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Tuesday, September 29, 2020

COVID pandemic will cause tectonic shifts in India’s medical education, health services

The world in general and education, in particular, is at a crossroads. With COVID-19, many of our beliefs and the systems we follow are bound to change.

Written by Subbiah Shanmugam | Updated: June 9, 2020 9:15:10 am
India Coronavirus Updates, June 8: Offices set to open in Mumbai, Kerala, 79 govt doctors test positive in Telangana I am sure that COVID-19 is going to create a long-term scar in the minds, and future professional lives of young medical graduates being trained in the corona era.

Confucius, it is said, once observed, “a seed grows with no sound, but a tree falls with huge noise. Destruction has noise, but creation is quiet”. As we all know, the world in general and education, in particular, is at a crossroads. With COVID-19, many of our beliefs and the systems we follow are bound to change. We have heard the loud noise of destruction. It is time to regroup and create things quietly.

Tectonic shifts are bound to happen. For instance, a gentle smile on the face of the doctor often reassures the patient. But after COVID-19, I am sure that my patients and I are both going to cover one-third of our faces, and we may lose the emotional connect between us. More importantly, as a medical student, I was taught that half the diagnosis is already made as a patient walks into the consultation chamber. And, like the gait of the patient, odour also was taught to be important: Alcoholic breath, ketoacidosis breath, halitosis and so on. Now, the question is, how far can I insist on the importance of this to my students after COVID-19? I am sure that by not being able to correctly recognise the smell, millions of dollars will be lost the world over on other investigations.

I am also certain that in the post-COVID-19 era, there is going to be, at least, a 10 per cent hike in the costs incurred in all procedures including consultations, because much is going to be spent on protective gears and other requisite equipment. Whether the financial and marketing experts with a stranglehold on corporate hospitals will stop at a 10 per cent increase is anybody’s guess.

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How the poor are going to manage without, or even with, any government insurance scheme is a big question. Rather than dumping them on government hospitals only, I feel that corporate entities should be compelled to take on their treatment. They can make up for the loss by cross-subsidising treatments of patients with premium insurance policies, or when the patients themselves are VIPs.

India has emerged as a country that has tackled the COVID-19 pandemic with relatively less morbidity and mortality. And, considering how the disease has changed opinions worldwide on China’s role, it may be an opportunity to concentrate on medical tourism and focus on encouraging foreign students to come to India for education in general, and medical education in particular. A detailed inter-ministerial standard operating procedure is the need of the hour while dealing with such medical tourism: It will help bring in resources for my poor countrymen so we can treat them better. Establishing a robust healthcare ecosystem and encouraging our people to learn the language of countries from where we are expecting medical tourism to grow will be a wise choice to make.

I am sure that COVID-19 is going to create a long-term scar in the minds, and future professional lives of young medical graduates being trained in the corona era. This is the first time that the skills imparted by our social and preventive medicine (SPM) departments are being tested. I am aware that this particular branch of medicine is less sought after, and it is seen to be more bureaucratic in nature in our country. I am sure that this pandemic is going to significantly alter our perception of branches like SPM, entomology and virology. But it is probably the right time to realise the potential of research in the field of virology. We can do great things because we have the potential. The only requirement is administrative transparency and academic vision.

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Once COVID-19 is under control, we need to sit together to understand the psychological and professional impact of the pandemic on our young medical students. I know their training in other areas of the medical field has taken a beating: Every medical and surgical procedure has been reoriented to the whims and fancies of the corona era which will affect the training imparted to our young medical graduates at least for some time. I am sure they will approach every patient, with pyrexia of unknown origin, as a coronavirus infection unless proved otherwise. Less training for students in other areas like surgery, obstetrics and gynaecology and orthopaedics needs to be addressed.

With the arrival of the software industry in the past two decades and the quick money associated with it, medical education has become somewhat less attractive for the younger generation. I hope that the pandemic and its impact on public health, the associated economic depression and industrial layoffs, may attract young people to medical education with renewed vigour. However, the increasing influence of corporates in the health sector and the industrialisation of healthcare delivery has meant that doctors — the nucleus of the health system earlier — have been pushed to the periphery. Market forces have taken over the centrestage.

But health was never sold as a commodity in our ancient tradition, and therefore, market forces can’t be the nucleus of the health sector — at least in this part of the world. Let us understand this and try to Indianise the modern health system in a way that is aligned with our needs and culture.

This article appeared in the print edition of June 9, 2020, under the name ‘Bracing for change’.

The writer is professor and the head of department for surgical oncology at KMC Chennai and national president of Akhil Bharatiya Vidyarthi Parishad

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