Unqualified medical practice is big business in India. The major beneficiaries, apart from those that rely on the services of unqualified health providers (UMPs), were, quite unexpectedly, qualified doctors.
The revolving door opens when a qualified doctor employs a medically unqualified worker as an apprentice. Over 18 months to five years the assistant learns the tricks of the trade — prescribing drugs for practically all outpatient conditions — vomiting, diarrhoea, fever, crashes, joint pains, respiratory distress, abdominal pain, flu, typhoid, dengue besides children’s illnesses. The door closes when the UMP sets up his own practice but re-opens when the UMP starts referring his patients to the doctor for earning commissions.
How did the UMPs acquire skills to treat medical conditions?
- They learnt what they know from qualified doctors who engaged them as helpers. Once they leave the relationship grows into a marriage of convenience when the UMP provides a regular supply of patients and receives commissions (up to 30 per cent of the fees charged) for this service.
- Women UMPs too are in high demand. Trained under qualified doctors who hired them as cheap help during deliveries, these skilled birthing attendants eventually move on and open their own maternity businesses.
- They describe every detail of how labour is induced; including the use of oxytocin injections after the dilation is sufficiently advanced. They could recognise pregnancy complications and were astute enough to refer cases to qualified doctors in time. The cost of delivering a baby here remains less than one quarter of going to a doctor’s clinic.
- Pseudo pharmacists form another large and ubiquitous category. They readily sell antibiotics and steroids over the counter based on stated symptoms and by recalling AIIMS and other senior doctors’ prescriptions for given conditions. In addition the medical representatives of pharmaceutical companies were their trusted allies as they gifted them a bagful of free samples on every visit along with a tutorial on medical conditions and drug dosage.
- A fourth category of UMPs were found dabbling in a mixture of allopathy, Ayurveda, homoeopathy — even electro-homoeopathy. From signboards and the display of a wide variety of medicine it was apparent that they were in demand for treating gupt rog (secret diseases) aka sexually transmitted diseases, reproductive tract infections, sexual problems and piles.
Missing in action
- Under law the Medical Council of India and its state chapters are responsible for taking action against those who practice medicine without a medical qualification. Responses given by the Health Ministry to Parliament have invariably stated that it is for the State Medical Councils to take action. The Indian Medical Association castigates quackery but does not deregister its members from training and then paying commissions to UMPs to garner patients.
- Other law enforcers too have safe alibis. Police officers and district magistrates even when they see what is tantamount to cheating and impersonation do nothing because the offences are not “cognizable”.
- In other words arrests cannot be made without a complaint — something no member of the public is willing to give.
- The State Drug Controllers have a responsibility to ensure that prescription drugs (of which there are nearly six hundred listed in the Regulations,) are only sold under a doctor’s written advice. In fact there is virtually no checking.
- While most State health departments prefer to look away, West Bengal began training the RMPs some seven years ago with the stated aim of preventing harm. Regular training classes have been organised using funds provided under the National Rural Health Mission.
- It is another matter that unsupervised use of antibiotics, steroids and fourth generation drugs has serious costs for society and ought to give nightmares to all authorities.
- To ignore an inconvenient truth any longer would be iniquitous, unprincipled and dangerous.