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“Odisha Should Focus on Affordable Optimal Healthcare Services”

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Dr Ashok Kumar Mahapatra is Director of newly established All India Institute of Medical Science (AIIMS), Bhubaneswar. In an interview with Mohd Ujaley he says that an affordable healthcare service is the need of the day for Odisha.

When you were appointed as the Director of AIIMS, you said that your aim was to make AIIMS, Bhubaneswar a world class institution and take it to the level of AIIMS, Delhi. How successful have you been so far?
I spent 37 years in AIIMS, Delhi and also served as a director of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. The aim of coming from Delhi to Bhubaneswar is to create a center of excellence, a small nucleus in Odisha which is practically one of the middle order states in India; it is neither in the lowest strata nor in the highest strata like Gujarat, Kerala, Maharashtra, etc. Here, the people are simple, per capita income is low so affordable optimal healthcare services is highly required. And as you know that many States in India, including Odisha have not created any Government medical colleges in the last 50 years. I joined my MBBS in 1970 in Berhampur Medical College that is the last medical college Government of India created in 1962. I think, health has not prioritised as it should have been.Health being state subject, state Government is equally responsible as the federal Government for this apathy.

According to UNICEF, 40 percent of all the children under three years old are underweight and 61 percent of adolescent girls are anemic. Don’t you think these are bigger challenges related to nutrition, medical care and education in Odisha?
You are absolutely right, India has about 400 million children and amongst the children, probably 50 percent of malnourished children of the world will be in India.It’s not that children are malnourished only in Odisha, your figure might be absolutely right, but even in Gujarat which is an affluent state faces same problem. When the same question was asked to Chief Minister, he said people are dieting. We cannot cover up our crime by giving answers like that. We have to really know the reason why the children are malnourished. It’s an international concern, because if we want to have intellectual, highly educated and highly productive adults then you have to look after them since the pediatric age. If a child is malnourished, he cannot be educated well because his performance will be bad. So you are absolutely right, this is a big challenge for the healthcare people and the administrator to see that our children are fed very well with balanced diet.

Government at the center and state, both are running various welfare schemes to eradicate poverty but they seem to have little or no impact on the life of people at grass root level, why it is so?
All over India, the public distribution system (PDS) has nearly not worked out. It’s not necessary that rice sold in Rupee One or two will benefit the public unless it reaches the intended beneficiaries. Many of the Central Government and State Government policies all over India do not work out because the policies are made only in the parliament and the assemblies across the country, when it comes to grassroots level people don’t get the benefit as in some cases they don’t incorporate adequately the regional aspiration or diversity. For example, in 1952, we started our Family Planning Programme, we are the first country in the world to have family planning programme but that was not given the adequate dividend, We also had malaria control programme, tuberculosis control prpgramme, about 12 million people suffer from tuberculosis in India every year and half a million die.
There is nothing wrong in planning, we are absolutely a master planner, we plan very well and spend money but when at the ground level somewhere down the line the people who are involved with implementation, they default. So if you give one rupee rice or even distribute it for free, it may not reach the people. The sad story is that in our country about 20-30 percent food grains are eaten up by the rats or get rotten in the godown, yet it’s ironical that people don’t get food. So it is something, where our policy makers, administrators and parliamentarian need to think. As you know Food Safety Bill has not yet been passed by the Parliament. Even if it is passed by the Parliament, what is the guarantee that the poorest of poor in the small tribal areas will get the food? So there is lot more to think and do and I, as a human being, get demoralised, when I see people are dying of malnutrition, children are malnourished, especially because I look after the pediatric age group in Neurosurgery. I sometimes operate upon a two kilograms child and face the challenge of saving a small baby of two kilograms with brain tumour. So for me, a healthy baby is always a welcome step for the country.

You have come from Delhi to Bhubaneswar to serve in tier-II city but young doctors are reluctant to serve in rural areas. What is the best way of overcoming this challenge?
I think it is a real challenge all over India. To take the doctors to the village is not only difficult, it’s totally impossible. With the materialistic life we lead during the MBBS course and when you have to give up this life to go to a village where there is no electricity, no water, and there is no proper road, you will think that you are going from some heaven to hell. It is not only true for the Government doctors alone; same applies to the engineers, lecturers and IAS officers. When you see a doctor who completes his MBBS at the age of 23-24 he is at par with engineer, IAS officer and a lecturer. They all get promotion in their career but an MBBS doctor will join as an MBBS and retire as an MBBS. He will not get any promotion over the 30 years time. At times, public may blame doctors for various shortcomings but they do not understand in the circumstance our doctors serve.

You cannot have a bank or ATM at a place where there is no electricity but you do have a Primary Health Care (PHC), that’s why across the country about 30 percent of the doctor posts in PHCs are vacant. Our ambitious plan such as National Rural Health Mission (NRHM) will have lots of doctors in village but they have not created any infrastructure where the doctor can stay or their children  and get education. Suppose, I am a doctor and posted at a PHC for the next 10 years, where do my children go for studies? So posting is  bigger issue. If you have a teacher who is underpaid, a policeman who is underpaid, a doctor who is underpaid, an underpaid person will always be craving for more money to meet his daily needs. So he cannot deliver the goals in a depressed and agonistic state of mind. There are more needs and no money. If you are giving a doctor Rs. 12,000 rupees in NRHM, you have done the greatest injustice to humanity rather than to the doctor, because no doctor will work in such circumstances. So the best way forward are to create conducive environment and at least put in place minimum infrastructure.

Odisha has the second largest population of tribal in India; they are the one who is least served. How we can reach them with better healthcare services?
May be half of Odisha’s population is tribal, but we have got 8 or 10 states in India with tribal population. The tribal population across India has the lowest occupational status and also less education and high infant mortality rate. So it is a challenge not only in Odisha but all over India. And I am sure the doctors who are educated in city will never go to the tribal areas to see their shortcomings. So it is
a challenge socially, financially and from healthcare point of view. But if you have to really take the medicine to the grassroots level where the doctors are not willing to go, then we have to manage the healthcare services by paramedical people like pharmacists, technicians and nurses, because their ambition and a doctor’s ambition is totally different. In such a scenario, ehealth or telemedicine has good role to play. We can have a programme like tribal telemedicine, where we can trainsome people in telemedicine and post them in tribal areas with the video conferencing system. The patient comes to him, he interacts with the patient and communicates with us and accordingly deal with patient.A good telemedicine strategy through consultation can serve the community exponentially.

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