Why Modi must show concern for Indian medical students in Kazakhstan
The Indian embassy had thoughtfully provided an Indian chauffeur with the car assigned to us during our visit to Almaty, Kazakhstan in 2004. To our utter surprise, we learnt that the chauffeur was, in fact, a medical student pursuing MBBS in Almaty. Shouldn’t you be attending classes, we asked him. He informed us that the taxi was his own and that he was regularly contracted by the embassy to drive Indian guests. He would attend classes whenever he could. Over the next few days we would learn that he was living with, and off, a local lady who was working in the customs. Do you propose to marry her? He shrugged. There have been many before her, there will be many after.
He said he liked the easy routine of the medical institute and not having to strain oneself .The teachers didn’t know much English, and if you spoke English well, you would automatically pass. Academic rigour and hands-on training were not the hallmarks of the programme. The programme focused more on theory, rather than practice, even when it came to basics such as anatomy. He would see postmortem autopsies carried out by local doctors, but the students wouldn’t get to touch the cadaver. The teachers translate for us, he added.
Rather than study the programme diligently, he was focusing on preparing for the screening test to be administered by the Medical Council of India (MCI) for foreign educated doctors when he eventually returned to India. Whenever he had the time and the inclination, that is!
What would happen if you flunked the MCI test, which seemed to be most likely given the fact that the number of foreign returned students clearing the test was abysmal? I can always come back and practice medicine in Kazakhstan, or do something else. I will get married to a local and settle down. The state runs a generous welfare system, he smugly announced.
There were several hundred Indian students like our chauffeur, pursuing medical courses in Kazakhstan and other CIS countries. The easy admission, low fee structure and less academic pressure were some of the reasons students from India chose colleges in CIS countries. Admission did not require top grades or impressive exam results, only a few thousand dollars a year — less than many Indian private medical colleges.
The lure remained undiminished in spite of formidable challenges. In Kazakhstan, depending upon the city, the temperature can range from -55 degrees in winter to greater than +30 degrees in summer. The traditional diet relies heavily upon meat and bread or grain with little reliance on vegetables. Vegetables are, of course, available but they are not of the quality and variety available in India. English is not widely spoken, so mixing with native Kazakh and east European descendants is difficult. Hence, Indian students tend to stay together with no or little contact with the locals (unless, like our chauffeur, one is co-habiting with a local woman and there are many such instances).
Many learn about the programme through advertisements in Indian newspapers. Prospective students apply through “agents” – some of whom were once medical students in the former Soviet Union. These agents take care of logistics, place the students, secure visas, charter flights, organise lodging and even arrange for Indian meals.
Concerns about academic quality don’t faze Indian students because India’s upwardly mobile population sees medicine as a prestigious profession. With a severe shortage of seats in Indian medical schools coupled with the rise in disposal income, many parents can now afford to send their children to medical schools in CIS countries. The number has seen an upswing over the years.
But the quality of the training raises major concerns. After the Soviet Union fell apart, the CIS countries’ education and healthcare standards plummeted. There was a human resource catastrophe in healthcare, with many older professionals regarding most of those trained in the subsequent years as unqualified. Even the local students go out of the countries to study, aware of the fallen standards.
Even with respect to the medical care, the rich prefer to go to other countries. The poor have to put up with a less than optimal health service.
We learnt of one incident which is emblematic of the state of affairs of the medical standards of our students there. A student was visiting the Indian embassy in Almaty for some documentation when a medical crisis took place with an embassy staffer. He had to be given an injection immediately and the student was requested to do the needful. He went red in his face and most embarrassedly expressed his helplessness. He could not administer an injection! And he was in his fifth and final year of MBBS. He was later to pursue an MD! The injection was eventually given by a Kazakh maintenance employee of the Embassy.
Having lived on a diet of vodka (absolutely outstanding), shashlik and plov for two days, we requested our chauffeur, and by now our friend and guide, for Indian food. He took us to Govinda, a delightful vegetarian restaurant run by ISKCON which has a presence in Kazakhstan. The servers were all locals wearing name tags bearing their original name hyphenated with the acquired Hindu name. We asked for a fixed thali. There would be five items, our serving lady informed us – dal, subzi, raita and roti. What about the fifth? That would be chutney, she smiled.
Kazakhstan promotes pluralism and secularism and freedom of religion is enshrined in the Constitution. As with other religions, Kazakhstan recognises ISKCON. The adherents are mostly Kazakh nationals. We learnt during our visit that relations between ISKCON and the Kazakh government had been rather rocky, but they have improved since then. All nine ISKCON centers in Kazakhstan have successfully re-registered under a new religious law passed by the Parliament in 2011.
Modi has just finished a visit to Kazakhstan as part of his larger tour of five CIS countries and Russia. His interaction with the Indian community would have certainly included medical students. It would be in the fitness of things if he and the government take a long and hard look at every aspect of this rather sordid medical situation. At stake are the country’s honour and the future of its public health.