Dr Jagdish Prasad is director general, Directorate General of Health Services (DGHS), Ministry of Health & Family Welfare, Govt of India. He has also served as the founder principal and professor & chief of cardiac surgery at Vardhman Mahavir Medical College and medical superintendent of the associated Safdarjung Hospital in New Delhi.
Dr Prasad did his MBBS and MS (General Surgery) from the All India Institute of Medical Sciences (AIIMS), New Delhi in 1977 and 1981 respectively. He did his super specialization (MCh) in cardiothoracic and vascular surgery from KEM Hospital, Mumbai in 1985. He has also done DNB in cardiothoracic surgery in 1986.
In recognition of his contribution to the field of medicine, particularly cardiothoracic and vascular surgery at Safdarjung Hospital and economizing the cost of cardiac surgery, the President of India conferred on him the Padma Shree Award in 1991.
In an exclusive interview with India Medical Times, Dr Jagdish Prasad shares his views on the overall healthcare sector in the country and some of the major issues concerning the medical profession:
How do you view the overall healthcare sector in India?
Overall healthcare sector is divided majorly into two — one is rural healthcare and the other is urban healthcare. Technically, we are very advanced as any other country such as in Europe or the US. Be it brain surgery, cardiac surgery or heart transplant, result-wise we are as good as they are. Take medical tourism – it will go up gradually, especially in private hospitals that are providing five star facilities which people want.
On the other hand, doctors are concentrated only in cities, not in villages. The reason behind this is not only doctors but the whole education system. There is no control over the education system in the country. Suppose if you are giving donation for studying in a private medical college, obviously you would like to earn the money. That means you can’t work for small amount, you would look for bigger opportunities. So this donation culture needs to be stopped completely.
Why doctors are protesting against rural posting?
Doctors are protesting against rural posting because they know infrastructures in the villages are very poor. Suppose you are posted at a village or in a block, you don’t get a house, how would you stay? There have to have some infrastructure, some schools. Now suppose a person who passes BA and becomes a deputy collector, and then a block development officer, the moment they become a block development officer, they get a car, a house, servants and, of course, power. Doctors don’t want power, but there has to be basic infrastructure such as house or at least they should have a quality infrastructure to work. A surgeon posted at a district hospital doesn’t have instruments, so how do you expect him to work.
But then it is both ways. Sometimes doctors are also bad — some doctors, who are posted at district hospitals, will go for one day in village and take the whole month’s pay. It will continue to run this way, until a consciousness comes that doctors should be provided basic infrastructure facilities such as house, water, instruments, electric supply, roads etc. Until the government develops these facilities, you can’t expect doctors to go and work in villages.
The time has come now that we must have a community type of basic healthcare centre and government should work on preventive and promotive healthcare structure. Even when you are healthy, you should have a regular health check-up rather than falling ill and then spend lots of money. For example, in the case of breast cancer, if diagnosed at very early stage, it can be 100% cured and one can lead a normal life but a little delay and you would end up spending lots of money. The same is with coronary heart disease, diabetes or hypertension, a regular check-up means prevention of further development of complications and your medical cost will also decrease. This, the government must understand and the people too.
There is digital India plan now being thought of, how do you plan to implement it in the Indian healthcare sector?
There is a big project that we have already planned but its implementation will cost a huge amount of money. Putting huge amount of money is not a very tough job but before that you also have to have an infrastructure.
No doubt, digital healthcare will make things very easier. Recently, we have introduced ‘Nischay’ (नि:क्षय) – a project where every tuberculosis patient is enrolled. We are giving palmtops to every 2.5-lakh population and they will keep the records so that we can follow every TB patient. This kind of digitisation we are doing in public healthcare system. In public healthcare system, or telemedicine system, it can play a tremendous role. For example, PGI Chandigarh is doing the treatment of psychiatric patients through telemedicine. They have connected with normal medical officer at district hospitals who collect the history of the patient and then introduce the patient to doctors sitting at PGI, explain the problem and the doctor then gives his advice.
So, digitization of whole system is going to help in big way in every sector — be it public service or education or healthcare treatment or diagnosis or teleradiology or telepathology. PGI Chandigarh has started telepathology. They (doctors at district level) put a slide on the microscope and send the picture to Chandigarh and then get the report. They think digitization requires a lot of money but that’s not true. If you digitalize the things then you can decrease the duplication of investigation to a great extent. Suppose, you have blood test done at one place and get the record, then if you visit to other doctors for consultation for the same disease, you don’t have to redo it and thus can save money. But then there is fault in doctors also, prescribing unnecessary medical test which is not required, and for that we are putting the Clinical Establishments Act which is getting objections from doctors. The Act is not to harass doctors but just to regulate the treatment and avoid the harassment of patients. Consider a chest pain case, which is a muscular pain, it can be cured without requiring angiography or angioplasty or anything but some doctors would prescribe it unnecessarily. This type of malpractice needs to be checked but it’s a difficult task.
To curb the unethical marketing practices of pharma companies, the government has issued a uniform code of conduct. How do you feel about it?
You have to change the basic foundation first.
How it can be changed?
We have to stop selling education in the country. Increase the facility, the infrastructure and don’t treat the doctors like an officer; they are professional people, they should be treated professionally. Doctors put hard labour; to become a surgeon it takes eight years, to become a cardiac surgeon ten years. It requires a constant hard labour and then you are treating them with a person who has just passed BA and becomes a bureaucrat. You need to give doctors some importance but the irony is… importance is realized only when they fall ill. Foundation of the doctors has to be taken care of; infrastructure has to be built up. The standard of education has come down. There is no uniformity in this sector, which is the biggest drawback in medical profession at the moment.
Do we need some changes in medical curriculum as well? There was news about NEET and Exit Exam.
It (NEET) was nixed… the Supreme Court judge could not understand that he has done a great harm to the country, to the whole citizens. It should have been implemented.
There was also news that the government has filed an appeal against this judgement?
Yes, it has been filed. Government has to change some policy. They have to check the basic structure, basic foundation, and correct it.
I will share an incident, 10-12 years back when I was on a tourist visit to Hong Kong, I saw there that at that time, one constable was paid (equivalent to approximately) Rs 1 lakh and the Prime Minister’s salary was Rs 5 crore in a year. The government was paying enough. Now compare this, I will give you another example, a CBI SP came to me (I will not take the name) and said, “Dr Prasad, can you refer some job for my wife, she is a senior doctor? As I have been transferred from state to centre and I am not getting that much (pay). It’s very hard to live here.”
So what pay government is giving? The cost of living has gone up. After doing 10 years of IPS service, if you are not able to give good education to your children then what are you forcing and to whom? This has to be changed. Things will change only when you make the facilities available. If you go to Cuba, education is totally free, they will give you books free, hostel is free, and almost everything is free but then they will post you in district hospitals. The doctor also does not hesitate to work in a district because he was trained, educated there only. Here (in India) students suddenly come from a village to Delhi, Mumbai, Allahabad, Lucknow, see the city environment where they get good facilities but when they look back at the village there is no light, no house, no roads. The infrastructure is also lacking, also there is lots of pay disparity, many other problems.
So, does that mean we need to set up more medical colleges, may be at district level?
No. No need to set up more medical colleges, we have enough medical colleges. It’s a wrong way to say that we can improve healthcare, get more doctors, by opening more medical colleges. No. Whatever doctors are available at the moment, if properly distributed, we will have enough. We have nearly 8 lakh doctors available in Ayurvedic system; we have to drag these doctors also for the basic disease treatment. Every single disease doesn’t require surgery.
But many doctors are against equating Ayurvedic doctors with modern doctors, some even call them quacks?
Government should take the policy decision, not protestors. How can they call Ayurvedic practitioners quack, they also study four and half years, they can cure some diseases which we cannot. They can’t call them quacks; they are qualified and registered practitioners. Ayurveda, Yoga, Homeopathy — all these forms are well-recognised systems of medicine which can’t be ignored. It has to be brought up in the mainstream.
There is no need to open more medical colleges. The need is to make the infrastructure good and available. Like in a village the need is to build a nice operation theatre, a blood bank should be available. You are making a district hospital but there is no blood bank. How the surgeon will operate? There is no instrument, there is no light, there is no water supply, there is no toilet… there are so many problems. The doctor has no place to stay, no house, they will ask you to rent a house. If you are making a hospital, make it a residential hospital – for the nurses, for the doctors, for the class-IV employees… why do people want to come to the All India Institute of Medical Sciences? Because every facility is available… they are working for the same amount of pay, even for less amount… nobody wants to leave, because the infrastructure is such. If they want to do research, they will do research; if they want to do good operations, they can do it; if they want good instruments, they will get it. So, if you make the facilities, definitely, they will come.
Antibiotic resistance is a major challenge in front of India and we are one of the largest consumers of antibiotics. How do you think we can cope up with this challenge?
Even though it is a tough task, the government has started surveillance in different places. We have taken the help of Pharmacopoeia Commission and we are taking pharmacovigilance. We have brought some medicines under the ‘Schedule H1’ category, which can only be given on prescription. We have also requested MCI to make it mandatory for every medical college to have a pharmacovigilance committee so that what antibiotics are used, why it is used, can be monitored. So that at the tertiary hospitals at least the use of antibiotics is not indiscriminate. Because the problem mostly occurs in the ICU, where lots of resistance come up. Few countries such as Sweden do not use antibiotics until and unless they do a culture test but in our country it is not possible. Suppose you are in a village and had a throat infection, you will go to a chemist and ask for an antibiotic. Though it may be get cured by a gargle but you will take some antibiotic. And you are not at fault because there is no doctor available to consult. This problem will take long time to resolve but there is definitely requirement to have a comprehensive check on the sale of antibiotics and lots of education is required for doctors as well, patients awareness is required too.
Nowadays, many of the doctors are attacked and manhandled at healthcare centres. How to tackle this issue?
In our country, the number of patients is more than the number of doctors, especially at public hospitals. If you go to Safdarjung Hospital’s gynae department, everyday you will see huge number of patients, mainly because all other hospitals close by evening. Imagine 100-110 deliveries in one day and suppose five patients require surgery but at one moment only two surgeries can be done because there are only two operation theatres. Other persons are also waiting, crying in pain. Those people can’t wait; they will ask: ‘operate my patient first’. At this point, both are agitated and annoyed — the doctor is agitated because he has been working since morning and the people are agitated because patient is suffering, the result is a tussle between them. This tussle is because the gap between the supply and demand. There is in no adequate infrastructure — only two operation theatres and 100-110 patients are waiting for delivery.
So, according to you, how to tackle this problem?
All the hospitals in the periphery should start working 24×7. After 4pm, apart from Safdarjung, Lady Harding and Ram Manohar Lohia Hospital, all other hospitals stop working. So, the entire load is on these three hospitals. Government should ensure that other hospitals too should be available for patients. Delhi government should make sure that all patients should go to the nearby hospital for delivery rather than flock into these three hospitals.
What message you would like to share with your fellow doctors?
I would only say: follow the ethics, do the research which is required. Talk to the patients nicely, and think of them as your brother, sister, mother. You must have a feeling of family towards your patients; treat them as your own.
by Vidhi Rathee