[dropcap]“[/dropcap]Nagaland’s first medical College in Kohima” Eastern Mirror 24th July 2013; “Medical college in Kohima soon” The Morung Express 24th July 2013; It’s all very well that the Nagas have finally been given an opportunity to scratch the 50 years itch. However, in our enthusiasm we could land up scratching all the wrong places and bypass the actual itch that needs scratching. The one thing I would categorically say at this juncture is that addressing this issue through a tribalistic prism would be our undoing. This is a time when our thinking box must be tempered with cool contemplation and dispassionate consideration of the ground realities, nothing more nothing less. Setting up a Medical College duly recognized by Medical Council of India (MCI) is no walk in the park.
So many technical factors are required to be taken into account. As a lay man I can at best present the peripheral perspective to the subject that would invariably impact on parents with growing up children. We also need to pay attention to the changing times. The Supreme Court’s ruling doing away with joint entrance exams and allowing the respective Medical Colleges to conduct their own entrance examination changes the contours of an even playing field. This necessarily foretells the drastic sequence of event that is about to follow: However brilliant a student, their intelligence will have to be backed up with exorbitant capitation fees that every institute imposes before an admission and this will be beyond the reach of an average Naga parent. With the independence granted to the respective Medical Colleges this situation can only get worse.
This only means that the medical field will be opened to the very rich Naga parents being able to afford a medical course for their children if at all, while poorer parents with brilliant children will find it extremely difficult to go anywhere near a Medical College. The unfairness of it all is damning. Our problems could get accentuated with a Medical College of our own: the seat reservation granted to the State as of now could get reduced or withdrawn altogether if we are unable to protect our own. All of these possibilities are going to be real time obstacles that we need to bear in mind as we deal with the business of establishing our own Medical College. We have no choice but to ensure that such a College is a qualitatively functional one at all cost. Extracting lessons from our neighboring State like Meghalaya could balance our thoughts.
So let us begin with North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya. This is an autonomous institute established by the GOI in lineage with AIIMS, New Delhi. The foundation stone was laid by no less than the Prime Minister of India, Late Rajiv Gandhi in 1987. The progress and development of the Institute was closely monitored by the PMO and the MoH&FW and was commissioned on June 2006. Even with that much of a concentrated focus it had taken them 19 years to bring this institute alive. The total estimated cost of this project was Rs.422.60 crores. Despite the fact that it was a centrally sponsored project with a very elaborate infrastructure, having a five year budget projection of Rs.1695 crores approximately and so on, it had received a confirmation of recognition by Medical Council of India (MCI) for its Post Graduate course only in December 2012 and its MBBS course only on 5th April 2013. Prior to recognition the students of this institution had to undergo a harrowing time after graduation because they could not get the license to practice. When asked why it had taken so long for this Institute to get MCI recognition for its MBBS course the Director of NEIGRIHMS had reportedly responded saying that it was primarily due to their inability to get adequate teaching faculties and specialists in place apart from deficient infrastructure, laboratories, quality and credibility. He further stated that NEIGRIHMS still suffers from the dearth of faculty team with at least 40 important vacancies still remaining unfilled. Now carefully compare the connectivity and other conveniences of Shillong with that of Kohima. They enjoy an edge over us by way of proximity and better connectivity to the mainland but even they still have critical teaching faculty problems. While Nagas are now very comfortably used to having one unqualified politically appointed teacher in many of the primary schools we cannot afford to apply the same yardstick to run a Medical institute with unqualified teaching faculty. Even our politicians would dread the thought or risk having to be treated by a Doctor groomed from our own Medical institute with teaching faculty they themselves would pick up from the streets because of the inability to get qualified personnel.
Coming to the issue of setting up the Medical College along with the proposed new District Hospital still under construction for the past few years in Kohima, sounds like a typical Naga approach to any proposition devoid of any ground reality check. We are so prone to counting our chickens before it hatches. In the first place the question that needs to be asked is: is the new District Hospital in Kohima ever going to be completed in time to complement the Medical College? Development budget being converted to election fodder by the powers that be is not about to diminish. The next natural step of the Government will be to escalate the estimated cost of the project beyond the Himalayas, desperately beg the Ministry to provide additional fund and repeat the dose of additional pilferage to recover the election investment on an emergency basis. Allowing such a cycle of misdemeanor to repeat itself, which is more than likely to follow, it would probably take another two plan period i.e 10 years or more before it gets operational, that too if we run into some freaky unusual luck. Now, according to the MCI criteria of eligibility no Medical Collage can hope to begin its academic pursuit without a hospital in place having a requisite 200 beds (in the case of the North Eastern States) to be increased to 400 beds at the time of recognition of the Medical College with an annual intake of 50 students at the time of inception. The ‘Hon’ble’ Minister H&FW expressing a desire to complete the project within two to three years sounds great but it is a typical political loud mouthing as would be expected from the species of their kind. ‘Desire to complete’ is one thing but actually getting it completed is quite another. With a limited budget of just Rs.200 crores for a project of this magnitude, consider the sequence of events that is bound to follow. We begin with land acquisition exercise that would include tax of the questionable kind; Since it concerns a Medical College, the table tendering will quietly be doctored and nursed by awarding the work to a contractor who would be willing to walk that extra mile and provide additional Thai massage of the same questionable type and then start scavenging the whole countryside for the kind of imitation construction materials that the Chief Minister had said they should avoid using, in order to make a profit and start chasing for work order to repair their work before it is even completed. The funds getting abnormally reduced for all the wrong purposes along the way will not be sufficient to complete the project and the escalation game will then be put to motion. If the Nagas desire to continue dreaming about a Medical college for another fifty years then this approach sounds fine. However if we really do mean business we better take proper stock of our options pragmatically.
Taking all factors into consideration, we have a readymade infrastructure at Dimapur which was earlier known as the Referral Hospital now known as CIHSR. The original estimate of Rs.32 crore for a 500 bedded Referral Hospital was escalated to Rs.200 crores and even then only 40% of the work was accomplished. As you can see, this too was once a white elephant establishment having gone through the same corruption pilfered process. Be that as it may, there are at least the existing infrastructures which are not being utilized to its optimum and can now fruitfully be used. The plus points in considering this option are that:
1/ We do not have to incur any expenditure on land acquisition and thereby eliminate the cost for land including the tax of a questionable kind. The minimal land required for a Medical college as stipulated by MCI is 25 acres only whereas CIHSR has 130 acres at its disposal at present, and can comfortably accommodate whatever additional infrastructure as may be required for the establishment of a College and conveniently use the ones that already exist as well.
2/ The infrastructure may not be at par with the requirement of a college as of now but the existing ones would go a long way towards strengthening the needed areas as against starting the project from scratch and thereby lift the burden of fund constraints exponentially.
3/ Time factor will also be reduced to that extent as well in the process for the completion of the project and enable the college to start functioning that much earlier. CIHSR already have 180 beds operational as of now and can enhance this capacity to 250 beds without too much of constraints.
4/ The ability to employ creditable teaching faculties and specialists will continue to pose a major challenge to the establishment but in comparison Dimapur will definitely afford easier choice to the intending candidates in view of communication conveniences of Air, Rail and road connectivity. It would greatly matter to those from the out State environ where Dimapur would definitely be a better comfort zone as compared to Kohima. Small issues like this will make the ultimate difference between a functional and a non-functional institution. From the experience of Shillong we should be prepared not to undermine such minute details. The experienced Doctors opined that a Medical College would be dealing with an average of 90 ( ninety) Faculties involving a minimum of 20-30 Medical Professors and specialists per faculty. In which case we would be looking at 1800-2700 Medical Professors and Specialists needing to be deployed. According to the informed sources, AIIMS is losing many of their top Professors and Specialists to the Private sectors because they would earn a mind boggling Rs.8 crores per month approximately as against Rs. 1-1.50 lakhs p.m in a Government establishment. In a competitive field such as this it is going to be a very challenging task finding the best brains to man the institution. Why add inconveniences of existence and communication to the list of repellants.
5/ With the involvement of CMC Vellore and Emanuel Hospital Association in CIHSR, the one critical advantage that it will possess is the fact of their connectivity ability with the rest of their associate organizations to augment the faculty deficiency related issue which will be critical. One would be inclined to believe that Kohima Medical College on its own would be desperately handicapped to cope with the problem of this magnitude without a proper networking capability.
6/ According to the working experience of some Doctors they believe the variety of diseases in a place like Kohima is much too restrictive and not too conducive towards medical studies. We have cancer, diabetes, alcohol related problems and HIV as the more significant common kinds of ailments. As compared, the plain sector inhabitants bring in a whole variety of diseases that would afford the medical students that much more scope for learning their trade and gaining experience that they must. Nothing much to be envious about but from the academic perspective Dimapur would take the cake and eat it too in this regard.
7/ Cadaver is an elementary prerequisite for any medical course. With our traditional attitudes of emotionally dealing with the dead body to the extent of not even allowing post mortem to be performed, getting dead bodies for the purpose of medical study is way out of Kohima’s league. In other metropolitan stations too they procure cadaver at auctions at a high cost and it is still not enough. The ideal equation in terms of dead body student ratio is supposed to be 1:3 ( i.e one dead body being dissected and studied by three students) as against the prevalent reality of 1:16 which is far from beyond optimal. We also have to deal with such problems once a Medical college becomes operational. These are sectors which cannot be compromised. It is not going to be an easy proposition but if at all, the possibility of Dimapur in terms of accessibility to cadaver or the acquirement of it from the neighboring state(s) is definitely better placed than Kohima.
These are few of the elementary issues that strike one’s mind as important and indispensable consideration to ensure that a Medical College becomes a real blessing for the Nagas. Perhaps the medical fraternity could provide a wider technical input and other perspectives should they be consulted. It would be of utmost importance that the Cabinet dispassionately debates this issue of locating the college in the right place for it to practically succeed and not be diverted by sentiments of any other kinds. We can ill afford to have another sugar mill and Tuli paper mill variety of white elephants in our hands. We are talking about the future of our next generation and the well being of the general health management of our people. We have to make it work. For once let us consciously scratch the 50 years itch where it really itches.
KHEKIYE K. SEMA IAS (Rtd)
