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Wednesday, March 08, 2006

Should medical students resort to a strike?

Should medical students resort to a strike?
Thomas George at http://www.issuesinmedicalethics.org/082mi059.html
Indian Journal of Medical Ethics Apr-Jun2000-8(2)

The medical students, resident interns and post-graduate students of Tamilnadu were on strike from February 17 till March 4. Although there were 16 grievances, the two main demands were an increase in the stipend and a law to prevent the setting up of any more private medical colleges in the state. On February 25, the government offered an increase in the stipend but refused to give an assurance on the private medical college issue. The strike continued and five students went on a “fast until death”. The students demanded an audience with the chief minister, but he demanded that they first call off the strike. The opposition leader raised the matter in the legislative assembly. Finally the chief minister agreed to meet the students on March 4.

The government agreed to raise the stipend from Rs. 2,250 to Rs. 3,027 for the resident interns. For post-graduates, the amount would go from Rs. 2,500 to Rs. 4,400 for first year postgraduates, Rs.4,641 for the second year and Rs.4,883 for the third year. Those doing super-specialty courses would get Rs. 5,366. The government also agreed to a 10 per cent annual increase of the stipend to prevent future strikes on this score.

During the course of the strike it became clear that the students were extremely concerned about the possibility of new private medical colleges in Tamilnadu. This was because in the recent past one had been started in Salem. This college had obtained permission from the Medical Council of India and the central government, despite being refused permission by the state government. It had approached the Supreme Court and won a directive to the state government to accord permission. The students were informed that this entire drama had become possible due to an amendment to the Medical Council Act in 1993, which vested the power to sanction new colleges with the MCI.

They had obtained a legal opinion to the effect that if the state passed a law to prevent the setting up of any more medical colleges in the private sector,it would override any law of the Central Government, since education is on the concurrent list. The students were apprehensive that this point was not being brought to the attention of the chief minister and hence their insistence on meeting him.

Other than the Christian Medical College, there are three private medical colleges in Tamilnadu. All of them were opened during the governance of the late MGR. Two of them have got deemed university status and admit students after collecting exorbitant capitation fees. They conduct bogus entrance examinations to give a fa├žade of fairness to the selection process, but it is an open secret that one has to pay a capitation fee if one wants to get seat.

This is not to suggest that the DMK has been correct in their approach to medical education. During their several stints in power, they completely corrupted the selection process and a large number of undeserving students got not only medical seats, but also post- graduate seats. Subsequently, many of them were appointed to faculty positions. Knowledge of the kind of people they have put into the teaching medical colleges is perhaps one of the reasons that politicians now hardly ever go to a state government institution for medical treatment. MGRwent to the USA for a renal transplant. Even his early treatment in Chennai was not at the so- called “premier” institution, the Madras Medical College, but at a private hospital. It was during the governance of MGR that an entrance examination was introduced for entry to the medical colleges. This was probably more a response to the number of writ petitions that went against the state government every year in the matter of medical admissions and the strictures of the court, rather than any desire for fair play.

The question arises: Should medical students resort to a strike, however just their demands? This has been debated many times. Some concerned people believe that doctors should not go on strike, although they agree that many of the grievances are genuine and that governments are unresponsive (1,2). It is amazing that in the two references given, one written in 1992 and the other in 1999, i.e. a full seven years later, the grievances of doctors remain similar.

This suggests that policy-makers do not care, and can be forced to respond only by an extreme act like a strike. It is true that the poor suffer the most when there is a strike in a public hospital. But this is equally true when, for example, transport employees go on strike. The fundamental problem is that the state is not sensitive to the needs of the poor. This is seen in so many ways, like the meagre allocations for education, while handing out tax cuts to the already filthy rich. Expecting doctors alone to always be ready to sacrifice is neither meaningful nor healthy. Society has to be structured in such a way that rewards are allotted in a just manner. Doctors, who put in a lot of hard work, as most interns do, certainly deserve better working conditions. Until they get them as part of their rights, such strikes are likely to recur. They are a symptom of a deep malaise in our society, of which one manifestation is that a few undeserving but powerful people grab much more than their share of the fruits of development, while the vast majority are left to scrounge for the remaining crumbs.

References:

1.Ashtekar A, Mankad D: MARD strike: our reservations. (Letter). Issues in Medical Ethics 2000; 8: 2.
2. Pandya S: Letter from Bombay. National Medical Journal of India 1992; 5: 44-45

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