Whatever be the reasons for the Russia – Ukraine war that is razing for the past fortnight, hapless citizens of Ukraine have been the most affected with a massive exodus of residents and immigrants. Caught in the crossfire, students belonging to and those that have come to Ukraine from other countries have been the hardest hit, with some of them even losing their lives. Many are still stranded without food, water and basic amenities in bunkers, bomb shelters and metros.
Should India be concerned? Apart from the collateral damage where the fuel prices have been going north, should we not be concerned of our students in that country pursuing higher studies?
That the government has pulled out all stops, finding alternate routes to fly them back, even as most of the airspace is shut, shows its human side. However, this is only half the solution, the other half being their rehabilitation in Indian Institutions. As per the Indian Embassy in Ukraine, 18,000 of a total number of 20,000-odd Indians in Ukraine are students pursuing medicine and engineering courses. They constitute almost 25% of all international students studying in Ukraine.
Why Ukraine has become a popular destination for Indians to study medicine, dentistry, and nursing for over three decades is a puzzle that must be solved though availability of reasonably good and cheap courses may be some reasons.
Indian medical education has been seeing some profound changes in the recent past though expansion has not been one among them. The erstwhile MCI was disbanded in favour of the National Medical Commission. Now five specialized doctors monitor the medical education.
There are 541 medical colleges in India. Many of them do not meet the standards of medical education and health care of the world. The pandemic has severely exposed the inadequacy of heath care and our hospitals. Apart from a dearth in seats, infrastructure, hospital facilities, nurses, doctors in almost all specialisations, there is a dearth of research as well. If the Urban medical facilities need improvements and augmentation, the rural medical facilities are not sufficient to even cater to basic needs.
There are about a million doctors registered under different state medical councils. Assuming 80% availability, the actual number would be about 8 lakhs. Whereas WHO recommends one doctor per 1,000 population, the number actually available is one doctor per 1,655 persons. Almost 6 lakhs more doctors would be needed to meet the WHO standards. Currently with an enrolment of 67,000 students for the MBBS programme, how many years would it take to even match the WHO requirements? More than a million apply for the available seats. No wonder our students migrate to other countries to pursue education that we could have easily been provided here.
There is a great dearth of specialists like Surgeons, Obstetrics, Gynaecologists, Physicians, Paediatricians and even nurses, both in the community centres and the hospitals. Several vacancies exist in the government hospitals. Attrition rate for nurses is 50% with most going abroad. We seem to have a first-world regulatory structure with a third-world infrastructure.
The requirements when it comes to medical education are very rigid. About Rs. 400 Cr is required to build a medical college in India. How many such medical colleges can be created and who will create them? Offshore medical schools in the Caribbean train students from the United States and Canada who intend returning home for residency and clinical practice after graduation. Most offshore schools are dual-campus programs with basic sciences being completed in the Caribbean, while clinical clerkships completed at teaching hospitals in the United States, Canada, and the United Kingdom. Most of our medical colleges train doctors in suboptimal numbers. We need 120 faculty to train a mere 100, whereas globally, 10 times the number are trained.
With cost of medical education being what it is, children from poor families cannot dream of becoming doctors. Rich children opt for radiology, dermatology and other specialisations so that they can reach home by 5 pm. Many of them opt for practice abroad or pursue higher education, leaving the country’s rural health centres in bad shape. We need to change the rules of the game so that children with a fire in the belly, even if they are poor, could study medicine in the country.
While the fee to study MBBS course in private colleges in India may range between Rupees 80 lakh to 1.5 Cr, pursuing a six-year course in medicine in Ukraine would cost Rupees 15 to 22 lakhs. While PG education costs 2 Cr to 5 Cr of rupees in India, it costs about Rupees 40-50 lakhs in Ukraine. Naturally, students who don’t get a seat in government medical colleges in India or are unable to afford the fees of private medical colleges would go to Ukraine. The standard of medical education is fairly high, ranking fourth in Europe and medium of instruction is English. The country has almost 33 medical colleges equipped with standard infrastructure, accredited by the World Health Organisation and UNESCO. With no need of an entrance test like the NEET, why should an Indian or any other not go there? They however, have to pass the National Board of Examinations’ Foreign Medical Graduate Exam (FMGE) to receive licence to practise medicine in India. It is another matter that while 4,000 take the test every year, only 700 mange to clear it.
Is it not time we increased both the number of UG/PG Medical seats in the country? US has 20,000 undergraduate seats to 40,000 postgraduate seats. We have for 65,000 undergraduate seats only 14,500 PG seats.
60% children are born in rural India. Why should every 12 minutes, a pregnant lady die during child birth? Why should more than 3 lakh children die the day they are born? Why must 1.2 million children die before they celebrate first birthday?
We need to liberate medical, nursing and para medical education from the clutches of the elite. Only then we would have democratised medical education in the country. Besides avoiding Ukraine like situation, we could produce doctors for other countries and stop a flight of 25,000 Cr Rupees annually as well, if only our line ministries and the private sector heeded our Prime Minister’s call for breaking the elitist mindset and expand the sector.