On the quack track: Over 50% 'doctors' in country practicing without formal degree

MD Masoor's 'çlinic' is a tiny 2 feet X 2 feet room, painted blue near Noida's Sector 16 Metro Station. There's no board ouside with Masoor's name, or the customary red cross of the medical profession. Inside, a cupboard holds several tiny syrup bottles, and a table a machine to measure blood pressure, a stethoscope, some notepads, a pen and other knick-knacks.

Masoor is treating a patient, and when it's my turn, I ask for a signed a medical certificate that needs an MBBS stamp. He refuses.

Masroor has been treating patients from past three years. He opens his clinic every morning, even in the chilly winters of northern India, and stays there till evening. He charges a meagre fee and also supplies medicines so that patients need not go to the pharmacy. While the entire colony knows him as 'Doctor sahab', he is only a twelfth passed and holds no certificate or degree from any medical college. According to him his maternal uncle, who he claims is a Registered Medical Practitioner (RMP), trained him and also opened this clinic, handed it over to him and went on to practice at another clinic in Noida.

Across the road, in JJ colony of Sector 16, Noida, SK Vishwas sits in another clinic. It is little bigger in size, has a tiny TV blaring a comedy show; a table with green curtains pulled down and a tiny bench for patients. Outside the clinic, there is a board with his name along with an initial of a doctor. Vishwas has been treating patients from past eight years. Even as the board claims that all kind of diseases are treated at his clinic, he admits treating patients with fever, cough, cold, injuries, minor infection and wound. He doesn't hesitate from giving glucose drip or tetanus injection whenever required. Ask him about his credentials as a qualified doctor and he confronts holding a forged Registered Medical Practitioner (RMP) certificate from West Bengal informing that he has gone to school only upto class ten.

(left) A board outside SK Vishwas’ clinic, who has gone to school only up to class ten, in Sector 16 of Noida —Heena Khandelwal/DNA
(Right) Inside SK Vishwas’ clinic, who claims to be a Registered Medical Practitioner (RMP) —Manit/DNA

These two aren't the only doctors who are treating patients without holding any formal degree. According to a recent study by World Health Organisation, only 42.7% of allopathic doctors have a legal medical qualification.

The study titled 'The Health Workforce in India', published in June 2016 by WHO, also revealed that in urban parts of India, only 58.4% of doctors have a medical qualification. The figure is really poor in rural areas with only 18.8% qualified doctors.

RMPs or Quacks?

According to Dr Anil Bansal, Chairman Anti-Quackery cell, Delhi Medical Association, RMP certificate was issued till 1956 to doctors who were practicing medicine for several years. However, in 1956, the Indian Medical Council Act was passed. The act stated that every doctor has to register him/herself with Medical Council of India (MCI) or a state medical council to prescribe allopathic medicines.
A similar response came from Minister of Health and Family Welfare Jagat Prakash Nadda to a question to Lok Sabha in April 2016. He said, "The Indian Medical Council Act, 1956, prohibits a person other than a medical practitioner enrolled on a State Medical Register to practice medicine in the State."

Even as he admitted that no data on quacks is maintained centrally, Dr Anil Bansal stresses that quacks are present in lakhs in India with around 60,000 working in Delhi. His statement is supported by the WHO study, which states that 57.3% allopathic doctors did not have a medical qualification with 31.4% educated only up to secondary school level.

The quack was defined by Supreme Court in 1996 when its ruling stated that anyone practising modern medicine without proper training in the discipline is termed a quack or charlatan.

Problems associated with quacks

11-year-old Bilal, a resident of Adarsh Nagar in Delhi, has an amputated leg. Two years ago, he was returning home from tuition class when a piece of glass entered his feet. Since he started bleeding, he was taken to a nearby doctor (Dr Aftab) who stitched the part and dressed it without removing the piece of glass. The sheer case of negligence by the quack and other government hospitals where he was reportedly taken cost him an important part of his body. His mother Reshma, who was working as a cleaner with city based hostel, has now left the job to take care of his son. Along with her husband, who is an electrician by profession, she has filed a complaint against the doctor.

In another incident, a 62-year-old diabetic patient Jogi Ram, resident of Madangir Area in South Delhi, lost his life after an insulin injection was given to him at his wrist instead of stomach or thigh. Realising that the doctor doesn't have any medical qualification, his son Rajesh Kumar filed a complaint against the fake doctor and fought the case for two years. Recently, he received a letter from Delhi Medical Council stating that they raid the given address but found no one. He alleges that the doctor bribed the police and is now running his clinic in Sangam Vihar.

According to Registrar and Secretary of Delhi Medical Council Dr Girish Tyagi, they have received several hundreds of complaints reporting similar incidents. "We have requested police to register around 415 complaints in the past 4 years from the capital city. Out of these, 145 FIRs have been registered by Delhi Police," he said and added that the registration of complaint is on police's discretion.

There are several quacks working the India's health sector in both urban and rural areas , posing a threat to people and society in large. While only a few have the resources to file the complaint, many assume death as fate, especially in rural areas.

These quacks are also said to be the reason behind spreading HIV and Hepatitis B infections as they do not follow the right procedure while treating infected patients. Many doctors believe that quacks should be banned since they are working at the cost of human lives. However, despite the outrage, quacks continue to work inside the system.

Legality and loopholes

"For Indian systems of medicine, Indian Medicine Central Council Act, 1970, provides that no person other than a practitioner of Indian medicine who possesses a recognized medical qualification and is enrolled on a State Register or the Central Register of Indian Medicine shall practice in Indian medicine in any State," replied Dr Harsh Vardhan as the Minister of Health and Family Welfare to another question sent to Lok Sabha.

He also added that action against the quacks and fake doctors is taken under the relevant acts by the states from time to time.

Indian Medical Council Act 1956, Delhi Medical Council Act 1997, Drugs & Cosmetics Act 1940 and Drugs & Cosmetics Rules 1945 have stated that only a registered doctor can prescribe an allopathic medicine.

While Indian Medical Council Act, 1956, mentions a punishment of imprisonment which may extend to one year or a fine which may extend to Rs 1,000 or both, the Delhi Medical Council Act, 1997 under clause (27) has mentioned 'rigorous punishment' of an imprisonment upto three years or a fine upto Rs 20,000 or both. The Indian Penal Code (IPC) also looks into these cases under section 429 (impersonation), 420 (cheating) and 120 B (criminal conspiracy).

Even though there are legal procedure to arrest and fine the quacks, they continue to flourish in the Indian health care system. According to Dr Bansal, it is because of several loopholes starting from lack of initiatives from Union Health Ministry due to shortage of funds, as tackling them requires not just manforce but also that the government would then be required to provide services. Add to that the poor allocation of health budget: .9% of the GDP, whereas WHO suggests it to be 10% of GDP.

Other reasons cited by the medical fraternity are the lack of coordination between various departments including the police, the drug control department, state government, central government, central and state medical associations and councils and the chief medical officer. And of course, the slow judicial process, which takes 7 to 8 years per case. Above all, the sorry fact is that that quackery is not seen as a serious crime by public and police

Local support to quacks

Ignorance and dependency also works in the favour of quackery. Ritu Singh, Pradhan of Shiv Nagari where MD Masroor has been treating patients, supports him entirely. She was unaware of the fact that he is not a doctor. Upon being told about it, she says, "He must be having some qualification and even if he doesn't, he will get one. He is trained and charges only a small fee. He is working for humanity and even when patients do not have money, he treats them. Also, he treats only minor problems ." Whereas government hospitals imply long queues and monies both in thin supply among the poor.

Consider the numbers. In India, only 0.7% physicians were available per 1000 patients in 2011, according to a World Bank report. Thus leaving a huge space to be filled. According to Dr Bansal, lack of infrastructure is another reason why doctors do not want to go to rural or underdeveloped areas as they don't have clinics, dispensaries, laboratories with equipments, electricity etc and thus a young qualified doctor doesn't want to go there. He or she would prefer working in a city and receiving better professional growth. Another issue is that around 50-60% doctors are females and can't be send to rural areas or backward regions due to lack of safety.

Can quacks be merged into the system?

There are voices from politicians and NGOs to impart training to the self-proclaimed and untrained doctors so that they can help in bridging the healthcare gap in rural areas.

In September 2014, a tweet sent out by official account of Press Information Bureau stated that Dr Harshvardhan spoke in favour of merging quacks with the health system. "One potential solution is to integrate quacks into the medical profession as paramedics by giving them requisite training: @drharshvardhan," read the tweet. In December 2015, Nobel laureate economist Amartya Sen also echoed similar sentiments when he said that if the healthcare infrastructure required in rural areas is non-existent and cannot be improved then people whom we call quacks can be beneficial if trained properly.

Although training has been announced in states like Bihar and West Bengal, the Delhi Medical Council, Delhi Medical Association and several senior doctors interviewed have been against giving any accreditation or training to quacks. "When qualified MBBS doctors can't operate in rural areas due to lack of infrastructure, how can an untrained person can treat people?" asks Dr Anil Bansal.

There are several pros and cons to this solution and until there is a definite one, quackery will flourish.