First, I would like to congratulate Prime Minister Narendra Modi for taking the bold step of complete lockdown. This single step can dramatically change the course of the pandemic.
A lot now devolves on the Medical Council of India, the apex body which controls medical education. Let me explain how MCI can save millions of precious lives just by regulatory changes. Soon, Covid-19 will reach the second phase when thousands of patients will flood ICUs. In Italy, it’s not the virus alone which is killing the patients, it’s lack of ICU beds, doctors and nurses. Mortality in Covid-19 is directly proportional to ICU beds. Thus mortality in Germany is 0.3%, almost like seasonal flu, while mortality in Italy is 9.26%. It is because Germany has 29 ICU beds per 1,00,000 citizens, and Italy has 13. India has 2.3.
India is perhaps the only country which, with the right strategy and execution, can match the German results. Our government is capable of commissioning 2,000 bed ICUs in every city in less than two weeks and ramping up ventilator production locally, or if required, importing them from China. India has the privilege of large government hospitals and medical college hospitals with well spaced beds. All it needs is piped oxygen and suction which can be done in two weeks’ time. What’s missing, however, is the doctors, nurses and paramedics.
India is the only country in the world which, just by changing MCI regulations, can produce over 1.5 lakh doctors and specialists out of thin air. This is our greatest ammunition against the Covid-19 pandemic. Let us first learn what developed countries did to address their doctor shortages.
The UK’s general medical council informed British medical universities to skip the final year exam of MBBS students and award degrees based on their past performance. Yes, doctors are given MBBS degrees without passing exams! The Italian government asked medical universities to cut short the duration of MBBS by 10 months and award degrees without exams. This will give Italy 10,000 more doctors. Fortunately, we needn’t take these extreme steps. We should concentrate on empowering experienced MBBS doctors legally. Our ICUs need thousands of junior and specialist doctors.
- Over 50,000 specialist doctors are waiting to appear for the final exam in vital specialties like anaesthesiology, pulmonology, cardiology, radiology, etc after spending three to six years in specialties under MCI or National Board of Examinations. Like in the US, these doctors can be given the degree “Board eligible” so that they can practise without appearing for the final exam and after passing they become “Board certified” to become teachers.
- There are 40,000 specialists like anaesthesiologists, intensivists and emergency medicine specialists trained by College of Physicians and Surgeons. Many years ago, MCI banned degrees from this 100-year-old institution.
- MCI should lift the ban on fellowships offered by Society for Emergency Medicine India and Indian Society of Critical Care Medicine, and on 2,000 specialists with diploma in community cardiology from IGNOU.
- Thousands of young doctors trained in Russia and China are waiting to clear MCI’s eligibility test. These doctors are eligible to practise in most parts of the world. MCI should give them temporary licence to work in hospitals under senior doctors.
- Legalise telemedicine, online consultation, prescription like rest of the world.
The battle ground will now shift from houses and streets to hospitals and ICUs. This tough battle can only be won by the young doctors and nurses. As doctors, when we struggle to save patients’ lives, in our mind it’s only about the patient, never about us. As a young surgeon many years ago, when I was scrubbing up for the first time to operate on a HIV+ patient, I had to fight an emotional battle first: In the next 10 hours with sharp needles and knife in my hand, I knew a tiny needle prick can kill me, I must protect my life first so that my wife and four young children are protected.
This is exactly what will be going on in the minds of doctors and nurses. We must assume that half of our doctors and nurses will not take care of Covid patients. I know in the end many of them will turn up for work. As such, we don’t have many doctors and nurses. This battle cannot be fought by senior doctors like myself because Covid is dangerous for doctors over 60. This is the reason why, perhaps for the last time in my life, I’m begging MCI to liberate medical education and empower the youth to protect the nation.
If we don’t do it now, we’ll be forced to beg China and Cuba to send their intensivists to save our lives, like Italy did. Remember we have at any given time over 15 lakh patients lying on hospital beds with heart attack, stroke and cancer, we need to take care of them as well. Posterity will judge our generation based on the tough decisions we took, and smart moves we made. Now is the time for the people at MCI’s helm to put the interest of 1.3 billion people first, and take the judgment call.
DISCLAIMER : Views expressed above are the author’s own.