Wednesday, 16 April 2014

Fake Doctors (Part 1)

The only thing worse than having no doctor to go to for treatment is being treated by a fake doctor.  As sure as God made little apples, there are many of these fake doctors practicing medicine when they are not fully trained to do so. I will tell you of incidents of quackery in India that will shock you.


Only one in 24 medical providers in India are qualified to practice medicine. Those statistics are frightening. Those quacks continue practicing medicine and collecting fees, even after their patients needlessly die at their hands.

On May 13, 2012, Kaamini Solanki woke up feeling ill. Her husband felt her forehead, which was so hot so they decided to see her gynecologist right away. She was two months into her second pregnancy. Her gynecologist referred them to a nearby hospital, where they arrived in the morning and remained until evening. Meanwhile, Kaamini life was fading. Around 8 p.m. she started to cry, saying she was in pain and complaining to her husband, Dheeraj, about the hospital’s physician.

Kaamini had developed septicemia, a blood infection that is usually fatal if not promptly diagnosed and treated. But Dheeraj realized that the blood infection wasn’t the real cause of her death. He believed that it was the quack in the hospital that killed her.

After filing a civil case against the doctors he had trusted with her care, he received some shocking news. The gynecologist had only a bachelor’s degree in medicine and the hospital’s doctor was a fraud, with no medical training at all. One is forced to wonder why the hierarchy of the hospital didn’t check out the credentials of those two doctors. The husband of the dead woman never suspected that those two quacks weren’t real doctors.  

And the last Dheeraj heard, the quack he says killed his wife was working at a new hospital not 10 minutes away.

The Delhi Medical Council, a state board, estimates that the capital alone has more than 40,000 fake doctors, outstripping the number of bona fide physicians. And in rural India, real doctors are few and far between.

India’s government has tried to rein in quackery, but experts say that the government’s efforts have been weak and the problem just keeps growing. Even at hospitals, patients can no longer be certain who’s donning the white coat—the real doctors or the quacks. “It is very difficult to identify a quack,” says Dr. Anil Bansal, who heads the anti-quackery committee at the Delhi Medical Council. He says that for a common man or a tourist, it is impossible to make that distinction.

Quacks often start out as helping hands at doctors’ offices, or as blue-collar workers at hospitals. Many have no schooling beyond eighth grade. Others have training only in alternative health systems such as homeopathy or Ayurveda (traditional medicine native to India and a form of alternative medicine).

The number of non-registered clinics is comparatively more than the registered clinics and the people go for such non-registered clinics in search of cheap medical treatment. The quack doctors prescribe them high-power medicines for instant relief and are simply not bothered about their side effects

In January, 2014, the local government in Delhi announced that hospitals illegally employing alternative practitioners as physicians will have their registration cancelled. But whether that will have a real impact is far from certain.

Unfortunately for the people of India, there are far more quacks in hospitals outside of Delhi than in the capital itself and no governing body outside of Delhi is trying to turf them from the hospitals. And worse yet, the hospitals themselves are making little or any effort to determine if there are quacks in their hospitals.

India already has laws banning quackery, though they are rarely enforced, in part because the country has little else to offer its needy citizens as health care. Properly trained doctors aren’t prepared to live and work in under-developed communities where they are sorely needed. The negligence of the central government and the lethargic attitude of state governments in the absence of appropriate laws against such quack doctors have led to these staggering figures. The quack doctors are not only seen in private clinics, but they are also spotted in nursing homes and some major hospitals in cities in India.                         
The insufficiency of the registered doctors, lack of awareness among the people of India, cheaper treatment, the local acceptance of the quack doctors and the negligence of the police and government are encouraging this menace of quackery to thrive. The Governments, federal, provincial and local should take some serious steps before the problem of quackery becomes too enormous to handle, but typically to form, they merely sit still and twiddle their thumbs while looking the other way.

The root cause behind the mushrooming of quack doctors in the metropolis of Delhi is the deficiency of registered doctors having been awarded a Bachelor of Surgery. (MBBS) If you consider Delhi, it has 40,000 registered MBBS doctors which is sufficient only to treat 1.75 patients in one district whereas Delhi has many districts.

According to the Indian Medical Association (IMC), there are around 1.5 quacks operating in Andhra Pradesh, 40,000 in Kerala and surprisingly the number in the national capital is more than 40,000. The lenient rules have increased the confidence levels of quack doctors. The Delhi Medical Council (DMC) caught 500 to 600 quack doctors in the 12 districts of Delhi last year, but no proper action was taken against them. As per DMC rules a doctor who is practicing alternative medicine and is not registered with Medical Council of India (MCI) falls in the category of quacks and as per the provision, such a person could be jailed for three years or fined 20,000, ($3,332 USD) Rupees or both. Unfortunately, none of the rules is being followed to punish the quacks.

In March 2014, five of the eight doctors accused of fraudulently obtaining licences for medical practice in connivance with middlemen and unknown officials of the Medical Council of India (MCI) were arrested by the Central Bureau of Investigation of India. They purportedly possessed primary medical qualifications from Russia and China. The agency filed the charges as a result of source information that some doctors were practicing medicine which was discovered by MCI registrations that had licenced these quacks  based on these quack’s false documents. Investigations revealed that at least three of the accused doctors had been working at government hospitals in Gujarat, West Bengal and Chhattisgarh.

As per MCI procedures, those with foreign degrees are required to undertake a screening test conducted twice by an autonomous body, the National Board of Examination. It is only after a candidate qualifies the test that the MCI issues a registration certificate that is mandatory for medical practice in India. So, how did these eight quacks slip by unnoticed?

According to the agency, the accused doctors did not pass the test and instead approached some unknown MCI officials through middlemen, who charged extremely large commissions per applicant for the job. While conspiring with these officials, computer records in the MCI registration office were fudged through false entries and on that basis, registration certificates were issued to the fake doctors. The verification in respect of the degrees obtained by the doctors from medical institutions abroad was shown to have been conducted much before the date of the submission of their applications to the MCI when they were seeking registration with the MCI.

Can this problem with respect to fake doctors in India be solved? I doubt it. India is rife with corruption so the quacks will continuously be fraudulently licensed.  There are as many as 7,933 cities and towns and 600,000 villages in India. Most of the villages are considerable distance from one another. There are only 400,000 legitimate doctors in India who are serving 1.21 billion people living in that country.  That comes to one doctor for every 2,500 persons.  That is far below acceptable standards. And worse yet, there are no doctors in a great many of the villages. In the City of Mississauga, Ontario, we have at least 752,000 people living in that city. There are 910 doctors in that city. That comes to one doctor for every 826 persons.

What is really needed in India to fill the gap of missing doctors are trained paramedics and trained nurses in villages that have at least a hundred persons in them. In Ontario Canada, we have trained registered nurse practitioners. They are authorized to interpret diagnostic tests, give diagnoses, prescribe pharmaceuticals and perform specific procedures such as conducting annual physicals, immunizing patients against disease, and even screening them for diseases. Of course they can also act as midwives however there are midwives in Ontario that are licenced.  The nurse practitioners can also conduct treatment for short-term acute illnesses (e.g., infections, minor injuries); and monitor patients with stable chronic illnesses (e.g., diabetes)

Further, fake doctors should be imprisoned for a minimum of three years if no one suffers any consequences of their acts, fifteen years imprisonment if anyone suffers devastating consequences as a direct result of their acts and twenty-five years in prison if anyone dies as a direct result of their acts. The fear of harsh imprisonment should deter most of these quacks.

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