January 31, 2007

Code of Ethics for Doctors not being Enforced says Health Minister

``It is a fact that the MCI's Code of Ethics is not being enforced at all,'' Union Health Minister Anbumani Ramadoss told The Hindu in response to a question on its enforcement. ``It is unethical,'' he added, ``to advertise for cures that have not been tested and scientifically validated. While the Ministry will be happy to assist in validating such claims, we will not allow such advertisements to be made.''

The Medical Council of India, a statutory body regulating the practice of medicine in the country, updated the Code of Ethics Regulations in 2002. The State Medical Councils have since adopted the substantive portions of the code. The question about enforcement of the code has arisen in the background of the media frequently publishing advertisements from medical professionals promoting themselves and their services, endorsing medicines, and promising cures for chronic illnesses.

Limitations
One problem is that the Council covers only allopathic medical practitioners registered with it, Dr.Kesavankutty Nair, president of the MCI, explains. Further, the Council can only act against complaints brought to it, he notes, citing the Supreme Court guidelines in the matter. Anyone disgruntled with any medical practitioner for advertising or rendering service must make a formal complaint with the State Council, which has to act on it within six months.

The MCI is an appellate body, one that a complainant can approach if he or she is unhappy with the action taken by the State Council, Dr. Nair said. The MCI could then take action against the doctors registered with it.

The Regulations are one way to ensure it. For instance, the ethics code even mentions that the names and signboards displayed by doctors should not be large, though they do not specify the size.

While complaints are necessary to proceed against doctors, it is possible for the State Council to take suo motu cognisance of any offence by a medical professional and issue orders to him or her.

January 30, 2007

Changes in curriculum

The Union Health Minister said the Government proposed changes in the curriculum and medical practice. "We need doctors with practical experience in rural areas. They should have comprehensive knowledge of social issues also." The concept of research must be introduced at the undergraduate level, encouraging students to present papers at the continuing medical education programmes, which would be made compulsory. Doctors must have 60 hours of CME to reregister every five years. He assured the association of financial and technical support for conducting the programmes.

Act planned to streamline hospitals, diagnostic centres

A Clinical Establishment Act has been proposed for streamlining hospitals and diagnostic centres to standardise medical services, Union Health Minister Anbumani Ramadoss said on Sunday. To create a central registry, the hospitals and the diagnostic centres would be registered at the district level. The hospitals would be networked, and the Government would be notified within six hours of outbreak of an epidemic.

January 16, 2007

Made in China - Indian Doctors

Hundreds of students from India are now studying medicine in Chinese universities.

IN THE high-tech laboratories of China's medical universities, the country's latest export to India is currently in the process of being manufactured: Made in China — Indian doctors.

Since 2004 more than 20 Chinese universities have begun to aggressively recruit students from India, so that for hundreds of aspiring Indian doctors unable to either find or afford a place at medical colleges back home, China has become the Mecca.

The average tuition for a Chinese medical university is between $2,000 and $3000 a year, plus another $1,000 to cover board and lodging. "In India its 20-30 lakhs just for the donation. This is much more affordable," explains Aishwarya Babu from Chennai, a second year medical student at Tianjin Medical University (TMU).

Manpreet Kaur from Chandigarh, who has been at TMU for just under a year, adds bitterly: "In India it's all so corrupt. All the seats are taken up even before the exams, so even though we study hard we can't get a seat over there."

Given the deep appetite for a medical career in India, Chinese universities are quickly realising that their neighbour represents somewhat of a gold mine for revenue generation.

Currently, a total of 230 Indian students are studying for an MBBS at TMU. According to Professor Gao Feng Lin, Director of TMU's International Exchange Department, the number of applicants from India far exceeds the available places at the university. He reveals that TMU received over 600 applications in 2005 but was able to accept only 180.

Vishwajit Sagar, an agent with the Nagpur-based South East Asia Educational Services, recruited 107 Indian students to study medicine at Suzhou University in 2004. Last year, the number of new students at Suzhou had risen to 200. Mr. Sagar also recruited an extra 100 students for placement at Nantong and Jiangsu universities in 2005, which given neighbouring Suzhou's success, decided to throw open their doors to Indians as well.

"This is a win-win situation for all," claims Mr. Sagar. He says that in Maharashtra alone 45,000 students sit for the medical entrance exam every year, competing for a mere 3,000 places. Studying in China, suggests Mr. Sagar, offers a chance to some of the leftover "thousands of deserving students," to pursue their medical dreams.

For the Chinese universities, Indian students add to the country's international reputation as an educational centre, something the Government has actively been trying to promote.

Primarily however, the students from India are seen as an important source of extra revenue. Entry requirements are thus lax and there seems to be little control over the quality of students being accepted.

TMU's Professor Gao says applicants must have around 70 per cent in their high school exams to gain admission. However, several of the students this correspondent spoke to admitted that there were no cut-offs at all.

One first year student from Hyderabad, who did not want to be named, complained that she was no longer motivated to attend classes, given that the majority of her classmates spent their energy in disrupting class proceedings rather than trying to learn. The organic chemistry class that this correspondent attended seemed to bear out her observations. Twenty minutes into the first hour of the class, dozens of listless, whispering boys in the back row began to browbeat the teacher into declaring a break even as he protested in vain that no break was due for another half an hour.

To be fair to the students, the teacher's English pronunciation was virtually incomprehensible making it hard for even the best students to focus. All the Chinese universities offering degrees to Indians claim to provide teaching in English. Yet despite this assurance, the situation on the ground varies greatly from college to college. A few months ago the Indian Embassy in Beijing had expressed concern after receiving dozens of complaints from students about the lack of properly qualified English-speaking faculty.

The experiences of Indian medical students in Russia and Eastern Europe raise serious questions about the quality of medical degrees abroad. Many of them found themselves struggling at sub-standard colleges, with poor teaching facilities, and failed to pass the screening test of the Medical Council of India (MCI) upon returning home.

But Chinese university authorities and their partnering Indian educational agencies are quick to stress that China is not Russia. "Unlike Russia, the educational environment in China is closely monitored by the government, so that certain standards are guaranteed," says Dr. Ramasamy an agent for the Coimbatore-based International Educational Consultants that began to recruit students to study at China Medical University in the northern Chinese city of Shenyang, last year.

Dr. Ramasamy adds: "China today has a buzz whether in manufacturing, textiles or education, so it's useful for young people to gain exposure to China." Professor Gao insists that students will have no problem in passing the MCI screening test once they return home. "We have made our syllabus and curriculum very close to the requirements of the MCI. Also we are very strict with the students. They have strict attendance requirements," he says.

The students this correspondent spoke to all expressed worry about the MCI test but many revealed they were preparing for the exam on their own in their spare time. Sonali Kaushal from Patna, a first year student at TMU, added that the university had indeed made attempts to bring its syllabus in line with that of the MCI. Thus forensic medicine, which was not originally part of the curriculum, was recently added, she said.

Cause for concern
A further issue of concern is that students are often lured by universities claiming to be ranked among the top 10 or 20 medical universities in China. But, in fact, there are no official rankings of medical colleges available, so that a university's position can differ dramatically depending on the source. One website, for example, ranked Suzhou University's medical department as number 17. But as Professor Tan Lu, the Vice-Dean in charge of foreign students at Suzhou himself admits, most other rankings have the university between 35-37th place.

TMU's Professor Gao cautions that students should not be taken in by rankings but should rather make enquiries of their own as to a particular university's reputation domestically. Professor Gao has big plans for TMU including a possible partnership with Manipal University in Karnataka, which would allow students to choose to do their internships back in India. However, the Indian Embassy in Beijing warns that the MCI has not given the green light for Indians studying in foreign colleges to be allowed to do internships in India.

At TMU, students will also have the opportunity to intern at one of the four hospitals affiliated to the university. But before they can do so they will have to master Mandarin, a notoriously difficult language. It is mandatory in Chinese universities for foreign students to take Chinese classes in addition to their medical studies, but despite the coaching most find it tough going. As a result, the Indians live a ghetto-like existence, eating together in separate dining halls and living together in segregated dormitories.

What most Chinese medical universities do have going for them is excellent infrastructure and the availability of laboratories and affiliated hospitals with cutting-edge equipment. Even AIIMS cannot compare, says Dipankar Misra from Gorakhpur, a first year student at TMU.

Other students tell your correspondent that the class in organic chemistry she attended is not representative of the better classes. "You should come to anatomy. It's really impressive," says one 18-year-old from Tamil Nadu. It will be another three years before the first batches of these Chinese-educated medical students begin to return to India. Only then will it be clear whether or not this experiment has been successful.

In the interim the flood of students washing up on the country's shores shows few signs of abating, but some caution would be well advised before taking the decision to dive in.
- by Pallavi Aiyar on The Hindu

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