An estimated 2.5 million people in India have earned bits of medical knowledge by working as a doctor’s assistant or from a chemist or even a relative. These people prefer to be called doctors and treat patients-especially in rural areas where a real doctor is not to be found. They are among the ones who are called quacks. But true to the nature of India where everything from its religious customs to the way the rich and poor co-exist has a surreal tinge , quacks are trained to be better at providing medical care.

However, for Dr Abhijit Chowdhury, professor of hepatology at Calcutta’s Institute of Post Graduate Medical Education and Research, they are not mere quacks but are strategically poised to provide service to those without proper access to health care.

According to the Healthcare Federation of India the country has a dearth of two million doctors. Also, 70 percent of the health care infrastructure is for 20 or so cities.

This is where Chowdhury- the founder of the Liver Foundation, a charity in Calcutta comes in. The organization trains quacks to get better at what they do. However, the Foundation prefer the term “empirical craftsmen” to quacks.

A solid premise but a flimsy solution?

The premise the charity has for having the programme is simple – sometimes the nearest primary health care centre could be over 30 kilometers away. This is the reason why when many villagers fall ill, they turn to a quack- someone who has rudimentary knowledge of treating routine ailments.

While there is no doubt that the Foundation’s premise is significant and the dearth of rural medical care personnel should be tackled, training quacks does come with dangers- sometimes quite grave ones.

For one thing, many or all of the quacks come from a non-medical background and have little knowledge of the human physiognomy. The lack of what should be seen as a fundamental knowledge should be alarming in itself. Then, there is the matter of misdaignosis- reports of deaths owing to quacks misdiagnosing a patient usually surface in the media.

Chowdhray asserts that the Foundation’s training is based on the ‘realisation’ that one can’t just do without the quacks since they offer a key service to those who have nothing else.

So far the training has been done in four districts in West Bengal. The training which is provided two days of each week lasts for 9 months. So far, over 2,000 people have finished the training.

Scaling up the programme

Even more surprising to the outsider’s eye could be the fact that the West Bengal government’s decision to back the project to scale it up. A programme that would cover the entire state is aboout to begin this very month, one that would see an estimated 1,70,000 quacks finishing the training.

The training includes theoretical knowledge, basic human anatomy, pharmacology, diagnosing fevers and infections and the dangers of over-prescribing drugs among other things. The core of the training programme is said to be harm reduction.

A new ‘breed’ of studies?

A World Bank study that came out in October 2016 shows that quacks who were trained still made unnecessary prescriptions. The same study ,however shows that there exists a 26 percent more likelihood that doctors would do the same.

Another study that came out in 2016- this one based on a similar project in Madhya Pradesh shows that quacks apparently are are no worse than doctors in diagnosis and treatment.

What’s most alarming about all these is the baffling inaction of the government to improve infrastructure in rural healthcare- the single most reason why many doctors don’t prefer working in such places. To make things better the central government can start by increasing the spend on health care which at present is a dismal 1.24 percent of the GDP.

A better deployment system for the existing doctors and also streamlining medical education so that more number of real doctors can start practise as early as possible would be measures that would help solve the problem once and for all in the not too distant future.

The idea of comparing trained quacks with professionals who have studied for years undermines the very system that the government has put in place.

Image credits: bbc.com

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