April 2014

NHM is so Ambitious that you can never Achieve it – Dr A K Mahapatra, Director, AIIMS, Bhubaneswar

There is huge shortage of doctors and whatever we have, they are not inclined to serve in rural areas. Dr A K Mahapatra, Director, AIIMS, Bhubaneswar in an interview with Mohd Ujaley says “our programmes such as National Health Mission (NHM) are so ambitious that you can never achieve the target, when you are not able to provide even a single MBBS doctor to PHC, how can you provide 6 doctors to CHC?”

Last year, when I interviewed you, things were on nascent stage for AIIMS, Bhubaneswar but now they have taken a shape and various projects seem to be underway. What have been major changes since we met last?

Lot of things have changed and improved since we met last. Academically, we have three batches of 210 students. There are now two undergraduate batches of 50 and 100 students respectively and 60 students have been admitted in BSC (Hons.) Nursing. We have occupied entire medical college building and today we have 70 faculty members which are largest amongst all the new AIIMS. Also, we have started outpatient service and on an average, we are examining 350-500 patients every day in the morning OPD. We have also started afternoon OPD for patients who need special care especially in the cases of high risk pregnancy, fetal malformation and also we have many special clinics such as sleep clinic, pulmonary clinic, hydrocephalus clinic, epilepsy clinics, thalassemia clinic, glaucoma clinic, oculoplastic clinic, and retina clinic. These clinics serve to the patients who required dedicated effort.

Lot of people in Odisha believe that AIIMS Bhubaneswar should take lead in reforming healthcare in the state and there should be more interaction between state healthcare centres with AIIMS, Bhubaneswar. Are you sending students and faculty members to local healthcare centres?

AIIMS is Government of India entity and bound by centre rules but indeed our impact is in and around Bhubaneswar and may be in longer run we can help in improving the healthcare service in the state by providing our expertise to all the state’s healthcare centres but larger policy decision has to come from state government. As far as student and faculty interaction is concerned, we have started sending our faculties and students to rural health training centre (RHTC), Mendhasar and also urban healthcare centre in Tangi which is a tehsil in Khorda district. Therefore our faculties and doctors have been regularly going to RHTC and UHTC.

There is acute shortage of super speciality care in the state, especially in the case when a patient has to go for chemotherapy and blood transmission. How AIIMS, Bhubaneswar is going to improve the condition?

I agree with you that lot of work has to be done for super speciality care. In Odisha, we have Acharya Harihar Regional Cancer Centre in Cuttack, but they don’t have anything – no oncologist, no linear oscillator, and no simulator and there is no dedicated cancer service. So, if a person suffers from cancer, he has to go to Delhi, Mumbai or Chennai. In June, we started day care centre of 10 beds and the centre has admitted more than 500 patients till 24th of December for chemotherapy, blood transmission, and for minor procedure after chemotherapy. The nurses and doctors are kept especially for cancer patients in two shifts. Also in afternoon clinic we are doing special training for the cancer patient and giving our services to RHC’s, CHCs and PHCs for the students training and community care. Recently, we have purchased equipment of worth 30 crores which includes 64-slice CT, 5 ultrasound machine, digital radiography, endoscopy, slit lamp etc. This investment which was not available to us three months back will definitely help in improving the service that we provide to the people of Odisha.

Today we have 70 faculty members which are largest amongst all the new AIIMS. We have started outpatient service and on an average, we are examining 350-500 patients every day in the morning OPD. We have also started afternoon OPD for patients

There are well wishers you say AIIMS, Bhubaneswar in coming year will be ahead of AIIMS, Delhi, but you do not have academic committee and yet to start Post Graduate courses, so how do you look at it and what is your own assessment of the progress?

I cannot compare a six month baby with a 60 years old man. In one year time we have achieved lot of milestones. Last time when you interviewed me, we had no governing body, no finance committee, no selection committee, and no institute body, today all our statutory bodies have been created. We have not been able to start Post Graduate courses because our academic committee is not formed and as per AIIMS act, all the matter pertaining to finance goes to finance committee and academic matter goes to academic committee, and administrative matter goes to governing committee, so we cannot start any extra academic activities beyond the undergraduate education without having an academic committee.

We are deficient by one million doctors. The latest census says that we are enrolling 46 thousand students but that is nothing when you compare it with the requirements

How long it is going to take to form the academic committee or start PG courses?

I am not sure about it, last time when I talked to Hon’ble Minister, he said that as per Medical Council of India (MCI) guidelines, at least three year period is required to start a Post Graduate courses after establishment of the medical college. However, I referred to AIIMS, Delhi which was started in 1956 and in the same year post graduate courses were also taken. I think it should be possible to simultaneously start graduate and post-graduate courses where the infrastructure is adequate and today our infrastructure is far better than infrastructure AIIMS, Delhi had in 1960s. After four year of its establishment, the total number of faculty was only 25 so if you compare today’s AIIMS, Bhubaneswar it is at least 20 times better than AIIMS, Delhi of 1964.

When my professor P.N. Tandon joined in 1965, there was nothing, in fact one table was shared between two Head of Department (HOD). At one side of the table Baldev Singh, Professor, Neurology and on the other side P.N. Tandon, Professor, Neurosergary used to seat but they did not give up. The necessary things for our people are to be positive. We should look at the future in a bright and positive manner, since all our negativity does not help us, how it can helps society.

The private medical institutes like Amrita Institute of Medical Sciences and Research Centre is using modern information technology tools like HIMS in a very planned way but that is yet to come to AIIMS, why there is delay in using ICT?

We have a small telemedicine entre here but ideally the policy and programmes of using information technology should come through Ministry of Health, Government of India. The government has created a committee under the chairmanship of M C Misra, Director, AIIMS, Delhi to look at the modalities of developing IT infrastructure across six AIIMS under which there is HIMS (hospital information system) which will include e-library, e-finance, e-education, ejournal, so far we have not been able to decide whether it should be open access system or close access system. We have met three times for the HIMS, and we are exploring what should be the ideal system. AIIMS Delhi does not have the HIMS, on the other hand place like Amrita Institute of Medical Sciences and Research Centre and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPI) have beautifully organized well planned HIMS system. In fact in SPGI, HIMS system started in 1995.

There is hug shortage of doctors and whatever we have they are not very inclined to serve in rural areas. In such a scenario, aren’t the prgorammes such as National Rural Health Mission (NRHM) too ambitious when it says there will be six doctors in every Community Healthcare Centre while there are no MBBS doctors even at some places in Primary Healthcare Centers (PHC)?

This is the huge concern for healthcare administrator in the country. We are deficient by one million doctors. The latest census says that we are enrolling 46 thousand students but that is nothing when you compare it with the requirements. America has got five times more doctors than the India. We are really suffering from lack of manpower. On other hand it is quite contrasting that our programmes such as National Rural Health Mission (NRHM) are so ambitious that you can never achieve it. None of these programmes have delivered the way they were planned. India had a National Tuberculosis Programme(NTP) in place from the sixties, yet more than 2 million people suffer from tuberculosis and half of a million die. The best way forward is that we should produce manpower without going too much into intricacies of MBBS. We need to accept the reality that our MBBS doctor will never go to village and we can never fill our PHC by well trained allopathic MBBS doctors. Kerala and Gujarat have achieved the target because they filled all the peripheral post by Ayurvedic, Unani and Yoga doctors. It is better to have something than nothing. NHRM says 6 doctors in CHC but there is not even a single doctor. You are not able to provide one doctor in PHC and telling six doctors in CHC, it’s nothing but a big joke.



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