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Indian Journal of Surgery, Vol. 65, No. 1, Jan.-Feb. 2003, pp. 66-67 Personal Viewpoint Rural Surgery in India N. H. Antia The Cliff, 27, Pachkhanwala Road, Mumbai-400 025.
Paper received: June 2002
Code Number: is03013 Even 55 years after gaining Independence, 70% of our population who live in rural India fail to receive the benefits even of basic health and medical care. This despite a vast increase in the production of doctors. Nurses, paramedics, hospitals, primary health centers (PHCs), drugs and medical equipments. The present annual expenditure on 'health' is Rs.80,000 crores. Unfortunately the facilities remain chiefly urban not only in quantity but even more so in quality and that too in affluent enclave. This is even more marked in the field of surgery. The correction of this distortion cannot be achieved by "more of the same" approach nor by pleading with urban surgeons to voluntarily allocate part of their time and resources to serve the rural poor in surgical camps. The problem, as well as its solution, lies in the mode of overall socio-economic development of our country of which health is only a part. While we may not by ourselves be able to change the entire mode of development and governance of this country, we as concerned and influential citizens can certainly help to question this unfortunate state of affairs. Failing this to at least correct the distortions in our own field. For over a decade several members of our Association who have chosen to live and work in rural areas have expressed a strong desire to form a Section within our Association where they could exchange their experiences and stimulate younger members to emulate their example. Unfortunately ASI failed to concede that Rural Surgery could be considered as a Section of ASI like several others. This demonstrates the change that has overtaken our association since its founding by general surgeons. In imitating the West we now take pride in over specialization regardless of the requirements of the vast majority of our people which is still for general surgical care within our limited resources. Instead of holding our annual conferences in medical colleges and living in students hostels as in the past, we now have medical and surgical extravaganzas in five star hotels hosted by the pharmaceutical industry and surgical instrument manufacturers where our vounger members and even rural surgeons, are inducted into the modern affluent society that lives cheek by jowl with dehumanizing poverty. This has distorted our values from service to our people to service to self. It has also changed the age old patient-doctor relationship from one of respect to that of an adversary which we now deplore. Must we too prostitute ourselves to Mammon in following the most inappropriate model of the US. This has also distorted our surgical training from appropriate basic general surgical care to increasing super-specialization for the benefit of a few who can pay for services. And yet it is heartening to know that almost 20% of our surgeons still continue to live and work in rural areas providing good basic care to 70% of our population. They live comfortably while enjoying the love and respect of their patients and community which no other profession can provide. Unable to persuade the ASI for over a period of over three years inevitably led to the formation of a separate Association of Rural Surgeons of India (ARSI). Commencing with seven founder member in Shimoga. ARSI in a period of 9 years has over 200 full members comprising of general surgeons and specialists from various other surgical and allied disciplines, as well as some associated members ranging from anaesthetists, to nurses and paramedics. Annual conferences are held in small towns in various parts of the country to promote this concept. These are well attended and include a CME session together with formal as well as informal exchanges of interesting experiences. The venue, arrangements and cost are deliberately kept simple and cheap since no donation is accepted from the pharmaceutical or medical instrument industry. These annual conferences are generally attended by visiting surgeons from abroad. An award of Rs.10.000 has been recently instituted for anyone providing an original contribution to basic surgical care. The first went to an anaesthetist for designing a versatile portable insufflator and another for the use of nylon bed net for the repair of hernia. ARSI in collaboration with the Indira Gandhi Open University has also organized a one year Certificate Course in Rural Surgery covering all relevant disciplines through the Distance Education mode. We are pleased that ASI has since established its own Rural Surgery Section. There has been some soundlings regards the merger of these two associations which ARSI feels is not feasible. Though the technique of surgery may be similar its application in the field requires a different approach under entirely different social. Cultural, economic and physical conditions of rural as compared to that of urban India from where the majority of our doctors originate and are trained. This is what differentiates ARSI from ASI. ASI would also be unable to accept the type of Associate Members that ARSI feels are important to serve the requirements of rural surgery. While several ARSI members like me are also members of ASI, younger members of ASI who desire to live and work in rural India and serve their people are welcome to join ARSI if they fulfil the stipulated requirements. The IGNOU course for Distance Education is available to all since it provides a sound training in the principles and practice of surgery including allied disciplines. The interaction between the ASI and ARSI will provide a new impetus to surgical care for the vast majority of our people, though not by their amalgamation. Copyright 2003 - Indian Journal of Surgery. Also available online at http://www.indianjsurg.com |
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