Recently there was news in national dailies that doctors and even Medical Council of India (MCI) are resisting 3½ years 'Bachelor of Rural Health Care' (BRHC) course proposed by Govt of India. In a contempt of court petition submitted to Delhi HC by a social activist, the MCI chairperson and Union health secretary were directed to reply to the court. Earlier in a November 10, 2010 order, the HC has directed the MCI to initiate measures to introduce the BRHC course by March 2011. But till today the course is not started. The short term course should have been introduced by now as per the resolution of 9th Conference of central council of health and family welfare in November 2007 and the recommendation of the 2007 task force on medical education reforms for National Rural Health Mission. Almost 5 years passed; MCI is sitting over the proposal and thereby clearly indicating its unwillingness to implement it.

What could be the reasons for this reluctance? What is doctors’ point of view? Is there any justification in it? What are the problems of rural health care? Let us analyse.

The reasons for absence of complete rural health care can be listed as follows: 1) Rural backwardness; 2) Long duration of medical education; 3) High cost of medical education; 4) Offers and attractions of urban life.

Rural backwardness
Notwithstanding the peacefulness of rural life, there are many disadvantages endemic in a rural society. A doctor and his family if settled in a village has to forgo a lot of conveniences like educating their children in a CBSE or international school by sending from or giving them the comfort of home. It is human nature that all parents want to ensure a better future for their children. Doctors cannot be an exemption. They also lose many amenities like better transport, Internet connectivity, even mobile connectivity and quality entertainment, which their counterparts in cities or other educated people in urban area enjoy. This apart the rural population has its own way of life, few interesting, many disturbing. Illiteracy, consequent superstitions, blind belief in god and god man or woman, poverty, bad self hygienic practices, absence of safe drinking water or toilets are few among many unique problems of rural life. Thus rural backwardness is the big disincentive to a doctor appointed in a village. That is why former president of India, Dr. Kalam has put forward his project PURA (Providing Urban amenities to Rural Area) to the Govt of India.

Long duration of medical education
A doctor has to undergo a minimum of 5½ years education after +2. That too, for getting the minimum qualification of undergraduate (MBBS) degree, which nowadays not guarantee either a better practice or better life. If they decide to go for PG another 3 years they have to spend on education. Thus only around the age of 30 a doctor starts earning. Preciously this was the reason told by many state toppers of +2 course for choosing engineering especially IT field, foregoing their bright chances of getting medical college seat in Tamil Nadu and other States.

This situation leads to an urge of making quick money among the doctors and naturally they refuse rural job where there is little chance for private or off duty hours practice to earn any handsome amount. If compelled to work in rural area, a doctor need long time to settle down in life. How many doctors can tolerate such an unpalatable situation?

High cost of medical education
If above situation is the case with doctors educated in government medical colleges, we can very well imagine the mentality of doctors from private medical colleges, where they spent few millions of rupees to get the basic MBBS degree. It is said to join in PG medical courses like MD or MS in private medical colleges one has to cough up crores of rupees.

After spending or forced to spent such a big amount how the government expects a specialist or even an MBBS graduate to work in rural area? It is the direct result of government forgoing its basic responsibility of providing health care to its entire population by not opening sufficient government medical colleges. Then why blame the doctors?

Ironically, government also focuses on the same reason - high cost of educating and training a medical student - for compulsory rural postings. How to end this blame game?

Offers and attractions of urban life
Though there are few difficulties in urban life a common man faces in a city, many of them can be overcome by money. Thus a city life has lot of things to attract an educated man who can reasonably earn in a city. Huge population, considerable people with paying capacity, quick access to diagnostic and other facilities make the private medical practice and money making comparatively easier in a city which a doctor find difficult to resist. Moreover, if you could write prescriptions for certain quantity of particular brand of medicines, you are offered even a foreign trip by unethical pharma companies. It is impossible and unimaginable in rural practice. All these things are additional personal benefits one can enjoy in a city apart from the few pointed out earlier. These attractions are tempting and to resist such an offer one has to be a saint or highly self sacrificing. Is it practicable?

Remedy
Then what is the solution for this problem? No doubt, government proposed BRHC is the remedy for this problem which is based on the experience of China. China is the only country comparable to India in its population and rural settings. They have solved the problems of rural health care by creating separate rural health provider popularly known as “bare foot doctors”. We have no other go than to follow that successful scheme. Remove the short comings, if any, of that scheme of Government of the People's Republic of China. One objection to the scheme by our Indian doctors is that we are creating a second grade doctor for rural population and thereby treating our rural people as second grade citizens.

If you closely analyse the argument, you cannot find any substance in that argument. The BRHC is the course going to be designed, executed and supervised by none other than MCI. The basic qualification is same (+2) as that of MBBS. Students who scored more than 90% in their +2 course and not able to reach 97.5% cut off mark to get an MBBS seat, are going to join this BRHC course. How can we claim 90% scorer as second grade person or inferior in knowledge? The only difference is duration of the course that too reduced for the purpose of providing basic primary medical care to rural people. For cases, requiring secondary or tertiary-specialist-medical care, the rural doctors are advised to send the case to referral hospitals.

If we admit students from rural areas only, for this course, we can expect lot of candidates coming forward to work and practice in villages. If required they can be prevented from setting up clinics and practicing within 10 KM from the borders of a city or town by law. Thus the apprehensions of MBBS doctors can be removed. If the scheme is not implemented, rural people cannot be rescued from quacks and spiritual self proclaimed healers who are now filling the void. It is not only going to affect the rural masses, unethical and misuse of drugs like antibiotics will result in resistant microorganism that will affect everybody including urban people. Hence doctors and MCI should introspect. their attitude of “I will not go to village to provide health care, others also should not go” is not good for the society. Nobody can resolve or remove the reasons listed above for the absence of rural health care, doctors will agree, we hope. Then they should accept the reality and allow the course. Thereby show their gratitude to the rural people who educated and provided experience to them by their repeated and varieties of diseases. If they are not there, doctors cannot be masters in their subject, will be same as doctors of relatively disease free developed countries with only theoretical knowledge.

Now Indian doctors are on the top of the medical world because our rural masses are at the bottom of their practice.