees in private colleges range from Rs 60 lakh to over a crore. This is far beyond the capacity of even the middle classes. Therefore, students look for relatively cost-effective institutions. To study in overseas colleges, the total cost including travel and living is around Rs 30 lakh.
To register with the NMC, these students must pass the Foreign Medical Graduate Examination (FMGE). Those who pass this exam become equal with the others. So to raise such frivolous questions about their level of education is to hide the inability to provide medical education at affordable rates within the country. The Prime Minister said more medical schools need to be opened in the country to prevent our students from going abroad and called on the private sector to come forward. This will not help because the motivation of the private sector is the pursuit of profit. He also said that half of the places in these colleges will be free. It is not something that can be controlled easily.
We have experience of how private sector corporate hospitals which have reaped several benefits from the government and for which they are supposed to provide affordable treatment to 25% of beds, evade responsibility with impunity. The government had previously proposed to hand over district hospitals to medical schools which will be run by the private sector. It has been proposed that 50% of patients will receive free treatment in these hospitals. Persons interested in receiving free treatment will need to obtain permission from the designated authority. This will leave the poor running here and there for clearance.
It is important to see that the careers of these young students do not suffer. Computer cell trollers who seek to defame these students should be reprimanded. Such words at a time when students and their families are so traumatized after the nightmarish experience and the prevailing uncertainty can have adverse effects. They are now very worried about their future. The government should reassure that it will approach the issue with empathy. Every effort should be made for the continuation of their studies in Ukraine once the situation improves. He would likely wait for a period of six months. The NMC’s decision to allow internees to do internships in India is a welcome step. Others who are still in the graduation process should be assured that if things do not improve in Ukraine, they would be adjusted here to government colleges while charging the same fees they had to pay in Ukraine . More medical schools should be opened in the public sector. To alleviate the health crisis in remote areas, a commitment can be made by students to serve in remote areas in the state sector for a period of 5 to 10 years.
In the nearly 75 years since independence, medical education has been provided primarily by the public sector. It was only after neo-liberal economic policies that the private sector got a boost. In 1980, there were 112 colleges of which 99 belonged to the public sector while only 13 belonged to the private sector. But from 1980 to 2022, the number of colleges that have been added to the public sector is 207 while the private sector colleges are 276. Many of these private colleges lack basic facilities for training despite amounts students. This trend must be reversed to give impetus to medical education based on the criteria of medicine as a service and not for profit as the primary motivation. (API Service)

Helen D. Jessen