Civil Society News New Delhi

THE world is looking at the work done by the rural surgeons of India as a model in public health care which is both affordable and sustainable and not tied to corporate profits.

The annual conference of the Association of Rural Surgeons of India (ARSI) was held at Pipalia Kalan, in Rajasthan’s Pali district, in the first
week of November. It was their seventeenth conference and it attracted significant international participation from Africa, Bangladesh as well as Britain and America.

“The importance of this year’s meeting is that the world increasingly recognises the Indian model of low-cost facilities with community participation as the way forward in meeting the huge demand for health care in the developing world,” says Dr JK Banerjee, one of the early members of the rural surgeons’ movement in India.

Dr Banerjee currently lives in retirement in Dehradun, but he is a legend in his own time. He was invited to Tanzania last year and the African interest in India was in evidence at this November’s Pipalia Kalan meeting where 61 physicians from Nigeria and Tanzania were present.

As the world grapples with the cost of privatised health facilities and the pitfalls of insurance, rural surgeons here have shown that it is possible for doctors to stop being driven by money and return to the values of their profession instead.

Developing economies need doctors who practice among the poor and provide them affordable treatment. Rural surgeons restrict themselves to general surgery because this where the demand is greatest. They also set themselves up in remote places and train local people to work in their hospices.

When the Rural Medicare Centre (RMC) was set up two decades ago at Mehrauli in Delhi by Dr Banerjee, his wife and a few other physicians, it was just a tin shed. It has been the same story for many of India’s 500 rural surgeons.

The rural surgeons charge very affordable fees. A surgery at the RMC costs Rs 1,200. In the beginning it used to cost Rs 200. The OPD fee even today is Rs 20. But they don’t believe in doing charity. Theirs is an alternative business model for public health care based on earning less, cutting costs, innovating with surgical techniques and being accessible.

They are skilled physicians whose hospitals and clinics are mostly located in places where the health system does not reach. They could be delivering babies, fixing hernias, removing stones, setting bones, doing hysterectomies and much more with very meagre resources and technology.

However, rural surgeons get little recognition within India. The government does nothing to promote their approach to public health care. It doesn’t make it easier for them to set up their small facilities.

The National Rural Health Mission, into which huge sums are being poured, similarly ignores them – though it would seem that they are a ready pool of talent to be drawn on for such a purpose.

Asked why this so, Dr Banerjee says: “Politicians and bureaucrats are in the grip of the mafia of high-tech driven doctors.”

He says all the government’s attention is focussed on high-cost, privatised health care, when what are required are facilities which can serve the majority cheaply. India has just 0.6 hospital beds per thousand when the World Health Organisation (WHO) norm is four beds per thousand. Even the beds that exist are concentrated in the cities and are mostly beyond the reach of average people.

Asked what the rural surgeons would like the government to do in India, Dr Banerjee says a policy environment is needed. Reaching the maximum number people at an affordable cost should be a national objective.

In the absence of such a priority rural surgeons continue to battle the system whether it is in getting finance or establishing facilities. Training has suffered. A certificate in rural surgery started with the Indira Gandhi National Open University (IGNOU) has petered out. Similarly, a course under the National Board is petering out.

“African doctors are very interested in learning from us,” says Dr Samar Basu, a highly qualified gynaecologist. “They had a big presence at our Rajasthan meeting and want to come back to learn more.”

Dr Basu was the head of the scientific committee of the recent conference where surgeons spoke on a variety of innovations developed in the course of their work in different challenging environments. There were presentations on inexpensive diagnosis of cervical cancer, an indigenously developed uterine manipulator for laproscopic hysterectomies, management of peritonitis in a rural setting and so on.

“What we have seen in India has amazed us,” says Dr Tunji Adenuga of Nigeria in a letter to the Association of Rural Surgeons of India (ARSI). He and other Nigerian doctors want to come back to India and spend time at facilities being run by ASRI members.

The African doctors found the IGNOU course material so useful that they took back a large number of books and want to buy more.

“We have bought the modules for your CRS programme for local adaptation and we still need more for our members,” says Dr Adenuga.

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