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ACTIVITIES REPORT New economics and medical practice in
India
The Forum for Medical Ethics Society and the Centre for
Enquiry into Health and Allied Themes held a seminar on 'New economics and
medical practice in India' on January 16, 2004 at the International Health Forum
in Mumbai just before the World Social Forum.
Mr P C Singhi spoke on a
17-year-old case of medical negligence that he had filed against a leading
hospital in Mumbai, where doctors and other staff had allegedly botched surgery
on his wife which resulted in her death. He urged the audience to take action in
similar situations.
Dr B Ekbal, the Vice Chancellor of Kerala University,
spoke on the 'Collapse of public health and rise of private medicine'. The
Indian government's funding of the health sector is among the lowest in the
world. Governmental policies and globalisation have allowed the private sector
to flourish as preventive services have taken a back seat. Good medical care has
become the privilege of the better-off. Self-financing medical colleges
contribute to the rot and also bring a different value system among students.
Speaking on new trends in the Indian medical market, Dr Ravi Duggal said
that medicine had ceased to be a profession and was increasingly seen as a
commodity. The new scenario of corporatisation sees the rise of new players such
as hospital administrators, health care managers, insurance agents and marketing
managers. Organising the public sector and calling for an increase in public
finance could stem the tide.
Dr Arun Bal spoke on the struggle for regulation
of the private sector and the role of health activists, NGOs, and other
agencies. Legislative measures, he felt should address issues that concern only
the patient and doctor. Other players such as insurance companies should not
dictate the process of regulation. Statutory bodies such as the Medical Council
of India (MCI) were seen as toothless regulatory organisations. The Association
of Consumer Action in Safety and Health analysed medical negligence cases to
find that the most common reasons for complaints were: instigation by other
doctors, poor communication by the doctor, over dependence on technology for
diagnosis, lack of clearly-defined standards and poor documentation.
Dr
Sanjay Nagral spoke on 'Market medicine and medical ethics in India'. The new
economy had directly and indirectly spurred the growth of private medicine.
People perceive public hospitals as inefficient and care offered here of poor
quality. Examples of unethical practices in the private sector include
advertising, 'cut' practice and poor organ transplantation ethics. The growth of
the private sector was largely driven by the monetary returns it provides to
doctors. Sreejit EM, Public Health Specialist, HLFPPT,
19th Road, Chembur, Mumbai 400019. e-mail:emsree@yahoo.com
Seminar on ethical values in health care
The Forum for
Medical Ethics Society, the Department of Nursing, Jaslok Hospital, and
Initiative For Change organised a day-long seminar on 'Ethical values in health
care' on February 15, 2004. Nurses from Mumbai participated in the
meeting. Gender in medical education
Concerned at the gender differences in the provision of health care and the
lack of training to medical students in gender issues, the Achutha Menon Centre
for Health Science Studies (AMCHSS), Thiruvananthapuram, initiated a project to
mainstream gender issues in medical education.
The first strategy in this
project is to train medical and nursing educators in short courses and support
them as 'agents of change' in their institutions. Participants are selected for
their interest, availability, popularity with students, involvement with the
medical education cells of their colleges and history of having done innovative
work in their institutions.
The second strategy is to do a baseline survey in
medical institutions to collect and analyse sex-disaggregated data. A
gender-based review of textbooks in several disciplines of medicine is underway.
The third step involves advocacy with the MCI/Nursing Council of India, vice
chancellors, deans of medical universities/institutions and professional bodies
such as the IMA to facilitate change.
The pilot workshop for medical
educators, held on November 10-21, 2003 at Thiruvananthapuram, was supported by
WHO-SEARO and involved 28 participants from South East Asia, 12 of them Indians.
Gender as a social determinant of health and specific gender and health issues
were discussed. Gender and rights perspectives in medical training in their
institutions were stressed upon. The last part of the course involved designing
projects to implement change in their own institutions. The Indian participants
will be supported by AMCHSS in their endeavours over the next year.
Many
participants began the course sceptical about the importance of these issues in
their settings. By the end they were concerned about how the lacunae debated in
the course had not been addressed. All were convinced about the need for
altering the curriculum and gave constructive feedback that will help the AMCHSS
further streamline the process.
Further such trainings have been planned for
2004 and applications from medical and nursing educators are
welcome. Anant Bhan, Achutha Menon Centre for Health
Studies, Sree Chitra Thirunal Institute for Medical Sciences and Technology,
Thiruvananthapuram 695011 e-mail:anant@sctimst.ac.in
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