It is said that path to hell is paved with good intentions. It would not be an exaggeration to say that in spite of good intentions of the Government and selfless service and hard work by the 1,600 odd Rural Medical Assistants of Chhattisgarh, they have gone through hell in the past 17 years.
Soon after the State of Chhattisgarh was created, the State government, faced with the problem of extreme shortage of medical manpower in remote rural and tribal areas, started a three-year medical course in the State.
This course has been fraught with legal trouble from the very beginning. The course was opposed by the Medical Council of India almost as soon as it was started. The State Government had passed a new law in the legislative Assembly to start this course but the Constitutional validity of the law was challenged in the High Court.
Under legal advice, the State Government amended the law several times. The State realized that despite its best efforts it will not be supported by Medical Council of India in its endeavors. It was decided to define the word medicine negatively in such a manner that it would avoid conflict not only with the jurisdiction of Medical Council of India but also all other Councils created by law. The result was that the word medicine lost all meaning.
In a recent order passed on April 26, 2017, Chhattisgarh High Court has rightly observed that – “In the civilized world, certain usages means certain things. The common parlance theory is resorted to when the definition clause becomes unworkable. We recall these principles for ourselves now because the definition of Rsmedicine’ in the Act is couched in such a way that even if we venture to dive deep into the different aspects in the field of medicine, we would not be able to reach anywhere in our search for the concept of the alternative medicine that would fall within the definition of Rsmedicine’ in the Act. Our pursuit in that regard will be like searching for the black cat in a dark room which is not there.”
High Court has further said – “legislative actions cannot lead to illusory situations because certainty of the applicable laws is itself an inbuilt guarantee as to equal protection of the laws as part of the equality doctrine contained in Article 14 of the Constitution of India.”
Though the action of the State Government was with the best possible intention of providing basic medical care to under-served people in remote tribal areas, the manner of implementation of this decision led to many legal challenges and has put the 1600 RMAs in their present plight. By way of disclosure I have to say that I was Secretary (Health), Government of Chhattisgarh when this decision was made and though the decision was made overruling some of my objection yet I cannot evade responsibility for this decision.
To top it all it was also decided that the three years medical course will be run in the private sector and the students had to pay a hefty fees to study in the course.
As a matter of fact the fees was much higher than the fees paid by MBBS students in Government Medical Colleges. Amidst this chaos one good thing happened. The course was designed by a team of very competent persons and it included almost all the subjects which are taught to MBBS students in Medical Colleges.
The Chhattisgarh Chikitsa Mandal also ensured that adequate infrastructure and faculty was available in the three years medical colleges so hat quality of education could be ensured.
Initially only 6 months internship was envisaged which was later increased to one year thereby providing enough practical bedside experience to students of the three years course. I have since then interacted very closely with many RMAs, who have passed this course and I have no doubt in my mind that they have adequate knowledge and skills to provide basic medical care. All the colleges were affiliated to the Ayush University of the State and this also ensured that the quality standards were fully complied with. This compliance with quality standards and good teaching practices at that time can actually deliver us from our legal difficulties and can provide a ray of hope for the poor under-served people of remote tribal areas if the State makes use of the opportunity provided by the High Court to come up with policy level solutions.
Chhattisgarh High Court has said in its order of April 26, 2017 – “We say all the aforesaid now because we do not intend or proceed to decide these writ petitions without giving appropriate opportunity for the State Government and the Union Government to think over the matter further, in the light of certain submissions made by the learned Additional Advocate General. The learned Additional Advocate General described before us the plight of the rural masses, who, are stated to be greatly deprived of medical aid.”
High Court has further said – “Along with the challenge levied to the statute in question, we are faced with the plight of the end consumers of the system and also the plight of those who are working with the government on regular, contract or temporary basis and have been trained following the modality prescribed in the impugned Act. We cannot ignore the fundamental rights of the rural population which, notwithstanding their socio-economic challenges, are also facing acute social exclusion on grounds referable to geographical exclusion and having their domicile in remote places from where true and timely access to better medical help to better pastures in cities remains a mirage.”
The three years medical course was stopped several years back. At present there are 1600 pass outs of this course in the State and most of them are already employed in the rural hospitals of the State Government. They are actually providing exemplary service in these medical institutions. It would not be wrong to say that most of the primary health centres in the State of Chhattisgarh are manned by the RMAs alone and if the services of RMAs are discontinued it will create a total vacuum in medical services in rural and tribal areas.
It may also be mentioned here that though the Indian Medical Association has filed a petition in the Court against the RMAs, in practice the MBBS doctors and RMAs have cordial relations and work together in the interest of the patients. The RMAs whom I have met have always told me that they MBBS doctors under whom they have been practicing for the last 17 years have always been eager to teach them. Most RMAs are grateful for the training which they have received from MBBS doctors.
In the light of the above discussion let us now look at some of the possible solutions to this seeming impasse. Firstly, the State Government must concede that the Medical Council of India is the sole authority for medical education in India. The Medical Council on its part should be pragmatic enough to appreciate the concerns of the State about the shortage of trained medical personnel in remote areas and large hearted enough to develop a policy which would provide an opportunity to the 1600 RMAs already working for the last 17 years in medical institutions of the State of Chhattisgarh. The IMA on its part should treat RMAs as younger brothers in the profession and help them in improving their qualifications so that they can acquire a qualification acceptable to the MCI.
Once all parties sit across a table with good intentions, it will not be difficult to find a solution. It is well known that MCI organizes an examination for students who have a foreign medical degree not yet recognized by MCI. Many students, who have a medical qualification from counties created from erstwhile Soviet Union, have to clear this examination before they are registered as medical practitioners by the Medical Council of India.
MCI may consider organizing a similar examination for the RMAs for their registration as medical practitioners. If the Medical Council has some issues about the duration of the course being 3 years instead of five years, it can prescribe an additional two years bridge course for the existing RMAs and can create seats for them in the Medical Colleges of Chhattisgarh for a limited period till all the existing RMAs have passed the bridge course. If I remember correctly a similar course of action was once adopted for the students of three years course form West Bengal.
The order of Chhattisgarh High Court has given us an opportunity to find a solution to this mess which has been created by different organs of the State. let us not waste this opportunity and find an amicable solution suitable for all parties most of all to the poor people in under-served remote areas of the State.
(The Writer is a senior IAS officer in Chhattisgarh and the views expressed by him in the article is his personal)