The first point of contact for healthcare for almost 60% of the Indian population is not a qualified doctor, but someone who has some sort of experience in treatment of diseases. For qualified medical practitioners, it is quite unthinkable to even contemplate about unqualified people practicing medicines. I used to think that quacks are a problem in only in the rural areas of the country, till I had a conversation with my dad – that was when he told me that when he was posted in Tinsukia, a town in North East Assam, there were hardly any qualified doctors. When any of us fell sick, it was to a quack we went for treatment. Of course, the quacks were more polished than the ones I see now in the villages around NJH.
I remember quite well the chamber to which we used to go when I or my brother used to fall sick. My father later told me that the ‘doctor’ whom we used to consult was in fact an apprentice to a former army doctor. Of course, we used to get better after the treatment from the quack. With the present state of medical care in the country, they have become a sort of ‘necessary evil’.
There have been enough efforts taken at various levels to involve quacks in the evidence based management of cases. The Revised National Tuberculosis Control Programme, the Acute Flaccid Paralysis Programme etc. are few national level programmes who have tried to involve them. We had tried to involve them in helping them find out danger signs whereby they would be able to refer patients to hospitals at the earliest. Unfortunately, the response from them have been quite disappointing.
However, the saddest story in the medical care sector of the country has been the overwhelming commercialization of the pharmaceutical industry, which is unblatantly interested only obtaining profit by hook or crook. A related post (
http://jeevankuruvilla.blogspot.com/2011/08/pharmaceuticals-in-india.html ) to this is the proliferation of unethical combinations of medications which are very freely used by quacks and doctors alike. Unfortunately, the pharmaceutical industry has been well supported by quacks in increasing the market of medicinal preparations and more so for the unethical combination preparations. Among the quacks they have also found brother-in-arms to combat the cost effective generic preparations.
What makes quacks so popular? There are quite a lot of things which we need to learn from the quacks. One of the major aspects which make them quite endearing to communities, especially in the rural areas is their ready availability for service. It is quite common to see them moving around in our nearby villages in cycles or mopeds with a bag filled with all the necessary implements, medicines including injections. The bag which they carry around with them has given them the name ‘jhola chap’ to such doctors in our part of the country.
Now imagine a patient coming to my emergency. The present system is that the nurse would first take the vital signs, and then inform a doctor – it takes some time for the doctor to come, most of the time it would need an admission. And with that come the costs - which bring us to the next advantage with the quack. They take their payment any time and in any kind, which is very difficult to obtain in the present system of treatment in any hospital of the country.
The next point is something which is quite an important aspect which needs to be noted by every qualified medical professional. That is the ability to communicate – clearly, logically and in a language which the patient can comprehend. We have very little time for our patients. Each of our patients are cases and beds. The humanity and identity of the patient vanishes the time they enter our ivory towers.
The last point is the treatment of demand which most of the quacks readily obliges. This makes them quite popular. I never took this aspect quite seriously until I met a quite senior medicine consultant in a mission hospital in the South of India. I was shocked to find quite well looking people in the emergency lying in the beds in the emergency ward taking intravenous fluids. I enquired about this – when she told me that many people came to her for i.v fluids for strength. It was a bit difficulty and when I enquired about the ethical part of it – she told she knew that there was not much of a evidence in giving i.v fluids for no reason, but that was what the villagers wanted. She took over the hospital when it was really going down – she struggled for the first two years. Later, just to make ends meet, she started to slowly oblige the villagers' demands for specific treatments. And within no time, she was quite popular. At the end of the visit, I felt she looked more of a quack than a qualified medicine consultant.
Except the last point, I strongly feel that the rest of them are major learning points for modern medical practitioners. By the way, I recieved an invitation to visit one quack and his practice in a nearby village. I've heard that he managed to even do surgeries - herniaplasties and hydrocelectomies... I happened to meet him during my break at Betla (
http://jeevankuruvilla.blogspot.com/2011/08/betla-diary-day-1.html). Please watch out for a blog on the interactions with him.