Dr Ashok Kumar Mahapatra is Director of newly established All India InstituteÂ of Medical Science (AIIMS), Bhubaneswar. In an interview with Mohd Ujaley heÂ says that an affordable healthcare service is the need of the day for Odisha.
When you were appointed asÂ the Director of AIIMS, you saidÂ that your aim was to make AIIMS,Â Bhubaneswar a world classÂ institution and take it to the levelÂ of AIIMS, Delhi. How successfulÂ have you been so far?
I spent 37 years in AIIMS, Delhi andÂ also served as a director of SanjayÂ Gandhi Postgraduate Institute of MedicalÂ Sciences, Lucknow. The aim ofÂ coming from Delhi to Bhubaneswar isÂ to create a center of excellence, a smallÂ nucleus in Odisha which is practicallyÂ one of the middle order states in India;Â it is neither in the lowest strata nor inÂ the highest strata like Gujarat, Kerala,Â Maharashtra, etc. Here, the people areÂ simple, per capita income is low so affordableÂ optimal healthcare services isÂ highly required. And as you know thatÂ many States in India, including OdishaÂ have not created any GovernmentÂ medical colleges in the last 50 years. I joined my MBBS in 1970 in BerhampurÂ Medical College that is the last medicalÂ college Government of India createdÂ in 1962. I think, health has not prioritisedÂ as it should have been.Health beingÂ state subject, state Government isÂ equally responsible as the federal GovernmentÂ for this apathy.
According to UNICEF, 40Â percent of all the children underÂ three years old are underweightÂ and 61 percent of adolescentÂ girls are anemic. Donât you thinkÂ these are bigger challengesÂ related to nutrition, medicalÂ care and education in Odisha?
You are absolutely right, India hasÂ about 400 million children andÂ amongst the children, probably 50 percentÂ of malnourished children of theÂ world will be in India.Itâs not that childrenÂ are malnourished only in Odisha,Â your figure might be absolutely right,Â but even in Gujarat which is an affluentÂ state faces same problem. WhenÂ the same question was asked to ChiefÂ Minister, he said people are dieting.Â We cannot cover up our crime by givingÂ answers like that. We have to reallyÂ know the reason why the childrenÂ are malnourished. Itâs an internationalÂ concern, because if we want to have intellectual,Â highly educated and highlyÂ productive adults then you have toÂ look after them since the pediatric age.Â If a child is malnourished, he cannotÂ be educated well because his performanceÂ will be bad. So you are absolutelyÂ right, this is a big challenge forÂ the healthcare people and the administratorÂ to see that our children are fedÂ very well with balanced diet.
Government at the center andÂ state, both are running variousÂ welfare schemes to eradicateÂ poverty but they seem to haveÂ little or no impact on the life ofÂ people at grass root level, whyÂ it is so?
All over India, the public distributionÂ system (PDS) has nearly not workedÂ out. Itâs not necessary that rice soldÂ in Rupee One or two will benefit theÂ public unless it reaches the intendedÂ beneficiaries. Many of the CentralÂ Government and State GovernmentÂ policies all over India do not work outÂ because the policies are made onlyÂ in the parliament and the assembliesÂ across the country, when it comes toÂ grassroots level people donât get theÂ benefit as in some cases they donât incorporateÂ adequately the regional aspirationÂ or diversity. For example, inÂ 1952, we started our Family PlanningÂ Programme, we are the first countryÂ in the world to have family planningÂ programme but that was not given theÂ adequate dividend, We also had malariaÂ control programme, tuberculosisÂ control prpgramme, about 12 millionÂ people suffer from tuberculosis in IndiaÂ every year and half a million die.
There is nothing wrong in planning,Â we are absolutely a masterÂ planner, we plan very well and spendÂ money but when at the ground levelÂ somewhere down the line the peopleÂ who are involved with implementation,Â they default. So if you give oneÂ rupee rice or even distribute it forÂ free, it may not reach the people.Â The sad story is that in our countryÂ about 20-30 percent food grainsÂ are eaten up by the rats or get rottenÂ in the godown, yet itâs ironicalÂ that people donât get food. So it isÂ something, where our policy makers,Â administrators and parliamentarianÂ need to think. As you knowÂ Food Safety Bill has not yet beenÂ passed by the Parliament. Even if itÂ is passed by the Parliament, whatÂ is the guarantee that the poorest ofÂ poor in the small tribal areas will getÂ the food? So there is lot more to thinkÂ and do and I, as a human being, getÂ demoralised, when I see people areÂ dying of malnutrition, children areÂ malnourished, especially because IÂ look after the pediatric age group inÂ Neurosurgery. I sometimes operateÂ upon a two kilograms child and faceÂ the challenge of saving a small babyÂ of two kilograms with brain tumour.Â So for me, a healthy baby is always aÂ welcome step for the country.
You have come from DelhiÂ to Bhubaneswar to serve inÂ tier-II city but young doctorsÂ are reluctant to serve in ruralÂ areas. What is the best way ofÂ overcoming this challenge?
I think it is a real challenge all overÂ India. To take the doctors to the villageÂ is not only difficult, itâs totallyÂ impossible. With the materialistic lifeÂ we lead during the MBBS course andÂ when you have to give up this life to goÂ to a village where there is no electricity,Â no water, and there is no properÂ road, you will think that you are goingÂ from some heaven to hell. It is notÂ only true for the Government doctorsÂ alone; same applies to the engineers,Â lecturers and IAS officers. When youÂ see a doctor who completes his MBBSÂ at the age of 23-24 he is at par with engineer,Â IAS officer and a lecturer. TheyÂ all get promotion in their career butÂ an MBBS doctor will join as an MBBSÂ and retire as an MBBS. He will not getÂ any promotion over the 30 years time.Â At times, public may blame doctors forÂ various shortcomings but they do notÂ understand in the circumstance ourÂ doctors serve.
You cannot have a bank or ATMÂ at a place where there is no electricityÂ but you do have a Primary HealthÂ Care (PHC), thatâs why across theÂ country about 30 percent of the doctorÂ posts in PHCs are vacant. Our ambitiousÂ plan such as National RuralÂ Health Mission (NRHM) will have lotsÂ of doctors in village but they have notÂ created any infrastructure where theÂ doctor can stay or their children Â andÂ get education. Suppose, I am a doctorÂ and posted at a PHC for the nextÂ 10 years, where do my children go forÂ studies? So posting is Â bigger issue.Â If you have a teacher who is underpaid,Â a policeman who is underpaid,Â a doctor who is underpaid, an underpaidÂ person will always be craving forÂ more money to meet his daily needs.Â So he cannot deliver the goals in a depressedÂ and agonistic state of mind.Â There are more needs and no money.Â If you are giving a doctor Rs. 12,000Â rupees in NRHM, you have done theÂ greatest injustice to humanity ratherÂ than to the doctor, because no doctorÂ will work in such circumstances.Â So the best way forward are to createÂ conducive environment and at leastÂ put in place minimum infrastructure.
Odisha has the second largestÂ population of tribal in India; theyÂ are the one who is least served.Â How we can reach them withÂ better healthcare services?
May be half of Odishaâs population isÂ tribal, but we have got 8 or 10 statesÂ in India with tribal population. TheÂ tribal population across India has theÂ lowest occupational status and alsoÂ less education and high infant mortalityÂ rate. So it is a challenge not onlyÂ in Odisha but all over India. And I amÂ sure the doctors who are educatedÂ in city will never go to the tribal areasÂ to see their shortcomings. So it is
a challenge socially, financially andÂ from healthcare point of view. But ifÂ you have to really take the medicineÂ to the grassroots level where the doctorsÂ are not willing to go, then we haveÂ to manage the healthcare services byÂ paramedical people like pharmacists,Â technicians and nurses, because theirÂ ambition and a doctorâs ambition isÂ totally different. In such a scenario, ehealthÂ or telemedicine has good roleÂ to play. We can have a programmeÂ like tribal telemedicine, where weÂ can trainsome people in telemedicineÂ and post them in tribal areas with theÂ video conferencing system. The patientÂ comes to him, he interacts withÂ the patient and communicates with usÂ and accordingly deal with patient.AÂ good telemedicine strategy throughÂ consultation can serve the communityÂ exponentially.