UP healthcare crisis Part 2: With only 78,000 doctors for 21 crore people, state has turned playground for quacks

Editor's note: Uttar Pradesh had been in the grips of a healthcare crisis long before Gorakhpur and Farrukhabad put the spotlight on the state's ailing public health system. The state's infant mortality rate is comparable to that of strife-torn African nations. There is one doctor for every 19,000 people; according to WHO, there should be one for every 1,000. This is the second of a four-part series that explores the state's policy-paralysis and places it against the larger backdrop of a systematic public health failure.

Lucknow: Pintu Mahadev's three-year-old son Anmol died while in the ICU at the Nehru Hospital (NH), which is affiliated with the Baba Raghav Das (BRD) Medical College in Gorakhpur.

Before being brought to NH, he was "treated" by a quack in his village. Anmol hailed from Bartha village of Deoria district.

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After being diagnosed with Acute Encephalitis Syndrome (AES) at NH, he was taken to Dr Rakesh Yadav with complaints of high fever and breathing problems. After charging Rs 50 for the 'treatment', the 'doctor' gave him an injection and made him swallow a couple of pills but the fever didn't subside. Finally, after three days, Yadav told Mahadev to take Anmol to the Deoria district hospital, which promptly referred him to the BRD hospital.

Anmol's died shortly after because of multiple organ failure. He could have been saved had he been taken straightaway to the BRD hospital but the 'quack' stood in the way till it was too late. Nevertheless, his family now blames the hospital for his death. Their main grouse is the "insulting behaviour" of NH doctors. "They treated us like animals," said Geeta Devi. Neither she nor Pinto blames Yadav.

File image of BRD Hospital in Gorakhpur. PTI

The crass behaviour of government doctors is one of the reasons why quacks have a field day in Uttar Pradesh's villages and towns. Such is the architecture of healthcare in Uttar Pradesh that quacks thrive despite handing out wrong diagnoses and misplaced prescriptions. It helps that they are available 24x7. As long as it's a passing fever, a stomachache or a headache, the quacks – mostly compounders and chemists – manage a "cure" but when confronted with AES or something as worse, they are totally at sea.

According to Dr RS Shukla, chief medical superintendent of NH, more than 90 percent of the cases referred to the BRD hospital come after seeing a quack/unregistered doctor first. He said patients are brought here only when their condition gets so bad that the quack cannot carry on with the charade any further. Labelling them as "jhola-chaap doctors”, he said quacks only have a rudimentary idea of medicines but are experts in the art of conning people.

Dr RN Singh, who has worked with the BRD, said quacks flourish in rural areas only because of the non-availability of qualified doctors at Primary Healthcare Centres (PHCs) and Community Healthcare Centres (CHCs). They operate with impunity despite a total ban on quackery in the state. The Allahabad High Court had in 2015 ordered all non-registered medical practitioners to stop practising medicine. The CMO of each district was asked to keep a check on such doctors. But apart from the occasional raid, the government does little.

Banned? They have an association

On paper, quackery is banned in UP. But only on paper. There is a full-fledged quacks' association in the state. 'Dr' Prem Tripathi, president of Gramin Swasthya Seva Sangathan (an association of unregistered doctors/quacks in eastern Uttar Pradesh), said that they are the first "doctors" people take patients to and they are available 24x7 in rural areas.

Proudly, he said that when someone falls sick in any village, he/she is not taken to a government hospital but straight to their clinics. He rued that they are looked down upon despite their service and nominal fees. He said the government punishes them and levies fines on them, and sometimes even seizes their clinics. "When even one case gets out of hand, we are hauled up for medical negligence," he complained.

A 2016 report titled 'The Health Workforce in India' published by the World Health Organisation notes that almost one-third of those who claimed to be allopathic doctors in 2001 were educated only up to the secondary school level and 57 percent did not have any medical qualification. It was far worse in rural areas, where only 18.8 percent of allopathic doctors had a medical qualification.

The Allahabad High Court had in October 2006 ordered the closure of clinics of illegal medical practitioners. Tripathi said many doctors were arrested in the state after that order and many are still fighting cases. He said the government should rethink its policy. "With proper training, we'll be an asset to society," he reasoned.

'Dr' RS Yadav, a quack practising in Ismailganj area of Lucknow for the last 25 years, told Firstpost that his father, a BAMS doctor, had trained him. He contended that a 2015 order by the state government allowed doctors like him to prescribe allopathic medicines.

"I'm doing nothing wrong. This is a social service for me. My father died doing it. I treat more than 30 patients a day. The police pick me up now and then but I will keep doing this till I die," he said.

Controlling measures

The 'qualified' doctors are not amused. Dr Satish Chandra, chief medical officer of Mau, said he has formed a two-member team to identify unregistered doctors. He said the team will go to rural areas, identify such doctors and strict action will be taken against them. Dr Balvir Singh, additional chief medical officer of Farrukhabad, where more than 45 children died in August this year, said there are more than 300 quacks in Farrukhabad but they don't shut shop despite repeated action. According to law, punishment for running a clinic without the necessary qualification is a penalty of Rs 1,000.

He said every quack hangs a shingle with fancy degrees, adding that it is not hard to get fake degrees and certificates with the help of Photoshop. He called them a threat to the patients. He shared how Ram Manohar Lohia Hospital admitted 211 cases of sick newborns this August and 145 of them had come through quacks.

In 2016, more than 60 quacks were booked in Moradabad after they were found to be chemists. Action was taken against them, said a report in Medical Dialogues.

Dr Seema Sahai of National AIDS Research Institute said in a report that people prefer to go to community doctors as the first point of care. Even for treatment of convulsions, jhola-chaap or Bengali doctors are the preferred accessed.

Doctor population

At the end of the day, everything boils down to the number of qualified doctors. Dr Pushpa Jaiswal, a noted gynaecologist from Lucknow, said there is a dearth of doctors in India, especially in rural areas. She said the government should focus on healthcare infrastructure and deployment of more and more doctors at the primary level. She said the government should also provide training to such doctors who have been practising for long but with restrictions.

"Work pressure on doctors is immense. Be it sub-centres, PHCs or CHCs, there is not more than one or two doctors at each one of them. For decades, nothing has been done to address this shortage," Dr Singh said.

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According to the figures available with MCI Uttar Pradesh, there are 78,476 doctors in the state while the numbers of Ayush (Ayurveda, Yoga, Unani and Siddha Healing) doctors in the state is 89,756. According to the World Health Organisation's recommendation, the state should have at least 2.1 lakh doctors for its population of approximately 21 crore.

Read Part 1: Chronic shortage of doctors, overdose of apathy have left govt hospitals comatose

Read Part 3: Per-capita health expenditure of India's most populous state is half the national average

(The author is a Lucknow based freelance writer and a member of 101Reporters.com, a pan-India network of grassroots reporters.)