Unraveling Indian healthcare scene: Dr Sharad Agarwal, President, IMA

Last Updated on June 19, 2023 by Team THIP

IMA president

Health is one of the major factors that define a nation’s development. If the citizens of a nation lead a healthy life, they contribute better to the development of the overall country. And doctors play the most important role in this. In an exclusive interview with Indian Medical Association (IMA)‘s current President, Dr Sharad Agarwal, we touched a lot of topics related to healthcare in India, including its role during the COVID-19 pandemic, its stand on AYUSH, technological advancements in the field of medicine and much more.

Dr Sharad Agarwal, MBBS, MD, MHA, PGDHHM, FCGP, FAMS, is the National President of Indian Medical Association (IMA). He is also a council member of the World Medical Association

What is the Indian Medical Association and what does this body do?

Indian Medical Association (IMA) stands as the premier organisation representing doctors practising modern medicine. With a membership of four lakh doctors, our association boasts an extensive network of 1750 branches spread across the nation. With nearly 95 years of dedicated service, we are eagerly approaching our centenary year in 2028. It is a momentous occasion that reflects the immense scale and significance of an association that has stood the test of time.

Furthermore, IMA has a membership of over 2 lakhs through Medical Students Network and Junior Doctors Network. Notably, we have established a commendable track record in serving the public and making significant contributions to society. Our association has three primary aims. Firstly, we are committed to uplifting society as a whole. Secondly, we prioritise the advancement of medical knowledge and skills of the doctors through continuous medical education programmes. Lastly, we are dedicated to upholding the dignity and integrity of the medical profession.

In order to address the primary objective of the Indian Medical Association, i.e., to uplift the society, we are running more than 70 projects. Our dedicated members are carrying out these initiatives across various branches. Furthermore, we have established different committees to focus on specific diseases. Our primary focus is on the prevention of such illnesses, aiming to provide assistance to the broader community.

In your opinion, how was the response of the doctors and other medical professionals during the Covid-19 pandemic?

During the COVID-19 pandemic, the invaluable contribution of IMA and the doctors was evident. It was a time when even close family members refrained from physical contact with the patients. But IMA members, Indian doctors and other healthcare professionals selflessly put their lives at risk to provide treatment and care. They made significant sacrifices to serve the society by attending to patients in need during this period.

As a result of our COVID management efforts, IMA’s approach received recognition and praise from around the globe. Tragically, during this period, we also experienced the loss of more than 2000 doctors, including many young professionals. These dedicated individuals, some as young as 30 or 32 years old, were working tirelessly in the ICU and tragically lost their lives.

We try to provide assistance despite the lack of external funding or aid. Our funds primarily come from the contributions of our members. In an effort to support those affected, we have established the COVID martyr fund. Through this initiative, we have already been able to provide financial support to approximately 32 families. Although we recognise that this amount may not be sufficient to sustain them for a lifetime, it serves as a meaningful gesture from IMA. Anyone can contribute to this cause and we also urge the government to recognise and contribute to the families of doctors and healthcare workers who lost their lives during the COVID-19 pandemic.

What are some of the key challenges faced by Indian Medical Association?

One of the main challenges faced by the IMA is violence against doctors, healthcare workers, and health establishments. This issue is prevalent only in India, with no other country accepting violence against doctors as acceptable. Government introduced an ordinance during the COVID-19 pandemic to punish such violence. However, this protection is only valid during the pandemic period, and it does not extend to normal circumstances. This is a problem.

The fear of violence and threats creates a stressful and threatening environment for doctors affecting their ability to make critical decisions and compromising patient care. If the violence persists, there is a concern that good doctors and hospitals may become reluctant to handle serious cases or perform critical surgeries due to the fear of potential consequences. The IMA emphasises that doctors work with dedication and without the luxury of second chances, operating with the same intensity and sincerity throughout the year.

If doctors continue to work under such stress and violence, it can lead to disastrous consequences in the future. We urge the government to recognise the unique nature of healthcare work and take effective measures to address violence against doctors and healthcare workers. Urgent action is required to create a safe and supportive environment that enables doctors to perform their duties effectively and ensures the well-being of both doctors and patients.

What are some other issues that you are currently facing?

The proposed integration of different medical approaches at the undergraduate level in India is another concern that we have. The existing medical education system has earned recognition and produced highly regarded doctors who are considered among the best globally. India has experienced significant growth in medical tourism due to its excellent treatment outcomes and cost-effectiveness. The country has become a preferred destination for medical treatment, even for many Southeast Asian countries. We recognise the need for change. Integrative medicine can be incorporated after the doctors have completed their specialised training. This will allow for a more comprehensive approach that will take into account the distinct procedures and principles of different schools of medicine. However, preserving our existing successful medical system is important. The sweeping changes that are being proposed can have disastrous consequences.

There is another concern, the Indian Medical Service Cadre. It is an important point and a long-standing demand akin to the Indian Engineering Services (IES). The government repeatedly acknowledges this demand, but it appears to be more of a rhetorical statement rather than genuine action. We provided a list of 1500 doctors ready to work in villages to the government a year ago. Nevertheless, there were no placements.

There is a notion that doctors refuse to work in rural areas. But the truth is that the doctors are willing. To accomplish this, the government must establish a system that ensures uniformity in working conditions, rights, and responsibilities, similar to other professional services such as IAS and railway services. It is essential to create an Indian Medical Service (IMS) that attracts good and dedicated individuals. The existence of such a standardised system will encourage all doctors to participate in a National Exit Test (NExT), which is currently being contested.

The government should engage in brainstorming sessions with the Indian Medical Association to receive unbiased advice and evaluate the positives and negatives of the proposed test. Numerous fallacies exist within the test itself, which is not appropriate. No other profession is subjected to such exams, especially in a country like India. Here, there is a shortage of doctors, and the focus should be on improving the doctor-to-citizen ratio.

The government’s emphasis on constructing numerous private medical colleges, approximately 200 in the past two years, raises concerns about the role of the National Medical Commission (NMC). The NMC has failed to maintain standards in medical education, including a lack of faculty in some colleges. This situation adversely affects students pursuing expensive education in private colleges. Since the implementation of NMC, the cost of education has increased significantly. It has reached around one crore rupees for undergraduate studies in private medical colleges. A lot of students are unable to secure admission to government medical colleges. It is safe to assume that they come from modest backgrounds. They resort to loans or even sell their assets to be able to afford private education.

The lack of control over these substandard private medical colleges by the NMC poses a risk to the future of these students and their families. It is unfair to expect every student to undergo a similar test when the standard of education throughout their five-year journey has not been adequately improved. These issues raise significant concerns in a country like India. The IMA is always willing to offer its voluntary services to the government and urges its inclusion in relevant committees. By providing unbiased advice, the IMA can assist the government in achieving cost optimisation and expansion of services to a larger population. If we are able to collaborate in this manner, the government could potentially reach 500 people with the same resources currently used to reach 50. 

What is the overall stance of IMA regarding the Ayurvedic medicinal system? 

IMA holds a position of respect towards all systems of medicine and is not against any particular system. However, we oppose the mixing of different medicine systems. This stance is not exclusive to IMA but is in accordance with the constitution of India and is supported by numerous court judgements, including those from the supreme court and high courts. These judgements have penalised doctors who have treated patients in areas where they lacked proper training, even within their own system of medicine, such as modern medicine. Therefore, it is not deemed acceptable for practitioners of a different medicine system, who have not undergone training in modern medicine, to prescribe modern medicine. We advocate separation of different medicine systems.

Modern medicine is based on evidence and research, with approved medications and treatments derived from rigorous scientific studies. We are asking for the same for other systems of medicine. There should be more focus on improving AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) by establishing more research institutes, which is a positive step that has already been initiated by the government. However, it is important to note that good intentions alone are not enough; effective implementation is crucial, and this is where IMA’s role becomes significant. Leveraging our nearly 100 years of experience, we can provide valuable guidance to contribute to the establishment of a healthy nation.

Antimicrobial resistance is a rising concern these days. What is the response of IMA against this crisis?

Antimicrobial Resistance (AMR) is a global phenomenon that poses a significant threat. There is a speculation that in the coming years, AMR could result in over 5 million deaths worldwide. In response to this alarming situation, IMA has taken a proactive approach and issued a press release advising doctors to exercise judiciousness when prescribing antibiotics. Additionally, IMA conducts regular online meetings to provide guidance and recommendations to its four lakh members across India.

Do you think technological advancements in healthcare can also give rise to a number of data privacy issues?

In today’s era, technology is developing very fast and has become an indispensable part of our lives. Only thing is we have to train ourselves and accommodate it in our lives. As I mentioned before, our aim is to upgrade ourselves by staying abreast of the latest advancements through Continuous Medical Education Programmes (CME).

Technology and data secrecy are not synonymous. Data secrecy is about digitalisation. We have come across a lot of news about data leaks by certain agencies. If the data helps the system, we are open to it. We are not here to oppose the government on each and every thing. We have to be in line with the newer advancements. It is the result of these technological advancements that we are able to treat serious cancer patients, which was not possible a few years back. We were dependent on outdated machines for radiation. But now we have the latest and more effective machinery for it. Therefore, advancements in technology are always welcome.

The implementation of robotic surgery is increasing in India. Do you think that there’s a need to create awareness about such treatment?

It is definitely a good thing. Proper training is crucial for utilising robots in hospitals effectively. Since it is costly, it is being done only by big hospitals currently. The robots are trained with specific data like stitching and cutting techniques, so that it can perform optimally under the guidance of a surgeon. The synchronisation between the robot and the surgeon is essential for successful outcomes. Therefore, when robots are introduced to a hospital, extensive training is provided to the doctors to ensure they can utilise the technology effectively. This modality of treatment, which was unimaginable in India before is now available and provides an advanced approach to medical care.

Awareness regarding specialised and sophisticated treatments exists, but the cost factor is a significant challenge in India. When it comes to obtaining such treatments, the resulting expenses can be substantial. It is important to understand it is not the doctors who are charging exorbitant fees, it is the hospitals. The cost of acquiring and maintaining sophisticated and advanced medical equipment as well as the expertise required to operate them is very high. In such cases, the burden of the cost falls on the patient or the government. Achieving the best possible medical outcomes often requires investment, and finding a balance between cost and quality of care remains a challenge.

What could be the reason behind so much health misinformation during COVID?

It is important to note that COVID-19 was a new and unknown disease for the entire world. Initially, there was limited understanding about the virus and its behaviour. As a result, information and treatment guidelines were constantly evolving based on new findings and patients’ experiences. What might have been considered an effective treatment or regimen one day could be modified or updated within a short span of time. This dynamic situation led to constant adjustments in medical approaches as healthcare professionals learned more about the virus and its impact on patients. Therefore, it would be incorrect to label information provided earlier as misinformation retrospectively. With the emergence of the internet and social media, information and misinformation is everywhere. So, the person consuming the information has to self-regulate and decide wisely where they gather their information from.

How does IMA perceive the effectiveness and the significance of the initiatives such as ‘Aao Gaon Chale’, ‘TB Control’ and ‘Save Girl Child’ programmes?

The Aao Gaon Chale project was launched by a visionary leader and our former President Dr Ketan Desai in 2004. The aim of this project was to promote rural development. During the COVID-19 pandemic, the project took a back seat as the focus shifted to COVID management. However, this year, we have relaunched the project.

Under this project, we have asked our 1750 branches to adopt a minimum of one village each. We are encouraging them to adopt more if possible. The adopted villages serve as focal points for regular medical activities, with a focus on prevention. Additionally, disease-specific tests such as anaemia detection, assessment of iron deficiency, and evaluation of vaccination profiles are conducted. The project also aims to raise awareness among villagers about seasonal diseases and provide guidance on preventive measures.

The Aao Gaon Chale project has been successful so far with over 1100 branches adopting villages. On June 25, 2023, the Indian Medical Association will relaunch this project on a larger scale, involving all branches across the country. This initiative demonstrates a commitment to rural healthcare and development by bringing medical services and awareness programmes directly to the villages.

In regards to the TB Control programme, when the government was in the process of adopting the DOT strategy, even the government doctors were untrained. In such a situation, IMA took the initiative and partnered with the government to train and sensitise nearly 3 lakh doctors through over 2000 workshops. We provided them training on how to implement the DOT strategy, how to report TB cases, etc. And as a result of the efforts of IMA, the government is hopeful about the elimination of TB by 2025, which was initially expected to be done by 2030.

The term ‘Save Girl Child’ was coined by IMA 20 years back. Beti Bachao used to be the logo on our letterhead. Another significant contribution of IMA was during the time when the cases of HIV-AIDS started coming up in India. In the late 90s, when HIV-AIDS came, even the doctors were afraid to touch the patients. The IMA took the initiative and collaborated with the Clinton Foundation and sensitised nearly 2.5 lakh members of the association through thousands of training workshops. Similarly, polio eradication was possible because of the efforts of IMA.

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