India’s Vice-President M. Venkaiah Naidu has expressed the view that MBBS graduates should be given their first promotion only after serving in rural areas. In doing so, he has cut the Gordian knot of a very firmly entrenched disinclination among newly qualified doctors to serve in rural areas. What is remarkable about this strong antipathy for rural service is that this aversion is not confined to doctors from urban areas alone, but is something shared by doctors who come from rural backgrounds as well. There are sound reasons to attribute this aversion to rural service not so much to the hardships or deprivations that a doctor posted to a village might have to endure, but rather to the lack of facilities to render the best possible service to the community that the doctor would have to look after as the only doctor in a large area. And this is bound to be a matter of serious concern since doctors often have to deal with life-saving situations. One can well appreciate the apprehensions of a doctor posted in a village on two counts. In the first place, a doctor posted to a rural health centre naturally anticipates the professional hurdles that are bound to crop up every day. He/she is aware that in a country that is unable even to declare itself as a welfare state, the infrastructure that would be available to a rural doctor could well be so inadequate as to make it virtually impossible to function as a trained doctor. There are many rural health centres that are without nurses and even without the very basic medicines that enable a doctor to function. Secondly, in a rural setting, the expectations from a city-trained doctor are bound to be quite unrealistic and irrational. In a rural setting, a city-trained doctor is generally expected never to fail. He is even expected to work miracles in saving lives—even without the minimum infrastructure of para-medical support and requisite medicines. In urban settings, where there are more educated people aware of the limitations of a doctor without the necessary infrastructure and medicines, people are bound to be far more considerate.
In India, the mindset of expecting doctors and other professionals to perform miracles will continue to create problems. In such an ambience it is pointless to expect rational responses from rural folk who have no means of appreciating the constraints within which a doctor in a village is required to function. As such, Vice-President Venkaiah Naidu’s call for mandatory rural posting of doctors marks a determined step in an ambience where no doctor is willing to put in any rural service. After all, should people in our villages always be deprived of the kind of medical service that every citizen of a welfare state has a right to expect? Someone was needed to tell the doctors that they could not possibly go on neglecting the rural population of India. People in our villages need doctors desperately since they cannot always afford to run to the nearest city for medical assistance. And considering the long years of neglect of the rural areas in respect of health services, it is now time for major amends. It is high time we concentrated on our villages where the real India lives. But to ensure proper health care in our villages, it is imperative that our doctors posted to our villages are provided the essential facilities in order to function efficiently. It is also important to appreciate that doctors cannot expect to be provided opportunities to work only in our cities. Our villages have greater need of doctors than our towns and cities do.