I read with interest India Medical Times dated 16th February 2017. It was diabolical that in articles by Dr Kamal Mahawar and Dr A J Prasad we talk of holistic development of Medicine with concentration on Primary Healthcare and in the same breath an erudite brain, Dr Devi Shetty, exhorts of the government to raise postgraduate seats in Medicine.
I am not sure how and from where the figures of 26 million and 65 million surgeries were quoted by Dr Shetty, because no source has been quoted, I presume it’s an intelligent “guesstimate”. However, setting this issue aside the questions that I ask are:
1. Why was the need for such huge numbers created?
2. How many of these surgeries are needed for lifestyle and man-made disasters?
3. Even if we treat them, won’t in no time an equal or more numbers emerge and we keep playing the catching up game?
4. Without proper Primary Healthcare facilities in rural areas, how would one ensure that these extra specialists go to rural areas, where they are needed the most, rather than adding to the mushrooming of specialists and super-specialists in urban areas?
5. American model has been quoted by Dr Shetty, but hasn’t that model failed miserably in that country?
6. Who will fund these additional surgeries and can we afford them?
I agree with Dr Prasad that, “Illogical imitation of the American Healthcare model won’t serve us well”. And for that matter, though we may study and learn a lesson or two from the Cuban and Scandinavian systems, we must not follow them blindly. We must evolve our own customised model.
We have probably the world’s largest primary healthcare infrastructure, which is lying defunct and unused or misused. We must revive that and equip it with both facilities and human resources of basic doctors and paramedical staff, kind of Physician Assistants which Dr Shetty has been passionate about, and correctly so, rather than developing specialists.
We must aim towards health promotion, pari-passu with efforts to prevent diseases, thus leading to reduction of the burden of disease, rather than chasing disease. In this endeavour, we must also tap into our huge resources of alternate forms of therapy, including Yoga, which have a wide acceptance with the bourgeoisie and likely to fair much better than modern systems of medicine.
Latter we may then be in a better position to play a significant role in mopping up of the residual burden of disease.
We need “Health providers” and not “Disease mongers” and “Disease treaters”. The latter two suit the corporate private sector and the industry but is neither in the interest of the patients nor of the country.
Food for thought!
The author, Dr O P Yadava, is CEO and Chief Cardiac Surgeon of the National Heart Institute, New Delhi.