Despite the medical council issuing a directive nearly 20 years ago to set up physical medicine and rehabilitation departments, most states do not have them.
In November, as the Mary Varghese Institute of Rehabilitation completed 50 years of service, the contribution made by Varghese in setting up the institution as part of the Christian Medical College and Hospital (CMC) at Vellore was fondly recalled.
When she was a medical student, Varghese was involved in a car accident that left her incapable of moving both her legs. But rather than be devastated by the event, she turned the life-altering episode into one of immense positivity.
Varghese used her visit to Australia for rehabilitation as a learning experience and trained to become independent using a wheelchair. Upon her return and when she realised that India lacked proper centres of rehabilitation, she thought of setting up one herself.
In pursuit of her goal, she went to the US, acquired the highest post graduate qualification in rehabilitation and upon her return, established the Department of Physical Medicine and Rehabilitation at CMC, Vellore.
However, even as the institute has completed 50 years of providing treatment and rehabilitation to patients with spinal cord injury, brain injury, stroke, amputations and cerebral palsy, overall, physical medicine and rehabilitation (PMR) still remains neglected in India.
This neglect perhaps also explains why there is an acute shortage of trained medical professionals for the rehabilitation of patients.
Data reveals apathy
Recently, it took another doctor, one with 70% locomotor disability, to point out that despite nearly two decades since a directive of the Medical Council of India to the effect, there still weren’t any departments of PMR in a majority of the states, including Delhi.
In a petition filed before the chief commissioner of persons with disability, which comes under the Union Ministry of Social Justice and Empowerment, Satendra Singh, an associate professor of physiology at the University College of Medical Sciences and G.T.B. Hospital in Delhi, noted that despite several guidelines to the effect, “PMR departments are non-existent or scanty in medical colleges of many states”.
Citing the case of a few states, Singh said that while Madhya Pradesh, Chhattisgarh, Andhra Pradesh, Telangana, Maharashtra, Gujarat, Odisha, Assam, Tripura, Nagaland, Mizoram, Sikkim, Jharkhand, Haryana, Punjab and Delhi – under state government – did not possess any PMR departments, some other states only had a few, a grossly insufficient number considering the population size.
He added that while Karnataka had a couple departments, and Bihar, Uttar Pradesh, Uttarakhand and Himachal Pradesh one each, some places like Chandigarh, Meghalaya and even one in Uttar Pradesh (Meerut) had departments which were non-functional.
“The lack of awareness on rehab services is appalling as evident by this year’s recruitment advertisement of PGIMER Chandigarh (Postgraduate Institute of Medical Education and Research) where they have equated physiotherapist with a physiatrist (PMR specialist). Moreover, there is no PMR specialist as the head of the department of central government’s PGIMER Chandigarh since 2009,” he said in his complaint.
Speaking to The Wire about why he filed the complaint, Singh said that several people, including doctors, often misunderstood physiotherapists to be PMR specialists.
“Some orthopaedics do not want to encourage this field as then there would be a decline in their implants/replacement surgeries,” he said, adding that it was also unfortunate that bodies of PMR also did not want to highlight the shortcomings as a majority of them did not have an interest in developing the field. “I am advocating this since I am a doctor with disability and am suffering.”
Lack of PMR department in the national institute
The apathy towards the issue, he said, can be gauged from the fact that even the national institute to deal with physical disablement, the Pandit Deendayal Upadhyaya Institute of Physically Handicapped, does not have a PMR department.
The petition, in which the secretaries of Ministry of Health & Family Welfare, Medical Council of India and the Department of Empowerment of Persons with Disabilities have been made respondents, also highlights how in the wake of India ratifying the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), it has become incumbent upon it to harmonise all its relevant domestic laws and policies with this international treaty. But due to these shortcomings, Singh cautioned, “we will fail to fulfil our obligation under UNCRPD”.
Following the resolution adopted by the Central Council of Health and Family Welfare in January 1999 and while discussing the role of the health sector in the implementation of Persons with Disabilities (PwD) Act, 1995, the Medical Council of India had in February of that year directed every medical college to start a department of physical medicine and rehabilitation. It had also written to all the health secretaries, registrars of the universities having medical faculty and deemed universities as well as the deans and principals of medical colleges to ensure that department of PMR were started in their respective colleges.
MCI guidelines flouted with impunity
However, as the data reveals, the compliance has been negligible.
“The World Report on Disability, 2011 by WHO stated that ‘physicians worldwide generally lack training about caring for people with disabilities, thus frequently compromising their health care experiences and health outcomes’ and the court of CCPD had in 2008 also instructed MCI and Indian Medical Association that ‘doctors not trained on rehabilitation should restrict their treatment of children with disabilities to their medical illness/disease or else action be initiated against such practices under relevant section of MCI,’” the petitioner said.
Ministry has not notified PMR as an MBBS subject
He also observed that while the MCI had in 2013 decided to include PMR and radiotherapy as mandatory subjects in the existing MBBS curriculum, this change is yet to be notified by the health ministry.
On the way forward, the petitioner has submitted that the chief commissioner for persons with disabilities should implement his order of 2008 which stated that “doctors not trained on rehabilitation should restrict their treatment of children with disabilities to their medical illness/disease or else action be initiated against such practices under the relevant section of MCI. They should refer such children to the qualified rehabilitation professionals.”
He has also urged that the health ministry should notify MCI’s request to include PMR as mandatory subject in the existing MBBS curriculum; issue an order directing MCI to implement the order of every medical college to start a PMR department; and in case of paucity of PMR specialists, made efforts to encourage specialists from preclinical departments like anatomy and physiology to undergo a six-month supervisory training under mentor PMR department to equate them at par with PMR specialists.
Finally, it has also been demanded that the Medical Council of India should issue an order directing all medical institutions in India to set up a PMR department at the earliest and the department of empowerment of PwDs apart from setting up a full-time PMR department at Pt. DDU Institute of Physically Handicapped, collect disability statistics for improving rehab services and involve doctors with disabilities in the planning, evaluation and monitoring of rehabilitation services.