India needs strengthening of healthcare delivery to tackle quackery

Jaya R, a domestic help in Chennai, tells her daughter Radha never to visit a doctor in her area beyond Red Hills. The doctors there, she says, are not trustworthy. She calls them poli (‘fake’ in Tamil) doctor. “I call her to my place in Medavakkam to take her to a physician whom I have been visiting for the past few years,” she says.

Jaya’s fears stem from a malaise that ails even a state like Tamil Nadu that boasts of a robust healthcare facility. The state alone has an estimated 30,000 quacks while the country has around 10 lakh of them, according to sources in the Indian Medical Association (IMA).

Early this month, at least 17 quacks were arrested in Tamil Nadu’s Vellore district during a raid by the Health Department. The raids have time and again blown the lid on the existence of a parallel system of healthcare that comprises of unlicensed and unqualified practitioners including compounders and lab technicians.

The Delhi Medical Council has an anti-quackery unit to issue summons to fake doctors. The menace of quackery in the country can be fathomed from the fact that last year at least 60 people were infected with HIV after a quack in Uttar Pradesh’s Unnao used the same syringe for all of the patients.

There are different kinds of quackery — from prescribing generic drugs, administering injections and sometimes even steroids, carrying out sex determination and illegal abortions, and even serving as referrals for qualified doctors in nursing homes.

Dr RV Asokan, honorary secretary general, IMA, says that quacks continue to enjoy a free run across India because there is no political will in fighting them and to eradicate them from the system. “It appears that they want to hide their failure in providing a robust system by running a blind eye to the quacks,” he says.

He adds that the World Health Organisation (WHO) also wants to legitimise their existence. “The fact is that if we have 10 lakh allopathic doctors and 10 lakh AYUSH doctors, then there are an equal number of quacks.”

Many rules but no implementation

In 2015, the Tamil Nadu Medical Council had come up with the concept of smart boards to track quacks. The smart name board carries the name of the doctors, photographs and their registration number. Doctors’ details can be verified by scanning the QR code available on the board or by sending an SMS with the registration number.

“About 40,000 doctors have come forward out of the one lakh odd doctors in the state to register for the smart board,” says Dr P Balakrishnan, former president, TNMC. He adds that repeated public service advertisements could also help create awareness among the public to stay away from quacks.

Training to meet shortage

While India is visibly short of WHO’s mandated one doctor per 1,000 people ratio, the other reasons for the widespread presence of quacks are the lack of will among doctors to serve in rural areas. “The quacks thrive in places where doctors are not willing to serve. They are available 24*7 and are one among the community,” says Dr J Amalopavanathan, vascular surgeon, who has retired from government services.

He recounts meeting a couple of malaria workers, who were treating villagers, almost three decades ago when he was posted near Dharmapuri. “I had to assure them that I will not disrupt their practice and encouraged them to contact me for any help or guidance,” he says.

In West Bengal, an initiative by the Liver Foundation has been training those practicing allopathy without qualifications due to their proximity and association with the branch of medicine, like compounders, assistants to doctors, etc.

Parthasarathi Mukherjee, director of the foundation, says that they have trained as many as 3,500 such people so far in West Bengal and Jharkhand. “They are not quacks; they are self-regulated and do not have any formal training. We aim at improving the situation by training them because they are ready for house visits and reach out those who need help in the remotest of districts,” he says.

“We are infusing a sense of responsibility among them as they can be useful in preventive medicine and can also work as referral points to government hospitals. There is an acute scarcity of doctors in many places and they can fill the gap,” he adds.

Mukherjee refuses to call such people quacks because they do not claim of a fake identity like in the case of an AYUSH doctor practising allopathy. “These happen even in the government sector. We are trying to restrict the role of such rural medical practitioners,” he says.

Another doctor, Amalorpavanathan, says that the solution to this lies in strengthening the primary health centres (PHCs). “In rural areas, agricultural workers will be able to visit a clinic only in the evening. Else, at least the PHCs should have health workers who are trained to handle patients,” he says.

“We need to ensure that there is medical help available round the clock and is accessible. Strengthening taluk and district hospitals is also important to keep away quacks,” he adds.