India trains quacks to ease shortage of rural doctors
Pioneering project by the Liver Foundation in Calcutta wants to give
unlicensed doctors in rural areas some formal training, to help people
in places where access to real health care is almost non-existent
PUBLISHED : Monday, 09 January, 2017, 1:12pm
http://www.scmp.com/lifestyle/health-beauty/article/2060490/india-trains-quack-doctors-rudiments-medicine-amid-big
SOURCE: SOUTH CHINA MORNING POST
There is a gigantic force in India – an
estimated 2.5 million strong – of men and women who have picked up
snatches of medical knowledge from a homeopath or chemist, or from a
relative, or from working as a doctor’s assistant, who prefix “Dr” to
their name and start treating patients in the remote village where they
live, where there is no real doctor for miles.
For city dwellers, these self-taught men are
quacks, perfect specimens of the truism that a little knowledge is a
dangerous thing. For Dr Abhijit Chowdhury, professor of hepatology at
Calcutta’s Institute of Post Graduate Medical Education and Research,
they are fillers of a void – the people who provide an invaluable
service to rural Indians who have no access to proper health care and
probably won’t for a very long time to come.
The Healthcare Federation of India said last
March that India was short of two million doctors and four million
nurses. It said about 70 per cent of the health care infrastructure was
concentrated in the top 20 or so cities. That leaves a lot of the
country out in the cold with not even a syringe in sight.
What does the downfall of Zhang Biqing, a self-proclaimed doctor, say about China’s credulous elite?
Chowdhury is founder of the Liver Foundation in
Calcutta, a charity that has been training quacks for years, not to
become not doctors, but to be better at what they do. The Foundation
doesn’t like calling them quacks. It prefers to call them “informal
rural health care providers”. “Empirical craftsmen” is another name
Chowdhury likes to use.
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The foundation’s training programme is based on a
simple premise. Rural Indians don’t have access to qualified doctors.
The nearest primary health care centre can be more than 30km away and
the doctor will probably be absent because medical practitioners shun
the idea of working in the countryside.
When villagers fall ill, they turn to the
“doctor” in their village, a person who seems to know how to treat
routine ailments such as fever, diarrhoea, malaria, anaemia,
hypertension, urinary tract infections and so on. They trust him (they
are predominantly male). He is available at night, he charges very
little and accepts payment in kind if villagers have no money. They know
that he helps. What they don’t know is that, at times, by failing to
recognise a serious condition, he can harm the patient.
“Our training is based on the realisation that
we cannot do without them and cannot wish them away. They offer a vital
service for people who have nothing else. Instead of ignoring them or
laughing at them, our training helps to improve the work they do and
minimise damage,” says Chowdhury, who spearheaded the project.
Dr Partha Sarathi Mukherjee, project director at
the foundation, says if the training increases the positive work of
quacks by 10 to 20 per cent and reduces their negative impact by 10 per
cent, that is a net benefit to their patients. “Instead of ignoring them
or ostracising them, we are harnessing their skills,” he says.
The training for rural practitioners has been
carried out in four districts of West Bengal (of which Calcutta is the
capital) in eastern India. It is carried out over two days a week and
lasts nine months. So far, more than 2,000 quacks have completed the
training.
The West Bengal government has been so impressed
that last month, it decided to throw its weight behind scaling up the
project. A state-wide training programme is to start this month to train
all of the estimated 170,000 quacks in West Bengal. They will be called
village health workers.
The Foundation has trained more than 100
trainers to work in the 33 centres that will be set up. The training
comprises basic human anatomy, some theoretical knowledge, pharmacology,
diagnosing fevers and infections correctly, the ability to judge when a
patient should be referred to a real doctor and the dangers of
overprescribing drugs,. The core of the training is “harm reduction”.
They are all given a grey coat to wear for the
sessions. A small number are women. “The first thing we make them state
formally, out loud, is ‘I am not a doctor,’” says Dr Saibal Majumdar who
is in charge of training. “We tell them they have to stop using ‘Dr’.
There is a lot of reluctance over this but we explain that they are
already respected in their area and can do without it.”
Around 15 to 20 per cent drop out, usually older practitioners who are
so well known they think they have nothing to learn. Their most common
errors, says Majumdar, are using injections to induce labour; using IVF
fluids unnecessarily; overprescribing antibiotics; giving antibiotics
for viruses; and lack of awareness about which drugs should not be given
to pregnant women.
“Many don’t know that dosage has to be
correlated with a patient’s weight. If they were once working as an
assistant to a doctor and saw him prescribing a certain dosage, they
give the same, even though it’s a paediatric dose for an adult,” says
Majumar.
Apart from making them renounce the title of
doctor, the second most painful moment for the trainee quacks is not
getting what they covet at the end of the training – a certificate. “We
deliberately don’t give them a certificate in case they frame it and
misuse it to claim that they are proper doctors,” he says.
Apart from making them renounce the title of doctor, the second most
painful moment for the trainee quacks is not getting what they covet at
the end of the training – a certificate. “We deliberately don’t give
them a certificate in case they frame it and misuse it to claim that
they are proper doctors,” he says.
A World Bank study in October showed mixed
results after evaluating both quacks who had undergone the training and
regular doctors. It found that although those quacks who had been
trained were more likely to adhere to checklists and had improved their
treatment, they still prescribed drugs unnecessarily. However, the study
showed that regular doctors were 26 per cent more likely to do this
than the trained quacks.
A study published last year based on a similar
project in the state of Madhya Pradesh showed that quacks tended to
spend more time with their patients than doctors and were no worse in
their diagnosis and treatment.
For Sanjit Ganguly, 42, who had “practised” his
profession for 16 years in a rural area outside Calcutta, before
undergoing the training a year ago, the benefits have been numerous. He
says he is better at diagnosis and the use of antibiotics.
“But the biggest benefit was understanding my
limits. A patient came to me late last night. All his vital parameters
were low. He didn’t seem to be in his senses. I told his family to take
him to the nearest government hospital without delay. This – knowing
when I can’t help – is the most important thing I have learnt,” says
Ganguly.
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