Citizens' Issues
Former Sion hospital dean suggests measures for complete overhaul of the Indian medical system

Dr Sadanand Nadkarni has a number of suggestions for improving the working of the medical system, and amending current academic practices. He is waiting for the Medical Council of India to act on his proposals

The academic system for producing medical professionals still has considerable scope for improvement. For example, many doctors use advanced technology for critical illnesses, but primary healthcare still remains a largely neglected area. Again, the complete medical system needs an overhaul—cases abound where professionals refer patients to expensive therapies where a simple prescription for a normal, OTC (over-the-counter) formulation would have done the task.

So how can the medical system be put through a complete overhaul?

Dr Sadanand Nadkarni, former dean of Sion Hospital (now called Lokmanya Tilak Municipal General Hospital) spoke to Moneylife on the suggestions that he had for overhauling the Indian medical system.

Dr Nadkarni said,”The Indian healthcare system is a mall, not a shop. It is an industry of repair and maintenance of human beings.” He added that there have been a number of cases where general practitioners refer patients to expensive procedures like brain and body scans. The tendency in India, Dr Nadkarni said, is to look at a doctor as a one-stop shop where all the patient’s ailments can be attended to.”
The former dean has penned a book called ‘Management of the sick health-care system’ in 2010. He had sent this book and a letter summarising suggestions for improvement to six members of the Medical Council of India (MCI). Out of the six members only one member, Dr Ranjit Roy Chaudhary, has replied to the letter on 8 November 2010. But none of Dr Nadkarni’s recommendations have been implemented. (Moneylife has a copy of Mr Nadkarni’s book, his recommendations sent to MCI and Dr Chaudhary’s reply).

The letter has eight suggestions for the MCI. First, Dr Nadkarni suggests raising the minimum qualification to 55% aggregate and 70% in PCB (Physics, Chemistry and Biology) at HSC/premedical examinations. He believes that this will prevent incapable students from becoming doctors. In his second suggestion, he proposes to have only one CET (Common Entrance Test) at the centre and state level each which should be conducted immediately after the final MBBS exam—and not at the end of the internship. He feels that allowing private practice to senior medical teachers outside the hospital premises is disastrous.

He advises that it should be strictly prohibited and instead 25% beds in each unit should be kept for paying patients with incentive payment authorised for senior teachers.

Since these beds are a part of the same ward, students can examine these patients, which will help them learn medicine.

Hospital training is 75% of medical education—so the method in which a hospital functions assumes importance. Dr Nadkarni told Moneylife, “Hospitals should work from 8am to 3pm where incentive-paying classes should be conducted between 4pm-10pm. One unit should be divided into two sub-units including a professor/assistant professor, lecturer and three resident doctors. Also, a part-time consultant should be allowed in each sub-unit.” Dr Nadkarni says that more applications will be available for the post of full-time professor or associate professors if the above process is adopted.

He adds, “OPD (out-patient department) and emergency should be clearly divided. In order to reduce overcrowding, cases referred from primary health care centres should have separate priority and timing while those coming directly should be charged moderately.”

Dr Nadkarni urged that unless the senior staff is occupied till 4pm, the tendency to move out for private practice cannot be effectively curbed. Only doctors who show efforts in research or writing textbooks should be granted the non-practising allowance.

Dr Nadkarni said, “MBBS should be taught for three terms instead of two and there is an urgent requirement to start certification or post-graduation for general practice. The PSM (preventive & social medicine) branch (could) possibly be renamed as the health care and social medicine department and conduct the course. And the primary health care (PHC) and the PSM department should conduct a social awareness and management course throughout the internship program and post graduation course.”

He told Moneylife,”Non-allopathic doctors should be given two years’ training in district hospitals before being allowed to practice allopathy. However, MBBS and non-allopathic general practitioners should be prohibited from prescribing very costly or recently introduced antibiotics and drugs and also from advising CT scans and MRI isotope studies. Instead, they should refer such cases to consultants who should be allowed to prescribe them. A list updated every two years that provides details about very costly drugs, investigations and drugs introduced in the last two years should be made available.” This, he says, will reduce health-care costs for the common man and prevent abuse.
Apart from MCI’s Dr Chaudhary, it has been eight months since Dr Nadkarni hasn’t got a reply from the other five members.




5 years ago

All doctors should practise what they have studied and examined for.
The shortage of doctors in rural areas is due to poor infrastructure. Most allopathic doctors may move to rural areas if given proper openings. All human beings are entitled to the best of the treatment.

Andhra Pradesh CRZ authority clears Hinduja power project proposal despite encroachment

Former power secretary EAS Sarma complains to the environment ministry also against similar clearances to other projects like the Gangavaram Port, an SEZ and a luxury resort

At a time when industries and mining corporations are coming under increased scrutiny, the government authorities themselves seem to be in a strange hurry to sanction large-scale projects without getting the assessment reports and overlooking the loopholes in information furnished by companies.

The Andhra Pradesh government recently granted coastal regulation clearances to a host of big projects in the Visakhapatnam area, the most prominent among these being the thermal power project proposed by the Hinduja group. Environmentalists allege that the clearances have been wrongfully granted, as many of them violate several laws.

The Hinduja power project appears to be the worst case. The group had asked for permission to desalinate sea water for cooling purposes and laying down of railway tracks for the plant.

Concerned that the clearance has been granted on the basis of misrepresentation of facts by the company, former power and finance secretary EAS Sarma has written to the Centre, asking for an immediate reversal of the clearance and an inquiry into how the clearance was granted by the state.

"I have requested the Ministry of Environment and Forests (MOEF) to inquire into the misrepresentation of facts by the company to obtain a "revalidation" certificate for a lapsed environment clearance," Mr Sarma said. He has complained that no public consultation has taken place regarding the project, thus denying the local people the opportunity to raise objections.

According to information available, the Andhra Pradesh Coastal Zone Management Authority(APCZMA) gave the green signal for the power project, even after the Hinduja group encroached on CRZ land which was declared off-limits. A compliance report from Hinduja National Power Corporation (HNPCL) in April 2011, shows that it had started work on 622 acres out of 1,122 acres of non-CRZ land. However, a survey list shows that 730 acres of the 1,122 acres is within the CRZ, which means that the company has encroached upon the no-go area that is largely agricultural land and sand dunes.

"The company admitted to have drawn water from groundwater sources, an activity prohibited in the CRZ. HNPCL stated that APIIC (Andhra Pradesh Industrial Infrastructure Corporation) has 'allotted' water to it. HNPCL cannot get the promised water from APIIC and since no desalinated water to the extent needed will be available, the company is perhaps trying to tap groundwater from CRZ survey numbers covering an area of 730 acres in its possession. This is clearly prohibited," Mr Sarma pointed out.

The situation of water shortage first came to light when Mr Sarma filed a write petition in the High Court against water committed to Jindal Alumina Refinery. It was shown that water drawn by existing industries and localities is already beyond the limits prescribed by the authorities for 'future' enterprises, impacting the environment negatively. Till date, the government has not responded to the court's notice. However, the Hinduja group has already invited tenders for construction of a cooling system and allied services.

The land allotted to HNPCL has also stirred up more controversy. Mr Sarma says that this is Wakf property and that the courts have questioned the propriety of the government to hand over Wakf lands to a private party. "The intake facility covers D-Patta lands in Appikonda and other villages, the alienation of which attracts action under the AP Assigned Lands (Prohibition of Transfer) Act,1977," he wrote in his letter.

Also, if the railway track materialises, the area will be affected severely by coal dust pollution. Mr Sarma said, "Hinduja Power Corporation's compliance report of October 2010 requires that the company should work out a common railway facility with the adjacent Simhadri power plant of NTPC, so that the stress on the local environment is minimised. HNPCL has evidently not complied with this requirement, making it mandatory for the MOEF to invalidate its clearance for the project."

The Visakhapatnam industrial area has already been identified among the top 40 highly-polluted industrial complexes in the country by the Central Pollution Control Board.

Apart from the Hinduja project, APCZMA has also granted clearances for the Gangavaram Port (GPL), an SEZ of Andhra Pradesh Industrial Infrastructure Corporation, a luxury resort of Brook Fields and Resorts, and a 1,600 MW thermal power project in Nellore. The clearance for the Nellore power project was granted even though a writ petition filed by local inhabitants is pending before the High Court. The authority also seems to be oblivious of the massive amount of explosive substances like ammonium nitrate being stored by Shravan Shipping Limited in the area.

The authorities have been directed by the High Court to pull down unauthorised structures in the CRZ area, but they have not done anything. Instead, the APCZMA has decided to reduce the CRZ area along Meghadrigedda Creek. The National Institute of Oceanography(NIO), the custodian of the CRZ, seems to have turned a blind eye to all this, which makes it a party to the wrongdoings.

"I request the MOEF to return the proposals straightaway," Mr Sarma says. "I would also earnestly request the MOEF and the National Coastal Zone Management Authority to introspect on their role and responsibility as custodians of the CRZ. They should provide a vision to the states, not become rubber stamps to legalise illegalities."


India makes first payment for Iranian oil in five months

MRPL last week deposited an equivalent of $100 million in a rupee account in the New Delhi branch of Union Bank of India which then routed euros equivalent to state-owned Turkiye Halk Bankasi (Halkbank) in Istanbul. Other refiners that import oil from Iran are expected to use the new payment route

New Delhi: India has made its first payment in more than five months for crude oil its buys from Iran when a $100 million wire-transfer by Mangalore Refinery and Petrochemicals (MRPL) was received by Tehran via Turkey, reports PTI.

MRPL last week deposited an equivalent of $100 million in a rupee account in the New Delhi branch of Union Bank of India which then routed euros equivalent to state-owned Turkiye Halk Bankasi (Halkbank) in Istanbul.

Halkbank has since transferred the money to the account of the National Iranian Oil Co (NIOC), sources said.

"The pipeline (for payments) has been opened... we have confirmation that money transferred has reached the intended beneficiary," a source said.

MRPL's was a test payment and now more refiners will use the same route to pay Iran. Essar Oil, the nation's second biggest importer of Iranian oil after MRPL, is to transfer money today and will be followed by state-owned Indian Oil Corporation and Hindustan Petroleum Corporation, each sending $50 million.

This is the first payment Indian refiners have made to Iran since February when it had paid 1.5 billion euros through German-based Iranian bank Europisch-Iranische Handelsbank AG (EIH Bank). But soon after that payment, US convinced Germany to block that conduit.

India owes more than $7 billion to its second biggest oil supplier after Saudi Arabia.

Iran had yesterday stated that the payment problem, which arose when the Reserve Bank of India (RBI) in December last year unilaterally scrapped a long-standing mechanism of trade through region's central bank, with India has been resolved.

The Iranian oil ministry's website SHANA yesterday quoted NIOC managing director Ahmad Qalebani to say that "the problem of Indian payments for imported oil from Iran has been solved".

It quoted NIOC's director for international affairs Mohsen Qamsari as saying that "the two sides had reached an agreement on the arrear payments... related bank accounts have been announced to Indian side and the amount deposited into our accounts would be revealed by reopening of the international banks on Monday".

Iran's 4 lakh barrels per day of oil exports, which is 12% of India's needs, were "going on as usual", he said.

The RBI had on 23rd December last year scrapped the Asian Clearing Union (ACU), winning appreciation from the US, which is using sanctions to force Tehran to halt its nuclear programme.

Sources said Iran, which has been supplying some 400,000 barrels of oil per day (bpd) on credit since the RBI move, had previously provided no plans for shipping oil in August but refiners can expect crude as usual.

Iran had on 27th June written about stopping supplies from August if the dues are not paid.

Mr Qamsari said, "A notice had been sent to Indian indebted oil refineries, but this did not mean stoppage of oil exports to the country."

"NIOC has no plan to suspend oil exports to India," he said, pointing to good relations with India.

Indian refiners had tapped Saudi Arabia, Kuwait and Iraq to cover for any supply disruption from Iran.

MRPL is the largest buyer of Iranian crude, at 1,42,000 bpd, while Essar buys 1,10,000 bpd of oil from Tehran.


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