Priyanka Pulla is a science and health journalist, a career she settled on after much meandering as an associate consultant in a strategy consulting firm, a film reviewer, a business journalist and a copy editor. Her interests today are anything to do with medicine, science policy and health policy. She has written for Science, The British Medical Journal, Forbes India, Nature India, Yahoo India and Mint.
What is your feature about?
It’s about the majority of medical practitioners in India, who outnumber doctors by a wide margin, and are known to most people as “quacks”. These are people who practice medicine, but have no medical degree. Sometimes they don’t even have a high school degree. Naturally, Indian regulations forbid them from practicing medicine. Yet, there is a growing conviction amongst health policy researchers that the only way to solve the dual problem of abysmal access to healthcare in rural India and the substandard healthcare offered by these “quacks” is to train this group of people.
My story explores two of the training programs running in India right now (there are others such as programs, such as the one run by World Health Partners) to understand if they can really make a difference.
What did you learn that you didn't expect?
First, I realised that I might have personally consulted and been treated by a “quack” once. I never knew the term RMP (rural medical practitioner). Many people think it stands for registered medical practitioner, or a doctor registered with the medical regulatory body in India, as did I, until I did this story. That’s when recalled that I had visited an ‘RMP’ once, who had treated me for a severe attack of bronchitis in a city I was new to.
Second, I realised that quacks are not the homogenous group of charlatans that media reports project them as. They are people with vastly varying levels of competency: at the high end are people trained in paramedical courses who have a good knowledge of anatomy and pharmacology, while at the low end are people without a high school education, who drifted towards this practice because they had no job opportunities elsewhere. At the high-end are ‘quacks’ who understand the threat their profession is in and have children of their own who are qualified doctors: the son of one of the RMPs I spoke to is now a qualified neurosurgeon. These RMPs know that there is no way out for profession, except to fight for more training programs for themselves. They are articulate, knowledgeable and very concerned about their reputation as medical practitioners. At the low end are quacks that are out to make a quick buck and won’t balk at embarking on complicated medical procedures. The challenge is to identify all these medical practitioners, train them according to their level of competence, and allow them to go back to their practices.
Third, while I knew there were a number of informal providers in India, I didn’t know that nearly 70 per cent of rural India goes to them for treatment. That’s a massive number, and impossible to ignore.
Read Priyanka’s article on Mosaic from 3 November 2015.