Playing with the Profession?
Health as a matter of right is recognized throughout the world for its intrinsic value. India as a signatory to the Alma Ata declaration is committed to provide ‘Health for All’ without any discrimination on the grounds of rich or poor and urban or rural. The national health policies are formed on the basis of this very principle. But inequality of opportunities, the gross mismatch between the stated objectives and the resources available and the inability of the state to bring quality health care within the reach of all has increased the vulnerability of the people, particularly the rural areas and has led to the emergence of a new tier of physicians, who run a parallel health care system and play a formidable role in the rural health care market as rural healthcare providers. This group of quacks manage certificates from unauthorized and unrecognized institutions.
‘Quack’, according to the Supreme Court are defined as, ‘a person who does not have knowledge of a particular system of medicine but practices in that system’. These quacks have neither MBBS degrees nor license to practice medicine, yet they run their dispensaries in remote areas with impunity. But thanks to the failed formal healthcare system, innocent rural population fall prey to the ‘magic pills’ prepared by these practitioners. Further, adding to the problem is the imprudent act of these quacks to use names of boards of qualified practitioners to run their business.
According to rough estimates, on average, there are 12 RMPs per 10,000 populations. About 90 percent of the RMPs are from the deprived social groups. They are relatively young and a majority of them have more than 12 years of education. Being the first contact in the medical emergencies, their popularity is very high in rural areas and urban slums.
Indian Institute of Health Management Research undertook a study in Sundarbans which manifested that ’80 percent of children were treated by quacks and less than 10 percent were referred to qualified doctors.
Are They Authorized?
Despite so many allegations, self-acclaimed practitioners are functioning in every nook and corner of the villages, without any resistance either from the community or the authorities. It would not be redundant here to reflect on how do these people are indomitably functioning as part of the rural health care market along with the other providers of health care.
For so long these untrained practitioners are playing with the lives of people, but governments still fail to set up an authorized council or statutory body to regulate their activities. Shockingly, quacks have a protective boundary called RMP Welfare Association at district, state and national level.
These practitioners, who don’t have rights for writing prescription, are fearlessly using ‘Dr’ before their names. Especially, brought up for providing first aid treatment like wound dressing, they are prescribing drugs, and some RMP doctors are involved in surgeries like Hydrocele and Hemorrhoid surgeries.
Such malpractices are hurting the genuine professionals. Once these qualified doctors through Indian Medical Association (IMA) filed a petition against these illegal practices in Supreme Court, but ironically, qualified professionals lost to these non-qualified doctors. In the ruling, Supreme Court said RMP doctors are not authorized prescribers but they are health care providers of rural India in respect of First Aid Treatment. Supreme Court has given certain boundaries to RMP doctors, to run First Aid clinics within certain boundaries as mentioned bellow.
- RMP should not prescribe drugs or medicine, even should not recommend more than two doses of OTC drugs.
- RMP should not deal legal, pregnancy, emergency cases.
- RMP should not terminate pregnancy.
- RMP should not administer injections.
Why Rural Patients Prefer to Go to Them?
In spite of knowing that they might be getting cheated in hands of these quacks, rural patients still prefer to visit them rather than government health care institutions despite the fact that they both are cheap. The fact that quacks run a formidable parallel health care system compared to a benumbed public health care delivery system is what encourages many rural people to run to them.
It is a bizarre that despite the fact that these people lack the necessary educational background, expertise, proficiency required for practicing medical science, exhibit fake certificates, cultivate commercial relationship with the qualified doctors and medical representatives, follow faulty treatments protocols, impair the sanctity of the profession, they are resolutely functioning as medical practitioners in different villages in India. It is the basic necessity of healthcare that empowers them and which transgresses the question of legality v/s illegality. It is unfortunate that development has remained so lopsided that even basic services are inadequate at the grass root level. Quacks fill this vacuum.
It is unlikely that in the near future, the government would be able to provide alternatives sources of treatment for the poor in the rural areas. It is therefore necessary to train the educated RMPs in the basic curative care and safeguard the interest of people in rural areas. The training in basic medicine is to discharge unnecessary injections, and inappropriate and incomplete doses of antibiotics. They can be trained in minor problems and in identifying serious problems for referring to qualified doctors.
It is a primary duty of the state to safeguard provide basic healthcare to its citizens. But the state seems to be in a dilemma so far quackery and quacks are concerned. Ground realities of the country warrant that quacks should continue, irrespective of the fact whether they are qualified or not, legal or illegal. State also seems to have compromised with the situation. With its inability to render adequate healthcare services, it has grudgingly accepted the existence and functioning of a third tier of quack physicians running a parallel healthcare system, even though it runs against the basic grains of ethics. Since they cannot be wished away, it is in the public interest to train the educated RMPs and regulate their services. But over long-term, there is no alternative but to put in place a functioning formal healthcare system and government cannot shirk this responsibility.