ANNUAL CONFERENCE OF KGMOA-2012 AT CALICUT

Respected president KGMOA, Chief Guest and other dignitaries on and off the Dias, KGMOA members and their family

First of all I place on record my deep sense of gratitude to the office bearers of KGMOA for inviting me to deliver the key note address. I congratulate you on arranging such a grand function.

Ever since I was invited I am worried about the content of my talk. Even today I am doubtful of my role. As a person working in another health stream for over 25 years, I can only submit my observations.

We know that heath sector in Kerala has advanced so much during the last decade or so. This is evident both in medical education as well as in health service. Be it in infrastructure, patient care, service benefits etc. But how well all these have percolated to the public at grass root level is still a question mark. Perception of the common man on health scenario is different. Their expectations are always high. We are no where near to that. And often we see the reactions of these.

The two branches of Health Dept namely Medical Education and Health Service are not working complimentarily. That is one huge problem we face. All the district hospitals where there is no proximity to med college are working like a huge establishment. But in districts where there is a medical college the district hospital is not developed like that. We both blame each other. Truth is entirely different. We never thought of complimenting each other.

Here we have to think of referral system. But what I see is that both at Medical Education level and Health Service level this is being opposed. Nobody come with a solid proposal or approach it with sincerity. The reason is not known to me.

I feel that we should bring the family practice to the forefront. If there is a referral system we can do this. The primary care level can concentrate on family practice. This will give us an opportunity to prepare the disease registry across the state. This will help us to plan the approach both at preventive and treatment aspects. Secondary level should be empowered to deliver the standard of care they are expected to. Tertiary level should be the teaching institution for treatment of patients referred from secondary level, teaching and research. The present load should be released from Medical colleges.

There is a growing concern that the public health activities are not taken seriously now. Once three tiers Local Self Government came many of the PHC were put under gramma panchayath or block panchayath. What happened after that I don,t know. But it is alleged that immunization, sanitation etc are not properly cared for. Every year we are getting new epidemics and thousands of people are affected. This creates a heavy burden on health system. But no concrete solution is being developed. There should be comprehensive approach, a combined act where medical college can also contribute to conduct field study and look for solutions. Field work in the health sector should be revived.

Another problem is the shortage of staff in the rural areas. Whatever steps the Govt. is taking we have problem in getting people to work at periphery. The latest is the CRS. I talked to many interns regarding this. They are not enthusiastic in pursuing CRS. One problem is our attitude to bonded labour. Most important is many of them do not understand the importance of working in rural areas. We are always promoting a specialized practice and our children are also not different.

It is important that we should create a cadre for rural service. They should be offered better incentives including a PG seat. Most important is that the system should recognize their service for future incentives too, that is giving them placement of their choice. In that case we can abolish CRS and only those who are interested will come for rural service.

I am sure that there are some positive initiatives in this line. There is a plan to start family medicine specialty in Medical colleges to give training in that line. Govt also is considering the system of cadre development during MBBS itself as practiced in AFMC. Initial discussions are started on developing the referral system in health sector. Only thing is that our approach also should be proactive and we should be able to give positive feed back on all hot issues in health sector in our state. We only can improve it. I thing KGMOA the largest service organization of doctors in the state can take initiatives in this line.

Thank you