May 2007 Edition
DR JK BANERJEE
SOCIAL prosperity of the common man, good health and education facilities should be the criteria for the economic growth of the nation. Pats on our back by the World Bank or the IMF should be thrown into the gutter. We have to redefine our own norms of economic growth. Western cultural slavery has made our people greedy and individualistic. Unless we hark back to Gandhian philosophy and economics, our country is doomed to remain ‘developing’. Gandhian philosophy is not against industrial or modern scientific growth. It is against the greedassociated with this growth. The Alternate Nobel Prize instituted by Sweden has for its theme the Mahatma`s saying: “In this world there is enough for everybody’s need but not for everybody’s greed”. The Association of Rural Surgeons of India (ARSI) was formed in 1992 to take definite steps in this direction voluntarily.
The founder members included stalwarts like Dr Balu Sankaran, Dr NH Antia and rural surgeons like Dr RD Prabhu of Shimoga in Karnataka, Dr RR Tongaonkar of Dondaicha in Maharashtra and Dr Sitanath De of Jhargram in West Bengal. These surgeons were determined to bring about a change. They were later joined by many others from across the country. Surveys were made of their working conditions. And the First National Conference of Rural Surgery was held at Sevagram in Wardha at the Mahatma Gandhi Institute of Medical Sciences. It was hosted by the Late Dr Sushila Nayar, who was herself an ardent follower of Mahatma Gandhi. Through the conference it was revealed to city-bred surgeons how, with limited resources, the rural surgeons were giving villages services that were equivalent in quality to those available in urban centres. More importantly, they were at a price that the rural population could afford. Today, the ARSI has a website, arsi-india.org, and a newsletter going to 400 members of our association and also to rural surgeons in other developing countries, especially in Africa. Rural surgeons are called forscientific conferences abroad because resources are scarce worldwide. The developed world is becoming increasingly keen to learn from the Indian rural surgeon. Establishing rural surgery as a specialty in our country has been an uphill struggle. Way back in 1986, the Association of Surgeons of India formed a rural health care committee with Dr RD Prabhu as its convener to go into the working conditions of surgeons in small towns and rural areas. A survey was done and140 surgeons responded. These surgeons had different specialties, including lifesaving caesarian sections. All of them were involved in teambuilding, training health workers and nursing staff from among local young people and running small hospitals where government facilities were scarce or did not exist. Although they were trained only as surgeons in the universities, out of societal needs they were training themselves to perform multi-specialty surgeries and manage a hospital.
They also generated employment by training local people who
were invariably from poor communities.According to these surgeons, ‘rural surgery’ had to become a separate specialty
to meet the needs of people. But, unfortunately, when these rural surgeons askedthe Association of Surgeons of India, their big brother, for this right they were
laughed at by the professorial mafia. In the national conference of surgeons’ associations
in Hyderabad in 1992, the rural doctors asked the professors who should
decide on a specialty. Should a specialty be decided by our western teachers or the
needs of our people? There was no reply. But rural surgery wasnot to be granted
specialty status.
There was no alternative for the rural surgeons
but to walk out and form their own Association of Rural Surgeons of India. Seven surgeons held the
first meeting of this association in March 1993 at
Shimoga. And the first national conference of
rural surgery was held at Mahatma Gandhi
Institute of Medical Sciences at Sevagram in 1993.
The rejection by the Association of Surgeons of
India turned out to be a blessing in disguise. Many
practising rural surgeons, who never bothered to
attend the conferences of the Association of
Surgeons because they were uncomfortable with
its five star ambience, joined the rural surgeons’ association. Our networking increased. Wonderful
innovations started coming to light, mostly to cut
down costs. Cheaper suture materials, cheaper
sterilising procedures, cheaper operation theatre
maintenance and so on. Of course all this was
being done without compromising quality.
Rural surgeons charged their patients small
fees, but since the numbers were big they managed
to earn a decent living. Of course they were
not of the greedy type. Society gave them enormous
love and respect. They all earned enough
money to own a car, a house and educate their
children in good schools.
This association now gave them a platform to satisfy their scientific and academic desires as well as to network with like-minded doctors across the country. With the news of this bold step of the Indian rural surgeon spreading across the surgical world, several surgeons from the West started supporting our move. Prof Stig Bengmark of Lund University in Sweden, Prof Wilfried Lorenz , Dr Thomas Moch, Dr Gabriel Holoch and members of the German Society of Tropical Surgery (DTC), Dr Peter Smith of Holland, Prof David Mulder of Canada and so on. The Association of Surgeons of East Africa became our jointsignatory. Surgeons from Kenya, Uganda, Tanzania and Nigeria started attending our conferences. Finally, the International Federation of Rural Surgery was born with Dr Prabhu of India as its first president at the first international conference of rural surgery held in Ujjain in 2005. The concept of rural surgery, which in other words is limited resources surgery, had come to stay across the world. Today, five billion of the six billion people of the world cannot afford access to modern medical and surgical care. The specialty of rural surgery promises to bridge this shameful gap in the 21st century by evolving appropriate care and management systems across the world. The rural surgeon professes to use technology as a slave for service to humanity rather than becoming a slave of technology himself. Way back in 1995, the rural surgeons approached the Medical Council of Indiato institute a post-graduate course in rural surgery. The request was turned down. Then Prof NH Antia took the lead in negotiating with the Indira Gandhi National Open University to start a course on rural surgery through distance learning.
Prof Balu Sankaran supported the move. Five years were spent in the designand implementation of the course. In 2005 however came the biggest breakthrough. The National Rural Health Mission came asa beam of light. The National Board of Examinations (NBE) of the ministry of health approached us to help them in designing and starting a post-graduate course in rural surgery. We are thankful to Prof Rajasekaran, Prof Shyamprasad and Prof AK Sood of this board for taking this step. This is a three year course after the basic degree of MBBS. Training will be imparted partly in rural hospitals and partly in nodal (multidisciplinary) hospitals. Twelve hospitals have been selected for the course across the country. And admission will be on the basis of the aptitude of the young doctor which will be judged through an interview only. At the end of the course, the doctor will be able toperform all the functions that a rural surgeon does today. He will be able to choose technologies that people can afford. And it will be possible for him to introduce modern sophisticated technology gradually in a cost effective way. tal. Ninety-five per cent of all the health and medical care problems of any given community at any point of time do not require the skill of a super-specialist. A rural surgeon reduces the super-specialist’s load of general care problems.
Email: dali_f23@yahoo.com
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