Stethoscope doctor

One of the collateral damages of the war in Ukraine is the future of Indian medical students who went to study there. The typical profile of the students was that they appeared for the National Entrance and Eligibility Test(NEET) which regulates admission to medical colleges in India. But their scores were not high enough to get them a government medical college or a college of their choice. Typically they would be able to secure admission to some private medical college with exorbitant fees and dubious infrastructure. A few never appeared for the exam and directly applied overseas.

The main reason for Indian students going abroad to pursue medical studies was the shortage of affordable seats in India. Going abroad – whether to Ukraine or elsewhere seemed a more cost-effective proposition. The cost of education was lower compared to most of the private Indian ones and then many had established reputations and branding. The fact that medical students who finished abroad had to clear a fairly tough exam before being allowed to practice abroad was not a deterrent. Numbers going to Ukraine rocketed after 2014 as Ukrainian universities actively recruited Indian students. The cost of study in a private medical college in India is about INR7 million (US$91,400). However, in countries like Ukraine, medical education costs about INR2 million (US$26,100).

Then the Russian invasion happened and after a torturous ordeal, the medical students had to abandon their studies and rush back to India.  With the war showing no signs of ending and the students staring at an uncertain academic future, they are demanding that they be accommodated in other medical colleges in India and allowed to finish their studies. They have moved the Supreme Court seeking directions to ensure their uninterrupted education. The petitioners, who are Indian citizens, have stated that the education of about 14,000 evacuated Indian students has come to a complete halt in the wake of the ongoing war.

There lies a tale regarding the manner in which medical education is administered in India. There are only about 90,000 MBBS places in 540 public and private medical colleges in the country, while in 2021, more than 1.6 million candidates registered for the National Eligibility cum Entrance Test or NEET, Indias medical entrance exam. Even though NEET was conceived as a single window exam for streamlining entry to medical colleges, instead of students having to appear for multiple exams for multiple colleges, NEET rapidly became politicised.  For one, health and medical education are state subjects. With a bulk of the country now ruled by the BJP and its allies, most states fell in line, but some like Tamil Nadu opposed it in court. Also, the exam exposed the educational underbelly. In a countrywide exam, those students who came from states with a strong educational base or an entrenched coaching culture had an advantage over the other, often more disadvantaged states.  But the humanitarian crisis for a time overshadowed everything else before varied responses began emerging.

The Indian Medical Association (IMA), the national voluntary organisation of physicians in India, has asked Prime Minister Modi to increase existing seats by 2%-5% in all government and private medical colleges in the country as a one-time” measure. In a statement, the IMA said all evacuated students could be absorbed as a one-time measure by existing medical schools in the country which would not require an increase in the annual intake capacity and should permit students to progress through the remainder of their MBBS (undergraduate medical degree) course. After graduating from Indian educational institutions, these students would be of the same standard as Indian medical graduates, it said. (An argument against providing places to returned students is that some foreign medical courses, including some in Ukraine, are considered sub-par compared to Indian qualifications.)

The National Medical Commission (NMC), the regulator of medical education in India meeting some demands but not all, has also recently issued a circular in which it has allowed such candidates who couldn’t complete their one-year mandatory internship in their respective foreign countries due to war or the pandemic, to apply for the same in India. However, these students will have to first clear the Foreign Medical Graduate Exam (FMGE). The NMCs circular will help only those students who have finished their studies but haven’t completed their one-year internship abroad. The circular doesnt address the problem of a large number of students who are in different years of their courses and have to leave in the middle.

One factor that is delaying a decision is that a decision regarding the Ukrainian students alone would open a can of worms. Over 40 thousand students, who had to return to India from China in 2020 due to the Covid-19 pandemic, are also victims of unforeseen circumstances. Any move by the government to accommodate students returning from Ukraine will prompt these pandemic-affected students to demand parity. So, the number of students would cross 60,000 who deserve relief on compassionate grounds. This is as huge as 75% of the existing medical seats in India.

There is also a view that we cannot immediately place these students in our colleges.  We have students who have got into these (Indian) colleges on merit, and there are also those who could not get admission in India and also did not also have the means to go abroad. The students who are returning from Ukraine have opted for universities that have a different system of teaching and curriculum and now that they have run into difficulties, they cannot suddenly demand facilities which Indian students who could not afford to go abroad were not offered. Seat distribution in India is merit-based and there are thousands of such students who rank better than those who have gone to Ukraine or China to study. By no argument, you can allow a candidate to become a doctor with low merit ignoring those who have ranked high in NEET or are more meritorious.

There is also the matter of infrastructure which the country does not have. Medical students cannot be just offered admissions and taught like a Humanities class. They need to see patients, diagnose illnesses, and gain experience. All that requires hospitals, patient beds, and teaching faculty, none of which India has in adequate numbers and doesnt offer any immediate solution. Some archaic regulations also do not help. For instance in India, medical professionals are divided into a teaching stream and a nonteaching stream and only those attached to medical colleges and attached hospitals can teach. Many capable professionals who are in non-teaching hospitals like district hospitals or those in the private sector or even those with an independent private practice cannot teach, thus choking off a valuable and scarce resource.

Caught between the devil and the deep sea, the government has informally advised the students to look for medical colleges abroad. In fact, many countries including Russia have actually come forward to accommodate such students and in fact, this approach may actually suit the students as the syllabus and pattern of education in many European countries which is patterned on the American system may suit them better than the Indian system which is patterned on the colonial era British system. meanwhile the fact that the matter is in court may be a matter of relief for the government. Earlier the government would have had to take an executive decision on its own. Now it can conveniently said that the matter is sub judice!

Dr Shantanu Dutta , a former Air Force doctor is now serving in the NGO sector for the last few decades.


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