Until last week, a man named Veeragandham Teja had a seemingly illustrious medical career. He is 23 and has worked in at least 16 private hospitals in the southern Indian state of Telangana. He even volunteered with the police to help migrant workers stuck in the state during the nationwide COVID-19 lockdown.
On September 10, the police, while acting on a mental and physical harassment complaint by Teja’s second wife, discovered that the man was not a doctor at all. In fact, he was a class 5 dropout, and all his school and medical college score sheets were forged and fraudulently procured.
In a similar case from the northern Indian state of Uttar Pradesh, a woman without any medical degree was arrested last week after a botched up caesarean procedure on a pregnant woman. The private hospital she worked at was sealed, and the pregnant woman just about survived the delivery.
Same week, a man with a forged medicine degree was caught working as a doctor at a tea estate in the northeastern state of Assam. Pankaj Kumar Nath was arrested and his office raided. The police unearthed fake medical degrees and seals.
These three news reports came out of the country in just one week. The number is not surprising considering a 2016 World Health Organization (WHO) report found that 57.3 percent of the health workforce in India is made up of quacks—a term used for fraudulent or unqualified practitioners of medicine.
The prevalence of informal doctors in India is a double-edged sword. In many pockets, especially rural and slums, informal vaidyas (doctors) are known to run dawakhanas (small clinics) in the absence of affordable medical health services.
The ubiquitousness of quacks mostly signals the crumbling infrastructure of the public health system in the country. The 2019 National Health Profile found that India’s public health expenditure is the lowest in the world. Health facilities in most parts of the country are either too expensive to access, or in a deplorable condition.
“Informal practitioners often fill in for absentee doctors in most of the underprivileged pockets in India such as villages and slums,” Yogesh Jain, a public health physician from the central Indian state of Chhattisgarh, told VICE News.
There is one doctor for every 1,457 people, which is lower than the WHO norm of 1:1,000. India’s population is 1.3 billion.
“It is also known that the skill levels of most of the informal workers are not frightfully poorer than the qualified doctors,” said Jain.
A survey in June this year found that the majority of healthcare providers in rural India’s private sector are informal, or untrained. Their strength is estimated at 68 percent of the total provider population in rural India. The study also found that informal health providers in some Indian states had more medical knowledge than trained doctors in others.
“It speaks volumes about the quality of training that physicians get in our medical institutions,” said Jain.
The shortfall of trained doctors in the hinterland also led the Indian government’s health ministry to try strategies from compulsory rural postings to offering monetary incentives to get them there.
So crucial are these quacks that many state governments have been holding programmes to train unqualified medical practitioners in order to fill in the gaps in hospitals and other healthcare facilities. In the eastern Indian state of West Bengal, the Liver Foundation, a non-profit, launched a programme to train local, untrained doctors on primary medical care. “We are recycling an existing human resource that is unregulated into the health system. By telling them what not to do and what to do, they can become useful,” Liver Foundation’s Abhijit Chowdhury told news outlet NDTV.
There’s also the trust deficit between doctors and patients in India. Some blame the commercialisation of the medical profession, along with high costs of medical schools and services. During the pandemic, the distrust manifests into discrimination and violence meted out to the doctors.
This distrust also pushes communities towards informal doctors who are often a part of the community and are available when the doctors are not. Gargeya Telakapalli, a member of People’s Health Movement, a global network of grassroots health activists, told VICE News that during the pandemic, the informal health providers also bridged the gap with patients when entire health systems were diverted towards COVID-19 control and essential health services were closed.
Experts add that even though informal doctors are crucial to the system, instances of fraud and exploitation should not be discounted.
During the COVID-19 outbreak, authorities launched a crackdown on quacks selling fake medicines. In April, a quack was arrested for telling people with common cold and fever that they had COVID-19. He also sold them “preventive medicines”. A month later, a quack was charged for running a clinic in a containment zone in New Delhi and prescribing medicines for breathlessness—one of the COVID-19 symptoms. In a major case in 2018, a quack injected 41 people with the HIV virus from one infected needle while promising cheap treatment.
“There will be instances of exploitation and opportunities to make money,” said Jain. “But if the authorities are monitoring the practitioners, they should also target the trained doctors who are misusing the public institutions.”
Private hospitals across the country were reported to flagrantly flout government rates on COVID-19 treatment and admissions, and overcharged patients.
On September 12, the Bombay High Court’s bench in the western Indian city of Aurangabad denied relief to a man whose allopathic prescription killed a man. The accused also claimed to be an Ayurveda graduate.
Ayurveda is a part of the traditional medicine system in India, that is also supported by the Indian government’s Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH). Ayurveda practitioners, among other traditional medicine doctors, are often considered quacks in India.
In China, “barefoot doctors”, or village doctors, gained prominence for combining western and traditional medicine to provide basic treatment in the light of the unequal distribution of health resources in rural pockets. The scheme is recognised by the WHO as a revolutionary, one that helped raise healthcare standards in China.
Telakapalli said that informal health workers are not the only ones filling in the gaps in the public health system. Exceptional situations, such as the pandemic, opened doors for other actors. “When everything was shut down during the lockdown and only pharmacies were allowed to run, people turned to those chemists for medical advice,” he said.
Jain added that instead of a crackdown, there are positive ways to turn things around.
“The way forward should be to upgrade the skills of these informal workers, and not use legal arms to crush them,” he said.
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