O P I N I O N S

Guest Column
A case for pride and reform in medical education
Dr SK Sarin
Though late, the Government of India has realised the importance of health and education as two important pillars of economic well being. The increase in population, health care demands, need for basic doctors and specialists and the public sector’s inability to foresee fulfil the needs provided ample opportunity for private players to enter medical education.

Touchstones
Why we can’t do a London in India
Ira Pande
They say this was the warmest summer London has seen in a long time and it seemed as if everyone was determined to make the most of it. The streets were full of holiday makers and cafes and parks overflowing with babies in strollers, dog lovers and aged folk tended by parents, owners and care-givers, respectively. English is a rarely heard language on its streets now and I was amazed at how culturally and linguistically varied England’s population has become in the matter of a just a few decades.

The view from inside Pakistan
There is a clear disconnect in Pakistan between what people think about relations with India and the confrontationist approach adopted by their government. In fact, most look upon India as the aggressor.
Raj chengappa
At school, among the many short stories I studied the one that made a lasting impression was 'Purdah'. It was a simple story of how a family hid its poverty by hanging a fancy curtain on its front door to veil the misery inside. Travelling on the Lahore-Islamabad motorway last week, I was reminded of this story. The motorway is Pakistan’s showpiece and is superbly maintained.

Guest Column
A case for pride and reform in medical education
Dr SK Sarin

Though late, the Government of India has realised the importance of health and education as two important pillars of economic well being. The increase in population, health care demands, need for basic doctors and specialists and the public sector’s inability to foresee fulfil the needs provided ample opportunity for private players to enter medical education.

In the last decade, these outnumbered government medical colleges. The demand and supply gap was huge and the arena so lucrative that politicians, middlemen and people with connections started influencing the policy makers, including the Medical Council of India (MCI), an autonomous body established through an Act of Parliament in 1956. Unfortunately, keepers of the law remained silent spectators, till the lid was blown. CBI raids on top MCI officials and several colleges brought so much ignominy on the government that it was forced to bring about a change. The government appointed a team of professionals with integrity as the Board of Governors (BoG) in mid-2010 — to bring to shore a sinking ship against the unfavourable winds and hungry sharks. The situation demanded swift action.

The board fast-tracked the routine monitoring of colleges by simplifying norms to set up and recognise medical colleges, facilitated increase in the seats, setting up web-based faculty identification system (to prevent passing off the same faculty in more than one college), changing ‘inspector raj’ (removing permanent inspectors) to ‘professional assessments’, etc. To maintain the ‘quality before quantity’ principle, the shortage of teachers was met by raising the retirement age from 65 to 70 and by permitting trained DNB specialists to be considered for teaching.

However, the BoG realised that monitoring skills and quality of education in about 340 medical colleges was not easy and would not yield the desired results. They decided it was better to assess the ‘product’, the medical graduate. This can only be done by ensuring good ‘raw material’ and a quality finished product. This gave birth to the National Eligibility-cum-Entrance Test (NEET) and the National Exit Examination, a licentiate exam to qualify as an Indian Medical Graduate (IMG). The BoG defined the proficiency level of an IMG. We do hope this exit exam, which includes testing knowledge and skills (makes internship purposeful), is introduced soon so that the suffering lot do not have to wonder where has the doctor graduated from!

As the National Eligibility-cum-Entrance Test became a reality in 2012, the private players in the medical education industry were not ready to accept it. They wanted the old system of regional exams, so they could fix the  price of seats.

The BoG-2010 also designed several new career options after MBBS, such as M.Med (previously called diplomas) and dual courses (MD-PhD). The need and process for equalising the PG and UG seats was set in place by removing ‘essentiality clause’ from PG education. This document on medical education, vetted by nearly 300 college deans and vice-chancellors, was called ‘Vision 2015’, and was well received.

The quality of ‘raw material’ entering the medical stream has become questionable, because of conflict between the payers and non-payers, the private and public colleges. ‘Simran Jain versus Union of India’ was a case in context before the Supreme Court. The BoG saw an opportunity to establish a common entrance test. It developed a comprehensive policy and took on board different states having their own educational priorities and standards. The BoG had its eye on the poor village boy studying under a lamp post with the dream of entering the AIIMS on merit, with no resources or ‘connections’. The issues of quota, religion, rural and urban, rich and poor, coaching institutes, etc, were, however, overbearing. The BoG took help from the CBSE to standardise various state board syllabi, set up eligibility and seat allocation criteria, allowing state reservation policies their say, and with the patronage of the Central government placed before the highest court a fair and transparent system for a national entrance examination.

In a landmark judgment, on December 13, the highest court gave the green signal for the NEET. After some initial hitches, the GoI undertook to have the NEET for both UG and the PG medical entrance in 2012. It was dream come true for thousands of students, right thinking medical men and hailed as a major milestone in ensuring equitable and affordable opportunity in a capitation-driven industry called medical education. The NEET breathed in minimum eligibility and a uniform and transparent assessment system which was convenient and economical; alleviating the need for students and parents to rush to nine-ten centres across India for entrance examinations. Above all, from the national perspective, it was to reduce corruption and malpractice. If you enter the profession by corrupt means, your approach and practice of medicine is bound to be tainted.

As the NEET became a reality in 2012, the private players in medical education industry were not ready to accept it. They wanted the old system of regional exams which permitted them to fix the price of the medical seats based on the demand. They knew the supply could not meet the demand for many years. They bought the best legal brains of the country, who joined hands to defeat ‘truth’ and the rights of ‘the village boy’ to be a doctor. In an unprecedented move, the highest court permitted the private players to hold their own admissions despite the NEET having been already conducted.

But there is hope. The Supreme Court judgment was divided, the dissenting clear verdict of a senior judge allowed a review writ petition by the GoI. The petitioners would again be challenged by the best legal brains. Why does the medical profession not join hands to clean up its own muck? Why does it want others to decide for it issues such as bringing in Indian Medical Council Amendments (2013). When chartered accountants, engineers, the IAS, the Bars (CLAT) can have a common entrance examinations, why should the very genesis of the medical profession be allowed to become unethical? We have faith in the judiciary and media, and do hope that a fair and far-reaching judgment on NEET would be delivered fast. The aspiring students need to know for which exam they have to prepare this year. We have miles to go before accomplishing ‘Vision 2015’, and NEET is the first and essential step.

The writer is a former Chairman, MCI Board of Governors, and at present Director, Institute of Liver and Billiary Sciences, New Delhi. The opinions expressed are personal.

Touchstones
Why we can’t do a London in India
Ira Pande

They say this was the warmest summer London has seen in a long time and it seemed as if everyone was determined to make the most of it. The streets were full of holiday makers and cafes and parks overflowing with babies in strollers, dog lovers and aged folk tended by parents, owners and care-givers, respectively. English is a rarely heard language on its streets now and I was amazed at how culturally and linguistically varied England’s population has become in the matter of a just a few decades.

The British Museum has been drawing huge crowds with a spectacular exhibition on the last days of Pompeii, the city destroyed overnight by a volcanic eruption. The recent Uttarakhand cloudburst must have been a similar tragedy when a living community was destroyed in a sweep. Sadly, we were unable to get tickets but I was told by friends that the reconstruction was an eye-opening experience. The bodies buried in fly-ash had disintegrated leaving holes that were carefully filled with plaster to recreate them. The result was a moving spectacle of a mother huddling under an archway with her children drawn close, a dog and people caught unawares when lives were snuffed out in the blink of an eye. The recreated city made a remote tragedy come alive to people separated by time and history and highlighted how close an event so far in time can be to one’s own worst fears and emotions.

London is a melting pot of cultures.

To turn to more cheerful matters: India featured in some cultural events around this time. A retrospective of Satayjit Ray’s films was being held at the British Film Institute while Hayward Gallery next door had an exhibition on Nek Chand’s Rock Garden! The South Bank area is a fine place to stroll and catch up with what is new and happening. It is also a wonderful introduction to the wonders of London’s constantly evolving skyline that has new architectural experiments sitting cheek by jowl with the venerable dome of St. Paul’s.

The lively Covent Garden, encourages young music students to perform during the day at its many cafes to earn some money. Some are surprisingly good. There are also clowns, jugglers, amateur magicians and on a sunny afternoon, it is fun to watch the endless spectacle of humanity.

Does anyone care to promote a new and young India at cultural centres or are they viewed as convenient parking sites for those who have personal reasons for seeking that post?

A visit to Cornwall was another treat. Known for its pirates and smugglers (remember Daphne du Maurier’s Jamaica Inn and Frenchman’s Creek?), it is now better known for its glorious beaches and sheltered bays, where it is difficult to find a place to sit when the sun is out and the turquoise waters of the Atlantic at their best. The Tate Modern has a small museum in St Ives, where special activities are laid on for young children and families. The displays are nothing much to write about but on its sunny terrace, we spent a lovely afternoon after browsing through the exhibitions. Nearby is the beautiful Barbara Hepworth museum, a tribute to one of England’s best-known sculptors. The museum is located in the building that housed her studio, and is set out among flowering bushes and water bodies studded with her work.

There is so much we can do with our stupendous cultural heritage and make it into a self-financing enterprise. However, we manage to get it wrong each time. I will end with a visit to London’s Nehru Centre (run by the Indian Council of Cultural Relations and the MEA) to attend a lecture. I could not spot any staffer, let alone the Director, to introduce or conduct the evening. It was left to Rachel Dwyer of SOASS and her publisher-husband to ensure an audience and later host a dinner in their charming home. Surely, the centre can offer some hospitality and reach out to a larger audience.

I am told that ever since it has become a cadre post to be manned by an IFS officer, it has lost the zing it had when a Gopal Gandhi or a Girish Karnad headed it. Does anyone care to promote a new and young India at such centres or are they viewed as convenient parking sites for those who have personal reasons for seeking that post? In times when our cultural life is booming with fresh energy, I would love to find out why we have let such prime properties and institutions become such musty places. Grace and favour have their place but to promote mediocrity is a crime against the aspirations of a nation desperate to improve its international image.