No wonder Indian doctors prefer to work in Welch than in Warangal or Wardha. But must the Indian taxpayer subsidize them for seven years to do so? As is usually the case, the responses from Indian readers who considered this question can broadly be divided into two categories: agreement (sometimes enthusiastic) and disagreement (often vehement). But many in both categories of respondents are willing to see some merit in the opposite point of view.
Dr. N. R. Ramesh Masthi, who teaches in a medical college in India and has served as a doctor in several remote rural areas, “fully agrees” with me, saying that in his experience, “nearly forty to fifty percent of the students migrate from every medical college each year.” He notes that “ninety to ninety-five percent of the students who join medical college are from urban areas, mostly capital cities, and [are] just not interested in working even thirty kilometers from an urban area.” Barely 2 percent of the students admitted are from rural or government schools. Dr. Masthi says with feeling: “If we cannot retain our doctors, the whole notion of merit in education has no value for people like me who are paying a very high tax to subsidize their education in the hope that they will give back something to the community which sponsored them.” He would rather have an average student joining a medical college and staying on to serve India than a bright student who goes abroad “because ultimately in medicine it is experience and commitment which makes a doctor good.”
Dr. Vishwa P. Rath from Canada says that medical education is no longer as attractive as it used to be to the younger generation. “The youngsters feel medical studies are time-consuming, less paid, makes one look thirty years older than one's age, and [offers] limited scope.” A computer science or technical degree, Dr. Rath says, provides a far better lifestyle. The solution is to offer Indian doctors better financial incentives and more attractive working conditions: “If a patient dies, a doctor should not be beaten in the corridor!” The good Dr. Rath adds, “Even if twenty percent of [doctors] emigrate, we still have eighty percent to serve our nation. Personally, I belong to a family of doctors serving in the Indian Air Force, Indian Navy, and other government assignments. Therefore subsidy is essential because for a family like mine this generous help has contributed seven doctors to our nation.”
An NRI blogger named “Seeji” (Dr. C. G. Prasanna) lists the “minimal number of postgraduate seats not catering to the thousands of [medical] graduates, illogical reservation system, a very low pay package compared to other professions” among the reasons doctors emigrate. Seeji asks: “How justified is it to blame doctors alone when even IITians and IIM guys have studied with the same taxpayers’ money?” But he proposes the passage of a law that would bind graduates to work in India for a specified number of years. “That should be applied to doctors as well as engineers,” he suggests. A regular reader, Anju Chandel, agrees that “the Indian government should first ensure a basic level of comfort, safety, and salary for young doctors and then enforce mandatory service in medically underserved areas for a stipulated time.”
The issue of subsidies for medical education elicits the most informed and contentious debate. Blogger T. A. Abinandan in Banga-lore points out that subsidies apply to “everyone — nonmedicos or medicos, irrespective of whether they work in India or elsewhere.” Noting that tuition fees are a pittance, he states that “such low fees do not allow our colleges and universities to upgrade their infrastructure and hire high-quality faculty. On the other hand, making every college student pay — up front — the true cost of higher education may render it inaccessible to the deserving among the poor.”
Mr. Abinadan suggests an “Australian model,” under which every college student (whether in public or private colleges) benefits from a loan from the government that he repays by paying taxes at a higher tax rate. “This additional tax kicks in only when the income exceeds a certain minimum, thereby protecting those individuals who fall on hard times.” The great flaw in this model, however, is that it does nothing to address the problem of doctors emigrating. If repayment is solely through the tax system, how will the government recoup its investment from doctors who, having emigrated, no longer pay Indian taxes?
Dr. J. Mariano Anto Bruno Mascarenhas of Tuticorin sent me a lengthy philippic explaining that the subsidy argument is a myth. Medical colleges have some twenty departments, of which most also treat patients; only three (anatomy, physiology, and pharmacology) are exclusively for students. So “98 percent of the subsidy is for health and less than 1.5 percent is for education…. The truth is that even if a medical college does not admit MBBS students, it will still have 98 percent of its expenses for treating patients.” Dr. Mascarenhas considers the main reason for emigration to be the poor remuneration for doctors. “Please understand one simple fact,” he declares. “No one will want to work in another country for money alone if he can earn enough in India.”
That may well explain why we can only expect the tribe of NRIs to grow and prosper.
52. Ajanta and Ellora in the Monsoon
IT IS TO AN ELUSIVE LION that we owe our rediscovery of the magnificent cave temples of Ajanta. A party of British officers, out hunting in 1819, pursued their quarry into a gorge in the thickly wooded Sahyadri Hills of west-central India. The animal retreated into the dense jungle, but the dazzling sun revealed, through the seemingly impenetrable foliage, the outlines of a horseshoe-shaped cave. The British officers followed, crossing a river to investigate — and soon forgot all about their hunting.
For they had stumbled upon a site lost for centuries — a series of thirty caves cut into the hill by Buddhist monks between 200 B.C. and 650 A.D., to serve as residences, temples, and schools. Each is adorned with statuary chiseled into the rock face by the monks, and in many cases by remarkable paintings, telling stories both religious and secular. “They took our breath away,” one of the officers reported, and they have continued to do so for generations of visitors since.
History does not record what happened to the lion, but the leader of the hunting party etched his name into the wall across a priceless painting: “John Smith, 20 April 1819.” (Fitting, perhaps, that so extravagant a treasure should have been found by one with so prosaic a name, and so barbarous an attitude.) The Ajanta cave-temples joined those at Ellora, forty miles away as the crow flies (and which had not been reclaimed by the jungle), as extraordinary monuments to human artistic accomplishment. Ellora has few surviving paintings, but its carvings, which represent three different faiths (Buddhism, Hinduism, and Jainism) and were created between 350 and 700 A.D., offer even finer examples of the skill, virtuosity, and determination of ancient India's artists and sculptors.
“Ajanta and Ellora, in the monsoon?” asked my then wife, Minu, when I suggested we visit the caves in the summer of 1998, when our twin sons, Ishaan and Kanishk, then fourteen, would be enjoying their school break. We were planning to go to India anyway, but Minu's idea of a monsoon holiday was to put her feet up at her parents’ home in Calcutta and consume vast quantities of mangoes, the season's great fruit. “We'll get soaked. And the flights will be delayed by the weather.”