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Social conscience can be taught

July 8, 2008

Medical graduates in India avail of subsidized education and in return are expected to serve a year in rural India. However they can escape this clause by pay a lakh of rupees.

Unfortunately, a majority of them do escape, according to a recent report. Surprising to read that even students who get free education (not just subsidized) due to their “reserved” status also prefer to duck the rural posting. And sadly, so do students who are from rural areas themselves.

However I am not here to bash the medical students, because one can always apply this you-must-give-back-to- the-country argument to all those who finish their higher education in India in government educational institutes, all of which are subsidized. Some people say that medicine is a noble profession and that doctors have a duty to society and so on and so forth and then there is the fact that India’s rural health infrastructure is in shambles although progress is being made.

I don’t think that medical graduates are some other breed though. They are a part and parcel of our society and will have the same ambitions and goals that everyone else has. I don’t expect med grads to behave any differently from engineers or managers or pilots or designers.

In any case, I have never believed that compulsion or force of any kind is a good solution to anything. If a person, even from the rural hinterlands, hates the idea of working in his own area, the problem lies deep, and we need to get at the roots of it to find a solution.

An article by SP Kalantri discusses this thorny issue of medical ethics. He writes:

Will compulsory rural service work? Can it work in isolation from the general trends in medical education and practice? Can we force ethical practice by edict, or do we also need changes at the level of health policy to promote ethical behavior? Can individual policy decisions work without a larger qualitative change?

He raises important questions. One cannot see med grads as people outside the society, and we cannot expect them to behave differently from the societal ethos of the day. Today, society lays tremendous emphasis on professional success which is measured by money and the prestige that comes from either private practice or being attached to reputed hospitals.

And then there is the comfort of life in cities and more. When it comes to education for one’s children, again it’s the city which offers the best.

As Kalantri says, rural service requires “personal sacrifice” and if medical students aren’t willing, we need to look into ourselves and wonder if we would have been willing. Would an IIM grad or an IIT grad spend a year in rural India? And consider that medical students get into medical school after years of backbreaking work and then spend long years studying.

I am not saying that this excuses anyone from social responsibility. In fact I strongly believe that each and every citizen of India needs to have this social awareness and willingness to do something. But these qualities cannot flower overnight.

Social service and voluntary work needs to be part of our educational system. It needs to be inculcated at school level, in every single student. It needs to be compulsory for all students, right from primary level. Today social service is not compulsory in our school system. At college level some courses make it mandatory, but most don’t. There is the NSS ofcourse, and if you put in 120 hours here you can get 10 extra marks. But again, NSS is not mandatory. A student can finish his higher education without doing an iota of service to the society and often may not even be aware of the tremendous problems India is facing. I think this is just sad. Our educationists keep talking of changing the curriculum to reduce the load on our kids, but I think they should increase their moral debt a wee bit.

(Photographs are by me and copyrighted)

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30 Comments leave one →
  1. oemar permalink
    July 8, 2008 10:17 am

    Te last para sums up the issue pretty well, thought I would like to add that a push from parents would see it through. Its really difficult for a school/course to develop moral values in a child without positive support from his home environment. In the end, the child is speding more time at home anyway. Like every other kind of training, even this has to begin at home and parents ought to share the blame for the current mess.

  2. July 8, 2008 10:47 am

    This problem of medical graduates not wanting to work in rural areas with lesser services is something Canada shares with India. The majority of our rural doctors come from Britain or South Africa, and I would venture an opinion that it is the same with other professions as well. It is an attitudinal thng – professionals who are willing to countenance practising their calling in rural areas are considered somewhat less capable and less competitive. This is not often stated, however, it is implied. This is unfortunate as there is something to be said for working in less than ideal circumstances, for a willingness to serve. The Russian writer Mikhail Bulgakov worked as a country doctor and wrote stories about his experiences. I believe doing so allows individuals to practice greater self-reliance and also empathy. G

  3. July 8, 2008 11:11 am

    There is one more thing. The exposure that the students get in rural environment would be much more challenging than what they could hope for in the city hospitals, with so many senior exp doctors. The exposure to the rural lifestyles etc. could teach them a lot of skills required in life, apart from medicine. Let them miss all this. They deserve to miss.

    Destination Infinity

  4. July 8, 2008 3:05 pm

    I agree to the part that we cant force people to serve others. Like you said, its within our roots. We tend to deviate from our ideals, our religious beliefs (which all point to the same thing, serving and helping others).
    But then there are many working professionals who take their time out to work for NGO’s and other community services.

  5. July 8, 2008 3:42 pm

    This is awesome! when i started reading the post i was eady to get back to you in case you said in oppoiste to what you actually said! 🙂 but u are something nita! simply awesome! 🙂 🙂

    i am not writing anything else as a comment as there is no need… u have put the point i believe so no discussion 🙂

  6. July 8, 2008 3:49 pm

    We should have :

    Compulsory Social service in our school curriculum.

    Compulsory Environmental projects (Sapling planting,etc).

    Compulsory 1 year military service for 18 yr olds.

    We need ‘better citizens’ who empathize with the problems which plague our society & not just ‘money making Machines’.

    As Shiv Khera says ‘Freedom is Not Free’.

  7. July 8, 2008 4:56 pm

    if the companies start a programme where they enroll med and otehr students and give them the rural thing as “training” then those jobs will become coveted 🙂

  8. July 8, 2008 5:17 pm

    Really nicely put Nita, It is so true that from a small age individual success is taught to be of more importance than the success of the society. Organizations like NSS don’t attract over burdened students who would rather take up extra tuitions than put voluntary work. Like you said, appreciation of social involvement should be more aggressively suggested in a student’s curriculum.

  9. Anon permalink
    July 8, 2008 6:40 pm

    Some time back the daughter of a family friend emailed me to ask about coming to the U.S. for medical education after completing MBBS in Mumbai. The reason was that she did not want to have to do the one year rural service. So, the mandatory rural service may be having unexpected negative consequences.

    On the other hand, I think most people would agree that the medical profession (like teaching) has a different connotation than most run-of-the-mill jobs (like pilot, marketing, or IT). What I mean is that one expects medical practitioners to have greater compassion and greater commitment to alleviating suffering than other professions. Since this is my personal belief, I am shocked by her mercenary attitude.

    She is concerned that she will lose income during the time that she is in her rural posting. I wanted to tell her that it was just one year, that over the course of her working life, she would make orders of magnitude more money than the IT and engineering graduates whom she envied for being free of this commitment.

    The other thing she said in her email message is that she has a heightened sense of urgency to leave India because simply breaking the bond would no longer work – that the government would go after the students who break the bond. So, even at the time of signing the bond, she planned to break it and was outraged that she would no longer be able to get away with breaking the bond with impunity. This level of disregard for the rule of law and the lack of a good faith commitment to enter into contracts with which one intends to comply was simply appalling to me.

    The problem is not the mandatory service requirement. Medical education is subsidized far more than other education tracks. The need to alleviate rural suffering is greater. And doctors have the ability to alleviate that suffering.

    The real question is – do these mercenaries even see poor people as human beings deserving of a better life?

  10. wishtobeanon permalink
    July 8, 2008 7:38 pm

    Good post and very relevant for our society today. The schools, governments, society should all come together to develop an education plan that benefits the community. Here in the US, importance is given to ‘giving’ right from pre-school level. Certain days are marked when children are asked to either buy or bring useful things like food or clothes for the poor – so ‘giving back to the community’ is not an alien concept and is deeply ingrained in the kids’ conscience.

  11. rummuser permalink
    July 8, 2008 8:07 pm

    The problem with anyone not willing to go to rural India has nothing to do with willingness or otherwise. If we can provide basic amenities like safe drinking water, power supply, proper roads, proper schools in the vicinity with transport, and sanitation, who would not want to go? I can assure you that if we can produce one village like this and advertise, the response will be mind blowing.

    Doctors are no less human than any of us city slickers. They simply want some basic things that will enable them to live a life of dignity and provide a proper environment to bring up their children.

    The so called middle class of India is entirely urban centric and steals away all resources towards itself. It is time that we reversed the process. Who will listen? And more importantly, who will act? Since we will not, we will have Maoists and they will cause serious problems for the entire country sooner than later.

  12. July 8, 2008 10:00 pm

    U have a very good point. Ofcourse most IIM or IIT grads wont go to work for rural India. But here I would like to ask the educationists why is it that rural service has been put in the curriculum of only medical graduates?? I think this is unfair.
    My sister did her rural service for one year as per norms and only sending doctors to rural areas is not going to serve the purpose if there are many basic amenities missing or bureaucracy interferes with social services.

  13. July 8, 2008 10:01 pm

    oops missed the word “raised”.

  14. amlistening permalink
    July 8, 2008 10:50 pm

    Hi Nita,
    This is a good solution to a lot of issues. I hope people in position take note of this. A Doctor family friend in US has to do mandatory serve in a remote location/so called rural as per the rules of his Medicine related visa.

  15. July 9, 2008 2:06 am

    I agree with you that forcing any amount of good experience is never the right solution in any case.
    There are two points here:

    – people who have a good heart and will, they will do this kind of Social work and feel good about it. People who are not inclined to that – they will only suffer and try to avoid.

    -on the other hand, seeing lots of grief and misery can be very heart-opening, awaken compassion in a person and generally lead to some transformation and review of values. May be sometimes it is worth trying?

    I guess in a way it is similar to serving in the Army – it does good to any man, but not every man want to do it 🙂

  16. July 9, 2008 8:08 am

    oemar, parents do play a very important part. In fact I think that whatever social conscience I have developed is entirely due to my parents’ influence.

    suburbanlife (G), It is human nature to want the comfort of a city so I am not surprised by what you say. In India however, living in the rural areas is very hard indeed. Power is intermittent, there is no security and problems of water are also present. Medical supplies and equipment also pose a problem. It is indeed a huge challenge for a doctor to work in a rural area in India, particularly if he is used to the city. But I agree that anyone who does venture out, grows as a human being.

    Destination Infinity, agree with you a hundred percent as you can see in my reply to G. Living and practicing in a rural area will enrich a doctor (and those in other professions as well) in many ways.

    Xylene, yes there are people who take time off from their normal routine and do this. Even successful doctors do this and also those who devote their entire life to social service. I have also heard of IIM grads who start off their careers in this sector. However starting off with this mindset in the initial stages of one’s career remains unusual, so unusual that it is reported in the newspapers!

    Sakhi, thanks. Being a doctor yourself this must be a senstive topic!

    Rahul, I too think that young people should do that one year compulsory military service as I believe that it would help them greatly but now it will be impossible to implement. Our country will not accept it. Too much time has passed now and it will take years of debate before such an idea will be accepted. There are countries which do this on a compulsory basis but they have been doing for years, right from the start almost. Maybe if we had this on our agenda when we became independent, it might have worked. I have written about this subject here.

    vishesh, know what you mean. If companies do it, and dangle a carrot, it will have a different meaning!

    thoughtroom, thanks, as you said most students today are so overburdened that they spare little thought for NSS.

    Anon, I do agree with your sentiments. But the fact is that while medicine is a noble profession like you say, the people who join it are one of us. I am sure most medical students are not like this girl where they want to hoodwink the government, but yes, they want to avoid the rural service.

    wishtobeanon, the curriculum there is wonderful. My elder daughter did her IB and even the younger one was in an IB school for a while. They did a lot of social service as it was compulsory.

    Rummuser,true, life in India in rural areas is very very hard. It is a tough call for anyone to make.

    Reema, I agree that it is unfair but people believe that medcine is a noble profession. Actually I think so too, but then they should do a psychological test and only admit those with a social mindset! But considering that societal values have changed, we need to keep that in mind that most people do want to make money and live a comfortable life. I agree with you that our educationists have failed miserably, by 1) not inculcating a social conscience from childhood in schools and 2) not making it mandatory for other professions as well. And we are suppoosed to have socialism ingrained in our constitution!

    amlistening, thanks. 🙂

    axinia, about your first point, well I do agree, but there is another problem. One is that in India rural life is very hard, but yes not all villages in all states are like this. Many villages in developed states in India are quite alright. However there is another thing about human nature. People need to feel secure about themselves first. As life in India overall is a struggle, people want to make sure they start earnign immediately. Well, this is what I think.

  17. Sakhi permalink
    July 9, 2008 9:44 am

    @ nita
    being a doctor this is a big sensitive issue! only that poeple always have a lot of expectations form doctors but forget about their social duties… but i hardly discuss such things! but anyways liked your post a lot!

    Thanks Sakhi. I agree with you whole-heartedly that we have no right to target doctors. Even teaching is a “noble” profession but how many teachers with the best qualitifications do a mandatory service in the rural areas! Why isn’t the government making it compusory, considering that our rural education infrastructure is in bad shape? – Nita.

  18. July 9, 2008 10:18 am

    Why isn’t the government making it compulsory, considering that our rural education infrastructure is in bad shape?

    Is the education and training to be a teacher subsidized by the government at the same level as that for a doctor?

  19. July 9, 2008 11:06 am

    No, it isn’t. But then one can have a different time frame. For example one month as opposed to one year for a doctor? Our rural schools sorely lack teachers and people wouldn’t mind that much if they had to go for a month or so. I think such an idea can be implemented.

  20. July 9, 2008 11:35 am

    I remember watching a documentary on the German TV about one Indian doctor doing Cleft lip and Palate Surgery going around in the rural India and collecting such children for an operation.

    There was a Swiss young doctor with him who wanted to go through this practice for several months. She was very much stressed by the stated of things like lack of materials, etc. And she said she would anyway prefer to do plastic surgery for women a-la Hollywood (breasts, etc.).
    But after all she was very greatefull for this kind of experience in the rural India.

  21. July 9, 2008 11:41 am

    Yesterday I cam across an article in HT, where students of Delhi were working as volunteers for various NGOs. They had undertaken projects like child abuse, RTI use, child education and labour in their summer vacation. There were working on week days, Nita! That way they would accomplish much more than I would on a weekend! I felt proud.

  22. rajan pathania permalink
    July 9, 2008 12:05 pm

    well written article.
    when in society as whole the meaning of success has come down to “HOW MUCH YOU EARN”,this is not a surprising.
    And irony is that it is not only the money but also the honor,respect ,prestige also.If you are working in a big city hospital,all will come to you by default,hardly matters how good you actually are and if you are working somewhere remote ,exactly opposite happens.

  23. July 10, 2008 12:27 am

    read the article. I strongly believe that some kind of Compulsory military service (3months/6months/1 year) is necessary to sensitize the populace with the hardship that goes on in maintaining a country & also to help them gain a more empathetic attitude towards the society as a whole.

  24. July 10, 2008 8:23 am

    Thanks Axinia. Yes there are doctors who do stints in the rural areas and some even practice there! In fact there is one doctor who comes to this blog, Dr. Dhruv who practices in a rural area.

    Poonam, some NGO’s and schools are active in social service
    but still a drop in the ocean. And when I read the word HT I flinched! 🙂

    Rajan, I agree that the amount of money a doctor earns is not the best way to evaluate his expertise.

    Rahul, thanks. Wish there were more young people like you who believed the same!

  25. July 10, 2008 11:11 am

    @Nita: Why you flinched, because they are doing it in Delhi and not Mumbai?

    And sadly yes, its a drop in an ocean.

    Poonam, I haven’t forgotten that HT stole my photo (link). I know that probably all media does it (stealing from bloggers) because that is what everyone tells me, but I am still hurt. They have not even bothered to reply to my complaint. Even the press council hasn’t bothered to reply! Clearly the press council of India is allowing lifting of photographs. I have no interest in fighting a case, I have better things to do! I used to subscribe to HT but now have stopped reading it. But ofcourse if they write something good, I will read it, but will always flinch a little! 🙂 – Nita.

  26. sereintemoin permalink
    July 10, 2008 1:15 pm

    Great post, and very balanced approach. Yes, we all think Medicine is a ‘noble’ profession, but forget, it is a profession. Those are real people, sacrificing a lot of money, sleeping 3 hours daily and losing minimum 10 years of their youth, working 36-48 hours at a stretch 3 times a week sometimes, hoping to make a decent living, hoping to make it worthwhile for their parents’ sacrifices and hoping to start a personal life at the age of 30 -35. But they get less than 2000 Rupees per month during training, and many do not get paid during their postgrad (while they are made to sign that they have received the stipend). And dont think the moment they step out into the job world they earn in lakhs. Why, would I go to a novice fresh in the market to get treated? So the few who do succeed, start earning well after years of sheer hard work, at around 45 years of age. They dont have good terms with their spouses (wont be visible on the outside) and they hardly have time for the kids. People who judge doctors so quickly, have never been ‘on call’, have never slept so little working 10 hours a week for so many years at a stretch, so it is so easy to condemn.

    Most of the doctors are not paid well, contrary to what people believe, and doctors dont want to be embarrassed admitting such a thing in open. So most of them after repaying loans and after buying books worth at least a lakh in total (over the years), dont really find what they were looking for in terms of job satisfaction, good quality of life, sense of personal or spiritual peace or good working conditions and environment conducive to quality work and service.

    Second point, the people who worry about the doctors not working in rural areas, how many of them have tried to live in a rural area for 6 months and work within the framework of ‘medicine – state politics-govt. policies-local politics- personal ethics’ and succeeded? Have they lived there for 2 months and tried to observe the problems the staff faces there? Have they lived without electricity/ transport/ proper housing and toilets/ phones/ roads/ proper school for their children etc for even 6 months, to comment on this?(I have)

    How will they like it if they are posted to some place like that for a year? So, dear friends, think over it coolly before you judge doctors to be ambitious, greedy and selfish monsters.

    Think of doctors as fellow humans and think of all the factors which are the reasons behind this problem.

    Thanks. Yes, as you say doctors are human too and people tend to forget that! – Nita.

  27. My Point of View permalink
    July 11, 2008 1:31 pm

    A very good article on a relevant issue of modern healthcare in India. I would like to present my opinion on ‘inculcation of social conscience’ in children.

    I had been associated with different charitable organizations or hospitals in India, as that was the work I loved. No compulsion. So your post is a topic close to my heart and I wish to congratulate you for a very balanced approach.

    I think, everyone does what they hope will get them what they love. Fame, money, status, life abroad, whatever. And one is happy pursuing what is one’s true nature, be it money-mindedness or cheating or altruism- if you are forced to work against your basic urges, you are not happy.
    And be it IIT grad or MBBS grad, people are no different.

    I have worked in rural areas in India. In one village, I remember, senior doctors did not want to go as the village and the health centre staff was ‘crooked’. So the post was vacant.

    The senior doctors advised me to bribe someone and change my posting. I not only stayed on, I established some new records too, in district level achievement. And my centre soon started attracting record number of patients in the OPD, including people from across the state border, who had ‘heard my name’.

    So being a woman doctor in a highly ‘unsafe’ village, where i didnt know the local language, and the lazy staff was not used to any serious officer, was an adventure. Though I broke records, but really, I didn’t do anything extra-ordinary there, I just did my job honestly.

    But it made me realize different facets of this issue, and how difficult it is for a doctor to live in a village and try to do any real work. It is far easier to do no work, offend no one, and just draw your salary, which is what most people in central states do.

    And it also made me realize how difficult it is for a person unfortunately born in a village to get good health care, or even good guidance.

    I must admit, as far as I have observed in myself and other close people who are motivated like me, that although ‘social conscience’ is present in our inborn nature, but it is also true that in our families, we were exposed to the ideology of ‘social conscience’ due to our parents.

    So you are right, it can be taught, but more than teachers or courses, it must be subconsciously taught at home. How many people do any sort or form of charity, that their kids may subconsciously observe and retain?? How many parents (the same people who rave and rant about brain drain or lack of medical care in villages) actually treat the maid humanely, or give their old clothes to orphanages or visit an orphan wing of the hospital in a year and donate 100 rupees for someone, or sponsor the treatment of some poor person they know, or buy books for the driver’s daughter, or sponsor someone’s education or you know things like that. I don’t count giving money to beggars as charity, it is a quickfix for guilty conscience and easy salvation for daily sins. The beggars, by the way, are actually a breed of actors, and as I have known, are sometimes quite rich- it is just the way of life they have chosen.

    We saw our parent going out of their way doing things for the less privileged. We didnt particularly meet too many charitably motivated teachers in our schooling or medical college life… I guess we got it all from our parents. So people, do something really good once in a month, and you will reap a new generation of charitably motivated IITians and doctors.

  28. July 11, 2008 4:45 pm

    oh, I understand that grouse against the newspaper. I am disappointed that even Press Council did into answer. Where should we go for your creative copyrights?

  29. July 13, 2008 8:25 am

    Perhaps a rural posting is unwelcome to most young doctors when they are impatient to start their career while their classmates in other disciplines have already gained 2 years’ experience and better salaries. It might be more useful to make it an option after a few years’ of service – but the salaries should be made attractive and the hospital conditions should be made more attractive for them to consider it a useful experience.
    Now it seems just a ploy to get rope in captive students into these lowly paid jobs to meet the staff shortage in these rural hospitals.

  30. Dr Nishith N Dhruv permalink
    July 20, 2008 11:48 pm

    That was a very nice article and I congratulate you, Neeta, on seeing us doctors as part and parcel of this society. I wonder if making social services mandatory would also work. The onus lies on the parents. It is the values they inculcate in their children that would ultimately change the scenario. My wife’s parents (she is also a doctor) and my own parents inculcated such values and we both dreamt of working in a rural set-up. That is how we landed up in Roha. Yes, working here is not very easy. Again we miss the elegance and pleasures of life obtainable in cities like Mumbai. But we are satisfied that we have spent efforts in establishing basic medical facilities where there was none. There are genuine problems of schooling. So you are very correct. It is when these facilities are created that more medical people would opt to settle in such setups. There are serious problems of political interference also that need to be looked into. Meanwhile, it would be a nice idea to reduce the terms of compulsory service from one year to say 3 months. Also, it would be a nice idea to urge the senior well-established people to spend some time in such setups so that the services provided by the fresh inexperienced medical graduates are properly supevised and people get the real benifit.

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