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Health

What Are We Doing About Unlicensed Medical Practitioners?

Unlicensed practitioners have simply filled in the gaps in the Indian public healthcare system.

Pari had just turned two when she complained of severe stomach ache. Her mother took her to a clinic nearby in Shalimar Bagh, New Delhi, where a self-proclaimed doctor prescribed her a dose of painkillers. However, Pari was soon vomiting blood and taken to Dr Baba Saheb Ambedkar Hospital, Delhi, where her body turned blue. She died shortly afterwards.

Lucky Kumar, coordinator of the Delhi Medical Council’s (DMC’s) anti-quackery cell, said the doctor was in fact an unlicensed practitioner named Anand Kumar (no relation), and was declared a quack.

Technically, a quack is any person who neither qualified to practice nor possesses the requisite license. In India, they’re typically purveyors of ayurvedic or homeopathic remedies, although many of them also practice allopathic medicine. According to a WHO report published in 2016, 57.3% of India’s medical practitioners are quacks.

“Quacks do not have the required knowledge, skill or qualification but they pretend to be professionals,” Lucky Kumar explained. “People who practice allopathic medicine in Delhi need a registration certificate from the DMC. Without such a certificate, they are not eligible to practice medicine.”

The Indian Medical Association (IMA) has estimated that there are more than 10 lakh such quacks operating in India, of which nearly 50,000 are in Delhi. Such medical practitioners have long been popular in India and their numbers have been rising by the year, according to the IMA.

In 1997, legislators presented an anti-quackery Bill in the Delhi assembly but it was never passed. The Delhi government claims the text had loopholes that would have to be plugged before it could be enacted. However, the government dropped the ball shortly after and the Bill remains in limbo.

In a dingy mohalla in Faridabad, in the National Capital Region, a banner with red block letters directs a prospective customer to a clinic upstairs. In a 10 ft by 10 ft room, near one wall fitted with a glass cabinet with small bottles of pills, is a medical practitioner known only as Doctor Sahiba.

“I was employed as an assistant in a local hospital and slowly I learnt about medicines there,” she told The Wire. “After 10 years, I opened my own clinic. Usually, I treat minor ailments and give medicines for free, but my consultancy fee is between 50 and 100 rupees.”

She attends to a patient complaining of stomach ache and vomiting. Doctor Sahiba asks a few questions, puts a combination of pills in a sachet, hands it over to the and says, “It’s just an upset stomach. Eat homemade food for a few weeks and drink [an oral rehydration solution].” The patient nods sincerely, pays the fee and leaves.

“All the locals come to my clinic – the nearest hospital is far away and expensive,” Doctor Sahiba says, alluding to the country’s most visible symptom of its ailing public healthcare system.

Dheeraj Chauhan, the DMC’s record-keeper, had the same view: “If somebody is able to cure an ailment with just 100 rupees, why would a person spend 500 rupees?”

However, far from legitimising unlicensed and unqualified practitioners, Chauhan said people have to be made more aware of the downsides of not visiting, say, an allopathic doctor at a government hospital.

For example, he said, quacks usually prescribe medication that provides temporary relief but allows the underlying ailment to worsen, often such that by the time the patient presents themself to a licensed practitioner, it is too late.

“These quacks mostly prescribe high-dose medicines that provide quick but temporary relief to the patient. These medicines can cause some serious damage that is not visible at first,” Girish Tyagi, the registrar of the DMC, added.

But even then, according to the National Health Profile (NHP) 2019, India has one government allopathic doctor for every 10,926 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. None of these figures are anywhere near the WHO-recommended ratios. The NHP also says that while India has over a million allopathic doctors for its population of 1.3 billion, only around 10% work in government healthcare centres.

All together, unlicensed practitioners have simply filled in the gaps.

There are some ways to get them out. For example, medical practitioners suspected of fraud have to prove to the government that they are legitimate. If they don’t, they are liable to be sentenced to three years in prism or pay a fine of Rs 25,000 – or sometimes both.

For another, the chief district medical officer (CDMO) is empowered to raid the premises of a clinic if the medical council lodges a complaint. After the raid, “the CDMO sends us the inspection letter and if [the practitioner] turns out to be unqualified, we … issue a show-cause notice and they have to appear before the council,” according to Girish Tyagi, registrar of the DMC. “If they still don’t shut down their clinic, we register an FIR.”

But in most cases, the practitioners simply relocate after receiving the show-cause notice.

A third way tries to keep them in while reforming them. With state government support, the Liver Foundation in West Bengal’s Birbhum district offers a training programme for unlicensed practitioners to continue working with certain restrictions in exchange for staying within the law. These restrictions include not prescribing Schedules H and X drugs nor stronger antibiotics and dropping the ‘Dr’ prefix. In turn, they will be called rural healthcare providers.

The IMA isn’t convinced, however, and has said training quacks will only legitimise them further.

Asma Hafiz, Ifreen Raveen and Ishita Das are graduate students of convergent journalism at Jamia Millia Islamia, New Delhi.