Our software can be breached: Prometric

The US-based company that conducted the National Eligibility and Entrance Test (NEET) — held to admit students into postgraduate medical courses in December, 2016 — has admitted that their software “can be breached”. The company, Prometric, told this to the Delhi Police via teleconference, as part of the investigations into alleged hacking of the examination software, which allowed students to cheat.

The 20-page chargesheet, prepared by the central range of the Crime Branch, also states that the accused planned the hacking way in advance — even telling aspirants which examination centre to pick so they could cheat. As first reported by The Indian Express, the Delhi Police had arrested four people in connection with the case, and established that the servers used to conduct the examination were hacked. The chargesheet also states that supervisors of two examination centres in Chandigarh and Greater Noida, where the exam was held, helped some students cheat.

In the course of their investigations, police found that the exam-controlling body, the National Board of Examination (NBE), had given the contract to conduct NEET PG (2017) to M/S Prometric Testings Pvt Ltd. “They had sub-contracted with CMS IT Services Pvt Ltd to hire engineers, site supervisors and other staff to prepare exam labs and for actually conducting the NEET (PG) examinations at various exam centres from December 5 to December 13. Later, CMS IT Services Pvt Ltd had further tied up with M/S Apex Services to provide manpower and technical staff at the examination centres,” police stated in their chargesheet.

Police said the “agents and sub-agents” were active through the year in search of candidates ready to give money for a good rank. “After finding such candidates, the sub-agents informed senior agents, who had direct links either with the candidates or their parents. These agents were in constant touch with site supervisors, engineers and officials, who got posted at examination centres. They only advised the candidates or their parents to choose a particular examination centre,” a senior officer said.

In its chargesheet, police mentioned that M/S Prometric Testings Pvt Ltd failed to identify the alleged software — Ammyy Admin, which had been used by the accused to hack the exam. “The alleged persons, including site-supervisors, engineers and senior officials, managed to break open the security system of Prometric and, unlike other students, their selected candidates got internet access on their exam computers, which helped them to connect remotely with some other computer outside the examination hall,” police said.

Police found that a site-supervisor of the Chandigarh centre used the software to put students in touch with agents outside, who would then solve the papers and pass them to the students.

Tampered computers gave NEET-PG applicants a lifeline

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The Crime Branch of the Delhi Police has filed a charge sheet in the court of Metropolitan Magistrate Satish Kumar Arora here against officials of Prometric Testing Pvt Ltd, hired by the National Board of Examinations (NBE), to conduct the National Eligibility Cum Entrance Test (NEET) in November 2016 for admissions to post graduate medical courses.

Nearly one lakh students appeared for the PG entrance examination, competing for 35,117 post graduate seats across the country.

Remote access given

According to the charge sheet, accessed by The Hindu, computers at the examination centres managed by Prometric were compromised. In some cases, select computers were installed with a remote, screen sharing software, Ammy, allowing ‘solvers’ outside to select the correct answers for the students.

In other instances, site supervisors, engineers and officials deployed by Promteric tampered with the security system and ensured that select candidates got access to the Internet by connecting remotely to another computer outside the examination hall, the police said.

The Crime Branch is investigating officials of Prometric and the National Board of Examinations (NBE). The charge sheet states that the involvement of “officials at the National Board of Examinations and Promterics” cannot be ruled out.

Sources in the Crime Branch said a list of 500 students has been prepared in a supplementary charge sheet.

Investigations revealed that the NBE contracted Prometric, which then sub-contracted the conducting of the tests to yet another company, CMS IT Services Pvt Ltd for engineering and support staff. CMS IT Services further contracted out the hiring of local vendors for staff at various examination centres.

“In this way, the selection of suitable staff for the exam seems to be compromised and the security and sincerity of the exam was breached,” the charge sheet says.

According to the charge sheet, the aspirants paid between ₹2.5 to 3 lakh to access the Internet during the exam. In one centre in Chandigarh, the site supervisor, one Ankur Mishra (named in the charge sheet) and hired by CMS IT Services, left slips with answers for select candidates.

The NBE is also under investigation for hiring Promteric, an American company, without inviting tenders from other companies. The Crime Branch says Prometric’s staff reformatted the computers and destroyed evidence after the exam.

Echoes of Vyapam

Dr Anand Rai, whistle blower in the Madhya Pradesh medical entrance examination, better known as the VYAPAM scam, and a complainant in the present case said, “The NBE handed over the contract to Promteric without inviting tenders. Promteric has admitted to formatting evidence on the computers [after the NEET], which should have been maintained for a minimum of five years. This is a gross violation of the Indian Evidence Act.”

Soumitra Roy, Country Manager, Prometric India said the company was “not aware of any such development” adding, “We proactively continue to support the authorities in their investigation.”

Heal the nation

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It’s welcome that government think tank Niti Aayog, along with the health ministry and World Bank, has come up with a model of public private partnership to boost India’s abysmal record of healthcare delivery. Public health and hospitals in India come under the domain of state governments and the model is in the form of a template which can be used to augment treatment facilities of non-communicable disease in smaller cities. This is a useful channel to expand the provision of healthcare facilities for resource strapped governments and needs to be scaled up radically across the board, as public healthcare delivery managed solely by the public sector has had a poor record in which Indians, in general, have little faith.

To be sure, states have already experimented with PPP in healthcare delivery in a limited way. Odisha announced this year that it had picked a private healthcare provider to operate and manage a cardiac care hospital in Jharsuguda, while Karnataka and Andhra Pradesh have devised elaborate insurance schemes which make use of private healthcare facilities for surgical procedures. But there is much scope for expansion as well as a process of trial and error to see what works.

Debate in India too often gets bogged down in ideological debates on public versus private healthcare. But policy needs to be pragmatic and facilitate what works: if the capacities of government and private sector can be brought together in a synergistic way to get healthcare services to cover the entire population, there should be no objection. However, based on India’s experience so far, it is important to get the design of PPP right. In the Niti Aayog proposal, there is a benchmark for pricing. This needs to be complemented with proper oversight that will prevent unnecessary medical interventions as well as corruption.

Last but not the least, India has an abysmal doctor-patient ratio and a lot needs to be done to enhance the supply of doctors. Regulation of medical colleges emphasises more on curbs in supply than on ensuring that doctors with a licence to practice are of a minimum quality. Such irrational restrictions need to go, and Niti Aayog had some earlier suggestions to this effect which must be implemented as well. Unless India produces more doctors, whether for the public or private sector, healthcare delivery will not improve.

How India’s family planning programme places well-being and unlocking the potential of women at its centre

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Guest article by Shri JP Nadda, Minister of Health and Family Welfare, Govt. of India

The story of India in the 21st century has been one of extraordinary growth and innovation. We have revolutionised the data and information industry, and we produce medicine cheaper than anywhere in the world. We eliminated polio under incredibly challenging circumstances. But India has not even come close to reaching her full potential, because we have only leveraged half of our resources into that effort. We’ve yet to unlock much of the potential of the other half: India’s women.

Only when India’s women are on an equal footing with India’s men will we be the nation we want to become. The government has already taken significant steps to provide health and development to women.

In India, though maternal and infant mortality have dropped precipitously in recent years, 200 women still die every day in child birth. Part of the problem is that not all pregnant women have easy access to the best ante-natal care. The Pradhan Mantri Surakshit Matritva Abhiyan, which was launched late last year, guarantees every woman in her second or third trimester free ante-natal care by private doctors at designated hospitals all over the country on the 9th of every month.

More than 50 lakh women have been given quality ante-natal checkups under this scheme. More than 56 lakh pregnant women have been immunised under Mission Indradhanush and the MAA campaign, through awareness and counselling, continues to promote better health and nutrition to mothers and children at community level.

Family planning is one of the most critical and long standing health programmes in India. Here too India has made impressive progress, with the fertility rate dropping from 2.7 to 2.1 over the last decade. But even today 31 million married women are not using any contraception at all; about two thirds of the rest are using sterilisation, which is effective but doesn’t help women delay their first pregnancy or space their later children at healthy intervals.

As a result, too many women are either having more children than they want, having children sooner than they want, or not leaving enough time between children for their bodies to recover fully from pregnancy. Realising this massive gap, the government has introduced three new contraceptive methods into the health system, including injectables and a once-a-week pill, so that more and more women will be able to plan their families.

Among those women who do get pregnant, almost half are between the ages of 15 and 25, so we’re also starting an intense awareness campaign aimed at this age group to make sure that they know the contraceptive options and feel empowered to exercise them. A complementary campaign will target men, since contraception isn’t always a choice a woman can make on her own. The better men understand family planning, the more supportive they’re likely to be when it comes to planning their families together with their wives.

The need for better contraception and ante-natal care is not spread evenly around the country. A quarter of India’s mothers who live in the poorest areas are twice as likely to see their babies die than the rest. That is why we launched Mission Parivar Vikas on World Population Day on Tuesday, doubling down our efforts in 145 districts in 7 states – districts responsible for half of the country’s infant deaths – for intensive improvement in family planning and ante-natal care services.

As part of this Mission we want to ensure that supplies are available at all facilities at all times for which we are developing a robust Family Planning Logistics Management Information System. This is a web and mobile based decision-making tool to monitor and manage the flow of contraceptive supplies – to reduce inventory fluctuations – and improve the programme’s effectiveness at all public health facilities.

We estimate that in 2017 nearly 137 million women in India are using modern method of contraception. As a result of this usage, 39 million unintended pregnancies will be prevented; nearly 12 million unsafe abortions, 16 million total births and 43,000 maternal deaths will be averted. We firmly believe that family planning is critical for our nation’s economic development, and is a big first step towards growth, equality and sustainable development that opens the door to opportunity and prosperity for women and families.

Doc, 31, kills self with drug injections

Varde’s residence; Friends recall him as a cheerful guy. Divorced two years ago, he was keen on remarrying

In an incident that has left the medical fraternity shocked, a 31- year-old orthopaedic surgeon at LG Hospital, Ahmedabad died of vecuronium overdose on Tuesday. While sources said Dr Mehul Varde is believed to have killed himself by injecting four times the normal dose of the muscle relaxant, which is used as part of general anaesthesia during surgeries, mystery shrouds the death as the doc did not show any signs of depression as per sources.

The alleged suicide took place between 2.30 pm and 7.30 pm at Varde’s fourth floor residence at Ishaan in Prahladnagar. According to the police, Mehul’s father Dr Ramesh Varde had been calling him on his cellphone repeatedly. Since he did not answer the calls, the worried father alerted Varde’s friend Neha Joshi to check on him. The door of his residence was broken into when Mehul did not answer the doorbell. He was rushed to Shalby Hospital where he was declared brought dead at 8.30 pm. What is intriguing is that Varde, an MS in Orthopaedics and a senior resident doctor in orthopaedic department, had attended the operation theatre at LG Hospital on Tuesday at 9 am, hours before the incident.

And according to his colleague, he did not seem depressed at all to take such a desperate step. “He was normal and like always he laughed and made others laugh. I could never have imagined that he could take such a step. He has always been jovial and a happy-golucky guy,” said a doctor on condition of anonymity. Apart from the fact that Varde got divorced two years ago and that his father runs a hospital in Deesa, his colleagues do not know much about his personal life. Fatesinh Pargi, PSI and investigating officer in the case, said, “Varde had divorced his wife two years ago. He was staying alone at his friend’s place and did not leave any suicide note behind. We will be investigating the cause of suicide. We will examine call details, scrutinise the postmortem report and question his friends and hospital staff to learn the exact cause of his death.”

‘Had placed a matrimonial ad’ 
A doctor at LG Hospital said the reasons certainly had to be personal. “He had already tendered his resignation and was set to join Zydus Hospital from July 26. He had also inserted a matrimonial advertisement in Ahmedabad Medico News, an Ahmedabad Medical Association bulletin, looking for a doctor pursuing post-graduation after MBBS.” It was understood that things were looking up for him before he suddenly decided to take the desperate step. LG’s Medical superintendent Dr Rajesh Shah said, “Dr Mehul Varde had joined LG on April 24, 2016 and had given his resignation on June 26, 2017.

He had given no hint of depression to his colleagues and friends at the hospital.” Deputy Superintendent (anaesthesia) Dr Charuben Pandya said, “He was an extremely good looking doctor who would have given any film star a run for his money. He studied at a University in Pune to become an orthopaedic surgeon and had worked at the VS Hospital before he joined LG. In fact, he and his mother had approached me and I had recommended his name for the post here.” Charuben said, “Vecuronium is given as muscle relaxant during the anaesthesia procedure that completely stiffens the muscles to keep your body still during the surgery. Normally, a dose of 1mg per kg of body weight is given to patients undergoing surgery.

It is a scheduled drug that is not available over the counter but it is not difficult for a doctor with his licence to procure it.” Judging from the ampoules found near the body, Dr Varde had injected four times the dose. Dr Kalrav Mistry, MD psychiatrist at Shalby Hospital, said, “Young doctors undergo a lot of stress much of which is work, financial, relationship or family pressure related that can cause depression. This appears more like a case of undiagnosed depression because of adjustment problem. There is tremendous stress in medical profession and stigma associated with psychiatry disorder. Divorce and marriage anxiety have a big impact and lead to depression. Also most common means of suicides by doctors are lethal medication overdoses.”

Government urged to make primary healthcare a speciality

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The Academy of Family Physicians of India on Tuesday urged the government to recognise primary healthcare as a “speciality”, saying their experts (family physicians) are the first point of contact for healthcare for most people.

The body asserted that strengthening primary healthcare would be a major step towards achieving the goal of mitigating the burden of diseases at advance state.

It is mainly provided by general practitioners but community pharmacists, opticians and dentists are also primary healthcare providers. The aim is to provide an easily accessible route to care, whatever the patient’s problem, it said.

“By strengthening primary healthcare (PHC), burden of diseases at advance stages can be prevented. It needs effective planning and future road map to reach the target. The PHC forms the anchor around which entire healthcare delivery system is organised,” said Raman Kumar, President of the Academy of Family Physicians of India.

Currently, primary healthcare by the general physicians is not recognised by the Medical Council of India as any form of specialty.

The World Health Organisation has identified five key elements as part of the primary healthcare, reducing exclusion and social disparities in health, (universal coverage reforms), organising health services around people’s needs and expectations (service delivery reforms) and integrating health into all sectors.

“Primary healthcare is not yet recognised by the Medical Council of India (MCI) as a specialty, although MCI has advocated for the creation of a diploma course in family medicine. Primary healthcare practitioners therefore have no formal system for career progression. They have lower pay and worse working conditions than their hospital colleagues,” said Kumar.

VIMSAR doctor caught on camera working in pvt clinic

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A doctor posted at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla has been caught on camera while working in a private diagnostic clinic during duty hours.

Director of VIMSAR, Aswini Pujahari, first noticed the doctor of Radio-Diagnosis department, B B Panda on Sunday engaged in the malpractice.

“I had gone to the department on Sunday. There was no consultant doctor at the department. Only a PG student was on duty. I made call to the doctor who was on duty to come to department. Though I made the call at 11 AM, the doctor did not come till 1 PM. Later, I got information that the doctor was in a private diagnostic centre,” Pujahari said.

Stating that he personally visited the private diagnostic centre and found the doctor working there, Pujahari said “I video-graphed the activity of the doctor at the private diagnostic.”

He said action will be taken against the doctor so that such activity is not repeated by other doctors. The matter will also be placed before the disciplinary committee of VIMSAR.

The accused Dr Panda, however, said he was at the diagnostic and claimed since it was Sunday and a holiday, he worked there for some time.

“I had visited the department on Sunday morning and inquired whether there was any case. And when I found that there was no case, I went to the market. Subsequently, I went to the private diagnostic,” Dr Panda clarified.

Sarkari Doctor’s Poetry

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Guest article by Dr. Mayank


मैं थक गया;अब तू ही बोल।
कैसे करूँ तनहा तुझसे;PHC में हर बुखार control?
उधर amoxy ने आवाज दी,
डॉक्टर साहब अभी मैं stock में हूँ पड़ी।
पर चेतावनी है;ध्यान दें,
किसी भी मरीज को चार कैप्सूल से जादा न लिख दें।
मैनें फ़िज़ूल की उससे बहस की,
चार कैप्सूल से तुम्हारा कोर्स पूरा होगा नही।
amoxy हंसीं और साथ में septran भी,
लगता है इस डॉक्टर की PHC में पोस्टिंग है नई-नई।
बोला बगल में betadine का बोतल खड़ा,
महीनों से बिन ढक्कन पड़ा-
सुन लो ये डाक्टर बाबू,
अगर चाहते हो मरीज रहे काबू,
तो दवा का पूरा कोर्स भूल जाओ,
और मुझे तो बिन ढक्कन खोले ही घाव पर लगाओ।
तब तो एक बार के बजट में,पांच साल चलूँगा,
अपने अंदाज़ से ख़त्म किया तो साल भर खलूंगा।
अब पानी मिले savlon की बारी आई,
बोला वो मुझसे-भूल जा मेडिकल की पढाई।
तेरी पढाई के इलाज़ से,
नही कोई मेल सरकार के मिज़ाज़ से।
सरकार का सिर्फ एक काम ,
खोलो अस्पताल सरे-आम।
फिर दिए दिखाय,
जनता को सारे उपाय।
कि हमने PHC खोल दिया है,
डॉक्टर मौजूद रहे चौबीसो घंटा;ये बोल दिया है।
हॉस्पिटल में सारी सुविधा निःशुल्क उपलब्ध् कराई जायेगी,
dial करो 104/108;एम्बुलेंस घर पर दौड़ी चली आएगी।
पर ये नेता जी शायद भूल गए,
104/108 आये दिन रहती है garage में खड़े।
और बिन सुई-दवाई,
कैसे इलाज़ करे मेरा डॉक्टर भाई।
इतने में cotton और gauge ने अपना expiry date का लेवल खोला,
और पुरे antiseptic अंदाज़ में बोला-
इतना प्रवचन डॉक्टर साहब क्यों सुनते हो,
सरकार की कागज़ी बातों को क्यों चुनते हो?
कैसे सिमित दवाओँ से हर मर्ज दूर हो,
क्यों डॉक्टर स्टॉक के हिसाब से दवा लिखने को मज़बूर हो?
इतना तो kidney tray में पला बढ़ा,
बेचारा artery forcep;जो अब है जंग चढ़ा।
भी बता देगा,
कि अब मुझसे कोई काम न होगा।
फिर भी उस scissor से,
जाने कैसे-कैसे,
आप काम निकाल लेते हो।
और सरकारी आदेश में,
ढल जाते हो आप भी उसी परिवेश में।
कि हर पेट की बीमारी की दवा MTZ है,
ठीक हुआ तो हुआ;नही तो हम आपके कौन हैं?
अचानक गुस्सा हुआ R/L का bottle,
दिया जवाब in sum total,
क्या पूछते हो PHC के डॉक्टर से,
कभी पूछा उनसे;किस दर्द से हैं वो गुजरे?
DNS बोला intracath के साथ,
भाई N/S तुम्हें नही पता;क्या है बात।
D 5% बोल रहा था,
सारे सरकारी राज खोल रहा था।
कि नेताओं का ये फार्मूला है पुराना,
कैसे अपने area के पब्लिक को है उल्लू बनाना।
एक PHC हॉस्पिटल बिना किसी संसाधन के खोल दो,
उद्धघाटन करो और public को बोल दो।
आज से हर बीमारी का इलाज़ यहीं होगा,
जो डॉक्टर समय पर नही पहुंचें;मुझसे कहना होगा।
पर नेताजी अपने उद्धघाटन किये अस्पताल पे विश्वाश नही कर पाते हैं,
और अपनी सर्दी-जुखाम का भी इलाज़ करवाने;air ambulance से मेदांता से अमेरिका उड़े जातें हैं।
अब सिलाई का धागा,
कोने में पड़ा अभागा,
बोला-ऐ PHC के डॉक्टर,
मुझपे एक अहसान कर-
जिससे मेरी आत्मा तृप्त हो जाये,
जब भी कोई नेता चोट खाये,
अपने उद्धघाटन किये हुए अस्पताल में आये,
जहाँ तुझे दिए हुए है बिठाये,
मुझ से सी देना उसका जख्म;बिन xyolocaine लगाये।
डॉक्टर तू भविष्य है,
कैसे तुझ से कोई खेल पाये।
और deriphyllin dexona की कसम,
Omez Rantac के साथ पूछे तुझसे हम।
क्या बेरोजगारी इतनी भारी है,
की 5 1/2 साल की पढाई पे;5 साल की सरकार भारी है??????

Outside experts set to head all 14 new AIIMS

AIIMS, PGI-Chandigarh, AIIMS management, Jawaharlal Institute of Postgraduate Medical Education & Research, indian medical institutes

MOVING AWAY from the AIIMS-Delhi model, where the Union Health Minister heads the highest decision-making body of the institute, the Health Ministry is looking at roping in external professionals or retired faculty from renowned institutes such as AIIMS, PGI-Chandigarh and others to head the 14 new AIIMS being founded across the country. Getting external professionals or technical experts to chair institute bodies of all the new AIIMS was one of the recommendations of the committee set up under former Department of Biotechnology Secretary Dr M K Bhan to look into the governance structure of the new institutes.

At AIIMS-Delhi, the Institute Body, the top decision-making wing in the institute’s hierarchy, comprises the Health Minister as chairman, Health Secretary, HRD Secretary and several other government functionaries, besides external representation such as the vice-chancellor of Delhi University. The governing body, which is lower in the decision-making hierarchy, is also headed by the Health Minister, followed by the standing finance committee headed by the Union Health Secretary.

“The idea is to both free the new institutes of political interference and also look at the logistics side — it is possible for the minister to attend two governing body meetings at AIIMS-Delhi, but to do so for 14 AIIMS is hardly possible,” a Health Ministry official said. “Getting a professional to head the institute body would improve the quality of functioning and bring in technical know-how and expertise that a political person cannot bring.”

The official said that the Bhan committee had recommended bringing in external technical experts at the helm to act as a mentor. “But we are still studying the report. It is possible that this requires changes in the existing AIIMS Act,” the official added. Dr Bhan, a former professor of AIIMS, is playing a similar expert’s role at the Puducherry-based Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), where he chairs the highest decision-making body of the medical institute.

The committee also envisaged an umbrella governing structure for all the other AIIMS, headed by the Health Minister and the Union health secretary among its members. The board will have control over the governance of all 14 AIIMS but not over AIIMS-Delhi or PGI-Chandigarh. The present governance structure is likely to continue at the Delhi institute, the oldest and the most prestigious of AIIMS, sources said.

Among members of the empowered board, as recommended by the committee, are secretaries of the Departments of Health Research, Biotechnology or Science and Technology, as also members from outside AIIMS —- on the lines of the current structure of the AIIMS Institute Body. With the Centre struggling to find suitable candidates for faculty positions in the upcoming AIIMS, the Bhan committee has also suggested increasing the retirement age of director and other faculty members from 65 to 67 years. Meetings of the standing finance committees of each AIIMS could be chaired either by the Union Health Secretary or any other person nominated by him, but not below the rank of Additional Secretary, the panel recommended.

AIIMS Bhopal shuts one of its busiest OPDs due to lack of doctors, faculty

AIIMS, AIIMS bhopal, all india institute of medical sciences, AIIMS doctors, AIIMS OPD, AIIMS OPD shut, AIIMS medical facilities, indian express news, india news

The dismal condition of AIIMS in Bhopal has come to the fore and it is shocking that it had to shut down one of its busiest OPDs due to lack of doctors and faculty, according to Indian Express report. Established under the ambitious Pradhan Mantri Swasthya Suraksha Yojna, AIIMS Bhopal started clinical services on August 15 in 2012, and OPD services on January 26 in 2013, reports say. Since 2013, AIIMS OPD for mental patients had witnessed footfall of 8,452 persons till May 2015. The closure came at a time when a national survey conducted in 2016 by NIMHANS showed that 15 crore people suffer from common mental health disorders in the country.

It has been learnt that the two professors who were looking after it have quit. The institute is yet to get a full-time director. Apart from this 80 percent of faculty posts are lying vacant, and it has filled only 73 of the 327 sanctioned slots for senior resident doctors. Of 41 departments, only 25 are functional, the reports say. On March 2014, AIIMS Bhopal had 27 departments with 61 faculty members. According to official records, the institute now has 41 departments but on the ground, the number of functioning departments has dropped to 25, and staff to 59, the report says.

The Department of Cardiothoracic and Vascular Surgery, which deals with cardiac conditions, has been functioning on paper but has not attended to a single patient since June 2015. In May 2015, its only faculty, an assistant professor from AIIMS New Delhi had quit. “This is a basic requirement for any tertiary care hospital but the department has been shut. We are hopeful that it would be reopened in the next few months,” a senior official in the institute’s administration wing told IE. At the Oncology department, where the only assistant professor who joined the radiotherapy department in July 2013 quit seven months later. The institute hasn’t provided any cancer-related services for the last three years.

This is also AIIMS: No doctors, no faculty, a crowded OPD shuts

AT LEAST 15 crore people suffer from common mental health disorders in India, according to a national survey conducted in 2016 by NIMHANS, the country’s premier mental health facility. But for over 19 months, the All India Institute of Medical Sciences in Bhopal did not see a single mental health patient.

In May 2015, AIIMS Bhopal shut down its OPD for such patients — one of its busiest, it had attended to 8,452 patients since 2013 and at least 15 patients a day in its last month. Reason: all of the two professors quit, one from NIMHANS in Bengaluru and the other from AIIMS in New Delhi.

The Indian Express visited the AIIMS facility in Bhopal and accessed official records to find that the dismal state of its psychiatry department mirrors a larger problem at one of the six new such functional institutes set up for “correcting regional imbalances” in healthcare. Quite like the pile of debris lying next to the unlit corridors behind the gleaming glass and brick facade of the AIIMS building in the heart of Bhopal.

AIIMS Bhopal started clinical services on August 15, 2012, and OPD services on January 26, 2013. Five years on, it’s yet to get a full-time director, has 80 per cent of faculty posts lying vacant, and has filled only 73 of the 327 sanctioned slots for senior resident doctors.

“Can you imagine AIIMS shutting down its mental healthcare services? In March 2015 alone, the institute attended to 1,059 patients. But within the next two months, the services were shut. In December 2016, one doctor was recruited, but that was a resident doctor and not a full fledged faculty,” says a senior consultant with AIIMS Bhopal. And this, when the NIMHANS survey dug up this ratio from Madhya Pradesh: one psychiatrist for 20 lakh people.

“For almost 15 months, patients had to be referred to other hospitals in the state or outside. When is the last time you have heard AIIMS referring patients? AIIMS is supposed to be the country’s top referral centre,” says the consultant.

That’s not all. Consider these findings:

41 depts on paper, only 25 functional

On March 2014, AIIMS Bhopal had 27 departments with 61 faculty members. And, according to official records, the institute now has 41 departments. But on ground, the number of functioning departments has dropped to 25, and staff to 59.

For instance, the Department of Cardiothoracic and Vascular Surgery, which deals with cardiac conditions, is functioning on paper but has not attended to a single patient since June 2015. In May 2015, its only faculty, an assistant professor from AIIMS New Delhi had quit. And this, for a department that catered to 4,180 patients in the two years it functioned.

“This is a basic requirement for any tertiary care hospital but the department has been shut. We are hopeful that it would be reopened in the next few months,” says a senior official in the institute’s administration wing.

It’s a similar story at the Oncology department, where the only assistant professor who joined the radiotherapy department in July 2013 quit seven months later. The institute hasn’t provided any cancer-related services for the last three years.

Besides, AIIMS Bhopal is yet to get key departments, such as cardiology, nephrology, endocrinology, gastroenterology, urology and nuclear medicine.

Heavy load, few doctors

The Ophthalmology department operates the fifth busiest OPD at the institute, catering to 19,886 patients in 2015-16. But from May 2016 to February 2017, it has been running without a single faculty member and with just two resident doctors.

“We are one of the busiest OPDs here, which is why it’s even more important that there is at least one senior faculty member to handle complex cases. Currently, resident doctors with less than three years of experience are managing the OPD,” says one of the resident doctors.

But what’s more worrying, say doctors, is the inadequate infrastructure. The department has only one refractionist to determine errors of refraction in the eye. “We ask patients to visit private facilities and come back to us. A single person cannot handle such a load and when this person is on leave, the department comes to a standstill,” says the resident doctor.

This lack of basic infrastructure, says the doctor, means non-availability of services. “Being an institute of national importance, we should have started cataract surgery by now under the national programme for control of blindness. But since 2015, the department has performed only minor surgeries and no major surgery,” says the doctor.

No casualty, emergency services

Five years since it began operations, AIIMS Bhopal does not have dedicated casualty and emergency services. For instance, the Orthopaedic department, considered to be emergency care department, does not have an emergency and trauma care.

“We cannot handle acute trauma cases. With the present infrastructure, we can only conduct elective surgery, which is scheduled in advance and does not involve an emergency. Even if we get a minor trauma case, we have to refer it to other hospitals,” says a resident doctor at the department.

Doctors blame the “lack of human resources and infrastructure” for the delay. “The departments of anaesthesiology and radio-diagnosis have just one faculty member each. Only if these two departments have enough resources and infrastructure, can the Orthopaedic team provide any emergency services,” says a doctor at the Orthopaedic department.

“We will soon begin casualty and emergency services on priority,” says the administration official.

Students ask: what clinical training?

If the treatment facilities at AIIMS Bhopal are far from “premier”, the teaching programme is no better. Students complain about “lack of quality teaching, faculty and infrastructure” and the “unacceptable” practice of having to “visit” other colleges to complete their clinical training.

“If this was a private college under the Medical Council of India, admission would not have taken place for a singe MBBS batch. The medical college would have been forced to shut down,” says a student in his final-year MBBS course.

The student, who was ranked among the top five in Madhya Pradesh for the entrance exam, says he now regrets choosing AIIMS, Bhopal “over other top ranking colleges”. “The problem starts in third and fourth year, when we have to undergo clinical training. We are being taught by a senior resident with less than three years of experience,” says the student.

“For example, at one point of time, there was no faculty in general surgery and cases were referred to a private hospital. During that period, we could hardly attend to any patient here. We are basically trained to be clinicians. But since we refer patients, we attend to only minor cases,” says the student.

“Even if we have cases, we don’t have any faculty to report to. In gynaecology, we have to note the medical history of the patient and report to the faculty. But there is no faculty to tell us whether what we are doing is right,” says the student.

Other students say the lack of infrastructure has led to a “drop in the quality of clinical training”. “For instance, the blood bank has been operationalised after four-year delay. But the institute has a licence only for ‘whole blood transfusion’. We don’t have a licence for transfusion of components, such as red blood cells, white blood cells and platelets… 90 per cent of high-risk pregnancies require such transfusions,” says another student.

And yet, what students find particularly difficult to digest is the “practice of sending us to other hospitals”. “The department of psychiatry is shut for more than two years, and we have to go to other hospitals for clinical training,” says a student.

Asked what an 80 per cent faculty shortage meant for students, the final-year student says, “One resident doctor does the rounds in the in-patient department. He also teaches undergraduate students. Then he goes to the OPD, where he sees at least 35 patients. Finally, he has to supervise 20 students posted at the department,” he says.

Will take time for AIIMS Bhopal to become a brand: Prof Nitin Madhusudan Nagarkar

Prof Nitin Madhusudan Nagarkar, director of AIIMS Raipur who was given additional charge of AIIMS Bhopal in 2015, speaks to The Indian Express about plans to resolve concerns about lack of adequate faculty and infrastructure:

AIIMS Bhopal is severely hampered by a lack of adequate infrastructure. How are you addressing this issue?

A lot of work has gone into the development of the institute in the last two years. The construction of a medical college was priority, and that is now complete. As far as infrastructure is concerned, we have started MRI and CT scan services at the institute. We have also successfully started post-graduation in paramedical departments. The priority has been to complete the civil infrastructure that was part of the original plan and by the end of this year we will have 900 beds. We are positive about the development of the institute and we aim to provide quality patient care in central India.

How are you planning to get qualified faculty?

Recruitment has been fast tracked since I have taken over as director. We have recruited 50 per cent of nursing staff in the last one year. In the last six months, we have been busy conducting interviews for 251 posts for faculty. I must say the response has been very positive. We received 1,500 applications for the 251 posts. The institute has conducted three rounds to finalise the list. Now the governing body will decide the final outcome. We are hopeful that by July 17, when the meeting is scheduled to take place, there should be a clear picture about recruitment.

AIIMS, Bhopal was planned on the lines of the country’s premier AIIMS in Delhi. How do you compare the two?

My approach is very positive. One cannot compare an institute that is 60 years old with one that’s just three years old. It is just a matter of time. For AIIMS Bhopal to become a brand, it will take some time.

The shortage of faculty has affected students pursuing undergraduate courses at the institute? Do you think their concerns are justified?

I am from PGI, Chandigarh, which is an institute of national importance. But in those days, we faced a similar situation. These institutions will gradually grow. In fact, students who graduate in such circumstances put in greater efforts and have successful careers.