I deem it a great honour to stand before you as president of ARSI on the occasion of 16th annual conference of Rural Surgery, which this institution has organized so meticulously and thoughtfully. It is indeed a rare privilege for me to be in this college twice; first as a member of ARSI to attend its first conference fifteen years back to present a paper on rural surgery in presence of stalwarts like Dr. Sushila Nair- a true Gandhian, Dr. N. H. Antia, Dr Balu Shankaran and very senior faculty members of this college. Today I am here for the second time as the president of ARSI after witnessing its growth for the last 15 years from conception to adolescence.
We all agree that the purpose of surgical care, whether in rural areas or in urban high tech hospitals, is the same and that is to give relief to the patient. The only difference with the rural surgeons is that they deliver this care almost at the door step of the rural population in a most cost effective manner with profound human touch, using their innovative skills and technology suitable to rural population and not the least, working often under tremendous resource constraint. Ignorance, poverty, malnutrition, diseases added with the paucity of resources multiplies the miseries of rural patients. Yet, working in this milieu, rural surgeons save hundreds and thousands of life every year- a heart rendering achievement indeed. All these are besides their ongoing research and innovations to make the technology effective, cheaper and easily accessible for the rural population.
I congratulate and salute all such brave souls for their daring feats, request them to continue their work with more vigor and without any fear of litigation. We have to accept this challenge to alleviate the suffering of rural population for which we are committed.
To highlight few of our achievements, "Rural Surgery" journal which was started with a humble beginning as a media for networking amongst rural surgeons and disseminating information about their work, has improved its quality and successfully edited by Dr. S. K. Baasu. I congratulate him for his sincere effort. This journal is now circulated to other part of the world amongst the IFRS member countries
ARSI believes that there are extraordinary possibilities in ordinary people. Antia-Finseth award was instituted with that belief to reward those people, who by their research and innovation could bring a change for betterment in rural India particularly in rural health sector. Four such persons have already been awarded and honoured for their wonderful innovations. This award is open for all; from a common man to a professor of a medical college or even to a rickshaw puller.
Shimoga Jhargram scholarship was instituted by ARSI to help rural surgeons for updating their skills and to learn newer technology suitable to the need of rural people. Rural Medicare Society award for the best paper of the year published in "rural surgery" is an effort to encourage more and more rural surgeons to contribute articles, sharing their experience/ innovation with others.
DNB in rural surgery, started by National Board of Examiners, is another feather in ARSI's cap. Indeed ARSI took the lead to conceive the idea, pursue the National board and gave lot of inputs for its implementation.
As I highlight some of our achievements, I also would like to share with you some of our problems which in spite of all our efforts we have not been able to solve. Non availability of blood in rural area still remains a problem due to non acceptance of UDBT on the part of the Govt. It seems they are totally ignorant about the reality of rural areas. The newly established blood banks are located in the cities and far away from the villages. Quite often desired blood is not available in these blood banks even after substituting donors. To save the precious life during emergencies, human beings are the best blood banks. Their fresh blood should be allowed / legalized to be used in rural areas during emergency conditions after doing necessary tests as per Govt.'s specification. This is the only solution till date than thrusting impractical high profile schemes made in corridors of power.
Rural India needs many physicians and surgeons. I sincerely feel the time has come that senior rural surgeons should be invited by the teaching institutions to share their experience about the working conditions among the students and inspire fresh graduates and postgraduate doctors with their own examples to serve villages. Involving both urban and rural doctors for training of graduates and post graduates will be complimentary to each other and most useful to coming generation of medical professionals.
The first thing we have to do is not to sit back and pat ourselves on our backs. Let us sit up straight. Let us start to learn from history and based on this learning, set our future course of steering the ship. What do we learn from the last sixty years history of healthcare development of independent India. Starting from the Bhore Committee report`s implementation, setting up the hierarchy of the health care administrative setups of the different states and the centre, and finally ending up in linear programmes. All of which failed to yield expected results in the long run. All of them, including the health components of the five year plans. And then jargons, comprehensive health care, primary health care health for all by 2000AD and so on. And in spite of all this, 400 million people in our country have no access to what the WHO terms as essential health care today. And finally, in a desperate attempt to tackle, the government, with opening up of the economy, is promoting privatization and corporatization of health care. And while 80% of our population is in villages and periurban slums, 80% of our hospitals are in large cities.
Here is a couplet for the people in power:
"Fakat doosron ko na updesh do tum
Yeh aadat buri hai, yeh aadat na dalo,
Watan ko hai agar khoon ki zaroorat,
To hissa zara kutch apna bhi dalo."
"Yeh dabdaba, yeh hakumat, yeh nasha, yeh Daulat
Kiraydar hai sab, ghar badalte rehte hai "
During all our ventures of life, let us not forget the advice of ages and sages. Charaka says "That a physician, who for the sake of his lively hood sells treatment as an article of trade, throws away hips of gold and collects clods of mud in return. He, on the contrary who devotes himself to living creatures attains the highest happiness- for there is no other gift equal to the gift of life."
Charaka also says at convocation: There is no limit to the science of life. The entire world is teacher to the intelligent and foe to unintelligent. Hence knowing this well, we should not hesitate to listen and if necessary act according to the instructions of even an unknown ordinary common man when they are worthy. It may enrich our knowledge and experience. Wisdom is not confined to any individual, race, region and time - It is god given gift.
A Chinese proverb says:
Go to the people
Live among them
Learn from them
Start with what they know
Build, on what they have.
At the end I may tell you that in spite of all handicaps rural surgery is pleasing, rewarding and gratifying.
Friends, let our association therefore not rest but gear up to face the new responsibility of delivering appropriate health care to the entire population of the nation. We have to make our own plans for doing so. Let me assure you no foreign professor is going to come and do it for us, neither any international collaborations. We will have to do it ourselves, and with voluntary effort. To achieve this, we need not be a large organization, but an organization of strong willed people. Let us be like the Pandavas of the Mahabharata, who won the war with a much smaller army than the Kauravas. And I pray to God, may He help us in doing so.
With best wishes
Dr. K. C. Sharma