Personal observations, gained while working on health problems in some dozen countries over the last four decades, leads me to the judgement that, almost throughout the developing world, Medical Education is hopelessly inappropriate.  I mean it is inappropriate in that the education offered does not reflect the needs of the society it should serve. There is no concern here with quality, or methods, but merely with choice of curricula. Quality, methods and other factors, of course, are of no small importance, but what does it matter if an institution turns out hundreds of first class brain surgeons, if there is merely one cranium opened up every five years? 

Our colleagues in the business community learned principals of ‘supply and demand’ decades ago. We, in Medicine, have done an uncommendable job in being able to ignore such principals, despite the monumental problems this has caused and continues to cause. These are problems for us and for others, and indeed - in some locations - whole nations suffer, and suffer needlessly.

Before a trader opens a retail shop, he makes up his mind about the merchandise he will sell, and before he buys from a wholesaler, he looks at the demand within his community. What do the people in his community need to buy, and how much of it do they need? His enterprise is doomed if he does not accurately determine the ‘demand’ and does not appropriately meet it with his ‘supply’.

In Business, the outcome is prompt and the reason for it obvious. In Medicine, the outcome can be seen to be even more disastrous, but the reason for it can become obscured by a host of variables, not the least of which is our (conscious or unconscious) unwillingness to admit we are human and therefore capable of making a mistake.

Perhaps the worst examples I have seen of supply of medical practitioners not meeting the demands of a country’s illnesses, have occurred when there has been lack of differentiation between Preventable and Unpreventable illnesses. In one country, in which I worked, 83% of the country’s illnesses were Preventable. If demand were influencing supply, then 83% of the medical training would have been wholly in Prevention. However, 98% of the training institutions were medical colleges all of which have an essentially Curative Medicine orientation.

In that country, what was the outcome? The preventable diseases were not prevented. Thus 83% of the illnesses should never have occurred.  Suffering occurred which should never have happened, and personal and public funds were spent curing illness which should not have occurred. Medical facilities were crowded unnecessarily while people with unpreventable diseases did not receive the facilities, the medicines and the treatments they could easily have had if we had done a better job. In this case, did anyone identify the culprit - our lack of considering supply and demand? Of course not. Instead, we blamed lack of proper care on ‘lack of expenditure’ or ‘not enough doctors and hospitals’, etc. 

My hope is that we shall do better in the future, although - apart from the Prime Minister’s pronouncement a year ago that India will have six Schools of Public Health (with little apparent affect) - there is scant evidence that we shall.  What can we do to correct matters?  Our choice to be part of the solution or part of the problem has never been so clear.  And clearly, we are going to be one or the other.

To be part of the solution, we might start by examining the illnesses our community, region or country has, and listing these under two headings, Preventable and Unpreventable. We could consult the best available statistics and discover what percentage of the totals of all diseases local people have fall under each of our two categories. Now we have the beginnings of our estimate of ‘demand’. 

If our system of medical training is appropriate to these broadest categories of needs, then the total percentage of the volume of unpreventable diseases is equal, or nearly so, to the percentage of medical training institutions which are Medical Schools. We could look at this from the other side of the equation and gauge if the percentage of the volume of preventable illnesses is approximately equal to the percentage of medical training institutions which are Schools of Public Health. 

To the extent there is not a match, to that extent there is a problem, and to that extent we SERIOUSLY let down the public we set out to serve. Various forces outside our control influence the directions medical education takes, but with curricula, we are left very much alone. What happens here is almost 100% our responsibility.

Of course, the above recommendation to separate the Preventable diseases from the rest is merely the first one. Finer and finer distinctions need be made to determine the exact demand of our community upon both Schools of Medicine and Schools of Public Health. Until this is done, we will continue to train surplus numbers of young doctors in certain specialties, to attempt to cure diseases we should have prevented; we will continue to facilitate unnecessary suffering, incur massive unnecessary spending, and continue to beg for more funds, pleading that lack of funds rather than our inability to plan is responsible for our poor performance.

W. Frederick Shaw, DrPh

Dr Shaw is the CEO and founder of Developing Indigenous Resources (www.dir-help.org), a charitable non-profit organization which strives to empower communities to develop and utilize local resources to improve their health and overall well-being. He is currently leading a project in Janta Colony, Chandigarh.

GIVING BACK!

Many of us from the pioneer batches are finally in the next phase of life – we have transitioned from being the learners to being the practitioners of medicine, have decided and embarked on careers that we will devote our energies and faculties to, and as some would say – have ‘settled down’ in life. And with time, we will get increasingly involved with our work and our families. And with time, many of us will forget a responsibility that was put on our shoulders as we took the Hippocratic Oath – that of a debt we have to pay off to the society, which has given us an opportunity to gain respect and status as a physician.

We have always reiterated that as physicians, we are leaders, whether we like it or not. And with leadership comes the responsibility of working for the common good of our community and society. The time constraints of modern medicine make it near impossible to focus on things that are not an obvious priority and are without material rewards. But we should always try and remember that we have to ‘give back’ to our society. All of us should volunteer. Volunteerism can take different forms – we can donate our time and skills or donate resources and finances, and it can be anywhere there is a need, in India or abroad.

We hope this special issue of Connections will inspire you to think about doing something for your communities.

Editors

Giving Back...

In February of this year I spent a month working with Developing Indigenous Resources (DIR), a non-governmental health care organization (NGO), operating at the Janata Colony. Janata Colony is an urban slum of about 2000 households. It comes under the jurisdiction of Punjab and borders the northwestern fringes of Chandigarh, ironically enough just some distance behind the PGIMER. The colony faces the typical problems one would expect: high rates of childhood malnutrition, a huge burden of preventable diseases, severe overcrowding, and poor hygiene and sanitation. Under the stewardship of Dr W. Frederick Shaw (see editorial), the NGO has been working at the ‘bustee’ for the last 2 years and has gradually made a significant impact on the health of the colony. The NGO aims to gradually expand into surrounding villages and slums in Haryana and Punjab and is frequently in the news these days for their good work. For details on the modus operandi of the NGO and their unique and sustainable approach to tackle health problems of a community, visit their website (www.dir-help.org).

My hope in making this trip was to develop a partnership between our college and the NGO, and in particular, to encourage medical students to move out of the boundaries of the medical school and engage in ‘hands-on’ clinical and research projects in the community which they serve. I felt that not only would working with a new genre of healthcare i.e. of a NGO broaden their range of experiences, but that they could learn immensely from Dr Shaw who has spent the last 35-40 years of his doing public health related work in various developing countries including India, Pakistan, Philippines and in Africa. Irish but settled in California, Dr Shaw is a spry individual and despite being in his 70’s, has a demanding work ethic, discipline and commitment to his work that is very motivating and sometimes awe-inspiring.

I was able to achieve a few of my objectives during my visit. It is unclear at this time how much of these will eventually bear results, but it was a good starting point.

1. After meeting and interviewing several students at the college, candidates interested in community-based research were encouraged to come and meet Dr Shaw at the main office of DIR in sector 8. About 15-20 odd students eventually had an hour-long meeting with Dr Shaw. A few students also visited the colony to get a lay of the land.

2. On the basis of the above and their interest in specific areas, the following students proposed specific ideas for research projects, including:

a) Supreet and Neha: ‘Anemia in adolescent males in an urban slum’,

b) Jaskaran and Aakash: ‘Prevalence of vitamin A deficiency in under-5 children at an urban slum’,

c) Tribhav Goel: ‘Natural history of parasitic infections in children under 5 years of age in an urban slum’.

3. A meeting was arranged between Dr Shaw and the Director Principal of the college, Dr H. M. Swami. There was a discussion on how there might be future collaborations between the Medical College and DIR and if it would be feasible for medical students to visit field sites of DIR and engaged in research projects.

4. There was a meeting with the core group of people involved with Koshish led by Krishan Sawhney. The most pressing issues were  registration of Koshish as a non-profit; whether or not, and if, just how much to involve faculty; making sure Koshish funds were not misused; and make a database of alumni, especially in India, to encourage fundraisers and increase awareness of Koshish. A pleasant interlude was an article on the Koshish group and their efforts in the Times of Chandigarh in the ‘Campus Buzz’ section (February 27, 2007).

5. Thanks to our donors, funds for Koshish are still coming in even though our annual fund collection drive has long been over. We have now collected about Rs. 1.3 lakhs ($3200); Approximately Rs. 70,000 has been used by the Koshish team for helping several patients and another Rs. 10,000 has been earmarked for ‘Koshish Research Funds’.

The month would not have been possible without the ‘three musketeers’- Divyanshoo Kohli, Harshabad Singh, and Krishan Sawhney. They went out of the way on numerous occasions to arrange meetings with students and accommodate my schedule, and most importantly, provided valuable constructive input. Many thanks!

Sandeep Kochar

’93 batch

Giving Back...

Malaria is endemic in the region. Fortunately it is still chloroquine sensitive. The region is infested with scabies and hookworm. Besides these, acute diarrhoeal diseases, upper and lower respiratory infections, antenatal care, alcoholic cirrhosis, trauma, animal bites (yes, including snake bites), acute abdomen, bowel obstruction, burns etc were also commonly seen. Whenever patients could be managed locally, they were treated with the medications available (which were surprisingly very generous). The others had to be referred to the nearest government hospital in Chandrapur.

Besides providing medical services, the Amte family has been working hard with the local people to initiate a grass roots level movement to eradicate illiteracy, poverty, malnourishment, unemployment and orthodoxy in these unfortunate people. They run a school upto class XII with 600 students in their own campus. All the students are from the neighboring poor villages. All these students live in the campus hostels. All food, clothing, books and education is provided to them free of cost. Though sounding simple on paper, providing for the needs of such a large number of students and patients is a mammoth task, which the Amte’s, along with their other volunteers, have been silently and very successfully performing over the past thirty years.

In the evenings we often used to sit down with the Amte family and the other volunteers who have also devoted their lives for this mission and eat food in the community kitchen. Through the conversations I learnt so much about the simple yet powerful means they have adopted to make this place as we see it today. “What keeps you going?” I asked Dr Prakash Amte once and he replied, “It’s all within you, just search for it.” I had the fortune to see life in a very different perspective in these ten days and I hope I get to do something in the years ahead that will make a difference in somebody’s life.

Hemender Singh

’91 batch

More information about the Hemalkasa Tribal Healthcare and Education Project is available at http://mss.niya.org/index.php

A Soldier's Diary

10-2-07

‘Waheguru! Eh meeh rok davo!’ CC Vajinder supplicated before the Almighty as I veered the car in the blinding drizzle which had placed our outdoor venue of the Mika night in danger. As we both drove all over the city to tie the loose ends, distribute the invitations, count the cash (over a lakh!!) and get demand drafts ready, reports kept streaming in … ‘Zirakpur sara booked hai’, ‘Woh s*** studio wala aadmi expensive bata raha hai’. Krishan had gone all over the city to find an alternative venue. Mika had arrived, barricades had been set up, light and sound was ready but the venue was a ditch due to the rains. The hurriedly arranged tarpaulin had surrendered. Aman and Ashish watched their hard work getting soaked in the rain. Suddenly an alternative venue came our way. Vajinder’s prayer (and Dr. Ravi Gupta’s tenacity) had worked. Phone lines and mobile phones shot into action as delegates, carpets, lights, sound system, tables, backdrops and other paraphernalia raced through the streets of Chandigarh. Meanwhile Harshabad and Kanika (2k4) had set the fest abuzz with their terrific MFEO event that had worked the packed audi to a crescendo.

At the venue, however, it was a security nightmare as Kynta, Sharan, juniors and I managed the crowds while Rajan, CCs, seniors and others worked inside. The moment the show began, our fatigue disappeared. Mika belted out the numbers while the euphoric crowds worked up into deafening roars. 2k3 also danced on stage with Mika! By pack up time, we were delirious with joy, congratulating on a job well done. Phone calls from the dance party venue got us crashing to the ground. The cars were zooming off again! The 3^rd day of the DP was a ROCKER, an absolute smash hit, continuing into the wee hours.

11-2-07

This was the grand finale. Clad in faded jeans, water logged boots (that squished at every step) and an unshaven stubble, I met Gaurav and Sukhtej who, along with Rahul Rai were creating miracles with the smooth conduct of the accommodation. They exchanged notes of their (rewarding and welcome!) stay in the girls’ hostel!! The audi was brimming over as my partner Sudivya (2k4) and I (with a sore throat!) got on with the prelims of the Mr and Miss Euphoria event - the highlight of the evening. By the time the band ‘Bhoomi’ had satiated the ecstatic crowds, we were all set for the event for which 8 (later 10) contestants had been finalized. The event went off well - a testimony to the sporting jury, crowds and hard work of my partner.

The closing ceremony was flawless. The shouting, dancing and photo ops over, it was time for an only-for - GMCHians rock show. A sumptuous dinner later, it was back-to-the-pavilion ... the Dance Party! This time all the sober fellows (like me) were involved in ferrying tipsy colleagues to the hostel (Kuch nahi badlaa hai folks!).

In these 4 days we learned more than the 4 ½ years of MBBS. Kudos and gratitude to Prof. Janmeja and Dr. Ravi Gupta who stood by us all along; to Prof C S Gautam for his tacit guidance and support; to all seniors and juniors who rallied around 2k3 to make this tour-de-force a success. We suffered fatigue, hoarse voices, bad hair days, frayed tempers, bruised knuckles, dead mobile batteries; one of us even had his car mangled. Another vivid memory is of standing in the rain with Robin, Rashi and Priyanka at 12.30 AM to meet a faculty member! In the end, however, 2003 batch especially the CCs Aman (Mickey), Robin (Mulls), Vajinder (Shakii) and the Org Secy Meenal (Rajey) had pulled off the impossible. For 4 days and the eternity beyond we shall all be the kings of great times! Cheers!

Divyanshoo Kohli

‘03 batch

Sports Meet 2007

The sports meet of GMCH was held on March 2^nd and 3rd. Best male athlete: Lakshay (2006); Best female athlete for record fourth consecutive time: Kamlesh Kumari (2003 batch). Best Batch Marching (second time on the top): 2003. Best overall batch: 2005. KUDOS TO THEM ALL.

Kudos

…to Navneet Majhail (’91), he has joined as Assistant Professor in the Hematology and Oncology at the University of Minnesota, Minneapolis, Minnesota (USA).

…to Puneet Tuli (’91), he has completed his MCh in Plastic Surgery and has joined as Assistant Professor in Plastic Surgery, PGIMER, Chandigarh. He is pictured below with Prof VK Kak, our second Director Principal on his MCh convocation.

…to Navneet Singh (’92), he has completed his DM in Pulmonary Medicine and has joined as Assistant Professor in Pulmonary Medicine, PGIMER, Chandigarh.

…to Sukant Garg (’93), he was invited to make an oral presentation on his research “A comparative analysis of various cytological techniques in diagnosis of lung diseases” at the 55^th annual conference of the Indian Association of Pathologists and Microbiologists, at Bangalore in December ’06; his paper has also been published in ‘Diagnostic Cytopathology’, an international peer-reviewed journal.

…to Nishant Puri (’98), he has matched for an Internal Medicine residency position at the Loma Linda University, Lima Linda, California, USA.

…to Kanwaljit Tethgir (’99), for being selected for the MPH program at Harvard University, Boston, Massachusetts.

…to Sachin Verma (’99) for securing the 24^th rank in the Australian Medical Council Exam; he is currently pursuing an MPH at the Victorian Consortium for Public Health, Melbourne, Australia.

…to Shilpa Goyal (’99), she has secured a post-graduate residency (MD) position in Pathology at GMC, Chandigarh.

…to Shivani Pahwa (’99), she has secured a PG (MD) position in Radiodiagnosis at AIIMS, New Delhi.

…to Veeraish Chauhan (’99), he has matched for an Internal Medicine residency position at Drexel University, Philadelphia, Pennsylvania, USA.   

…to all from the ’00 batch who have secured residency spots in India:

• 	Ashish, Anaesthesia, SMS Medical College, Jaipur

• 	Avneep, Anaesthesia, AIIMS, Delhi

• 	Gaurav, Orthopaedics, PGIMS, Rohtak

• 	Gunjan, Pharmacology, GMC, Patiala

• 	Megha, Biochemistry, PGIMS, Rohtak

• 	Nita, Obst & Gynae, SMS, Jaipur

• 	Parul, Ophthalmology, GMC, Chandigarh

• 	Rajiv, Orthopedics, SPMC, Bikaner           

• 	Rakhee, Pulmonary Medicine, KGMC, Lucknow

• 	Shivani, Obst & Gynae, GMC, Chandigarh

• 	Sushant, Pulmonary Medicine, GMC, Chandigarh 

…to all from ’00 batch who have matched for residency positions in the USA:

• 	Bhavna Bhasin, Internal Medicine, Wayne State University, Detroit, Michigan. 

• 	Ikjot Kaur, Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania. 

• 	Manpreet, Internal Medicine, Newark Beth Israel Medical Center, New Jersey, New Jersey. 

• 	Rajani Rangray, Internal Medicine, Mount Sinai School of Medicine (Bronx), Bronx, New York. 

…to the following students who have been selected for the Indian Council of Medical Research (ICMR) Short Term Research Studentship for 2007

• Aakash Aggarwal (’04)

• Aakriti Gupta (’05)

• Anupam Talwar (’04)

• Kanika Arora (’04). 

Congrats

…Dinesh (’95) got married in January ’07.

…Sonica Saini (’96) got married to Madhu Reddy on 28^th March ’07. Madhu is a graduate of AFMC Pune and they are both pursuing residencies in Internal Medicine at Creighton University, Omaha, Nebraska, USA.

…Hemant Bhardwaj (’98) got married in February ’07.

…Nishant Puri (’98) (below) got married on February 19^th ‘07 (Click HERE for more photos)

…Sumeet Khanduja (’98) got married in February ’07.

…Megha (’99) wed Varun (’97) in April ’07.

…Balika Gupta (’99) wed Manish (from MAMC, New Delhi) in February ’07.

…Kunal Gupta (’99) got married in April ’07.

…Vidyabushan (’01) got married in January ’07.

Stork Line