The Unanswered Questions about Reservations in Medical Colleges

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We asked defenders and critics about the pros and cons of caste-based reservation in medical colleges. Several students and experts responded to our call out. Here’s what they said. .

Abhishek Royal, a medical officer at the Antiretroviral Therapy Centre of the National Institute of Tuberculosis and Respiratory Diseases, Delhi, wants to change many things about his profession-including the perception of patients about his credibility based on his caste.

Has it made an impact on a crusade against casteism in the medical profession? Probably not. However, he notes that it is not an easy battle to win."When I joined AIIMS Jodhpur in the Masters in Public Health course, I faced a lot of discrimination and bullying. Some of my seniors used to utter words ' neech to neech hi hote hain' behind my back. The college disposed off the matter, saying that it was just a fight among students. I was harassed indirectly many times in my class, which compromised my mental peace. I finally resigned from the program after 11 months of joining. Many counter allegations were put against me to cover the matter."

A graduate from Jawaharlal Medical College and Hospital AMU, Royal says that during his field visits, patients at times ask his caste before letting me examine them. "Recently, when I raised my voice on these caste issues in medical education and posted this on FB page comprising of 1.25 lac Indian doctors as its members, I got trolled whether I sweep roads. I was tagged in many hate comments," he says.

Why the regulation is not working yet

This month one of the big news stories is about the suicide of 23-year-old postgraduate student after allegedly facing harassment due to her caste at a healthcare institution. It is not the first time that educational institutions have come under fire for discrimination. The Ministry of Human Resource Development under Kapil Sibal asked the UGC to pass a regulation against caste discrimination against Dalit students and other marginalised students in higher educational institutions.

Time for a rethink

Dr Roshan Radhakrishnan, consultant anaesthesiologist in Kochi, Kerala is disappointed that senior members of the IMA blindly dismissed the notion of casteism recently in light of the tragic death of Dr Payal. He says, "For me, that seemed to be a very 'ostrich burying its head in the sand' approach. You could have set up an enquiry or sent the members of the association a questionnaire, at the very least, instead of laughing it away. Casteism is not something that is actively planned and practised in hospitals and departments. It just needs one senior doctor with a narrow mindset to throw caste based comments on his or her juniors consistently and get away with it because others laugh it off or refuse to stand up to the bigotry. I am sure doctors across India have seen this in their workplace, both as students and as staff," he explains.

He also says that there are myriad reasons for regulations not having an impact. For one, students are not likely to take on an institution or a senior doctor when it comes to caste or even religion-based discrimination and are more likely to keep mum and bear the brunt of the taunts silently, hoping to pass and leave. 

"Under such circumstances, it is all the more critical that well-established doctors stand up and speak about their own experiences now so that we can help the new generation of students. We may not be able to stop a doctor from having casteist thoughts, but we can at least prevent him or her from openly harassing someone else because of it," says Radhakrishnan.

Four years ago a study of 73 expelled students from IIT Roorkee revealed that out of the 73 students, 31 were from ST category, 23 from SC category, four from PD, eight from OBC & 7 from general category 90.4% students are from the reserved category.

What does a general category student make of these facts?

“Reservation in post graduation is extremely unfair since post MBBS (which already has an exorbitant reservation system based on all things non-merit) every student is supposed to be equal. The government has already uplifted them in giving them a platform equal to the "privileged" (or ironically the underprivileged general / meritorious quota in India) students. Giving them an allowance in post graduation is blatant casteist politics which is ultimately downgrading the quality of doctors in our country,” says Parthvi Khandar, a Neurology first-year resident in Mumbai.

She says that at the periphery, unchecked and rampant malpractices are ongoing by these SC/ OBC/ ST category doctors, based on their degree, which they misuse. “Not saying that only they misuse their degree, but they do have a huge dearth of knowledge since they got the admission at appalling low merit as compared to those who were in general category. If you notice reservation category students in any medical college, you will see a clear difference. Knowledge is paramount and has no substitute,” Khandar adds.

How much does the government spend on reservation students?

Before we take criticisms seriously, one should also look at the facts. “The 2018/19 budget has allocated only Rs 30 billion towards scholarships for the SCs. The non- payment of scholarship money to SC students resulted in increasing dropouts from colleges and universities. The enrolment rate in higher education was 22 percent for SCs, compared with 29 per cent of Other Backward Classes and 41 per cent of others, states Sukhadeo Thorat is Professor Emeritus, Centre for the Study of Regional Development, School of Social Sciences at Jawaharlal Nehru University, in the book Majoritarian State, How Hindu Nationalism is Changing India.

Reservation versus Privilege

What are some of the leading arguments against reservation? Kamal Mahawar, the author of Ethical Doctor, points out that India needs to look at reservation again. "Though there is still a role for caste-based reservation, it should only be for those families where either the father or the mother has not benefited (education or employment) from reservation before. There should also be some income-based reservation for high caste poor if the total family income is less than a certain sum of money per month. However, above all, we need to make sure that all forms of reservation still leave approximately 50.0 - 60.0.% seats for open quota students. We need to make sure it is the merit that is running the country while we support the groups left behind," he explains.

The Unanswered Questions

Professor US Vishal Rao has another concern-that reservation policies are not designed in a finite time-bound manner. "When a country and its citizens aspire to improve its healthcare programs and systems, it aims at credible knowledge from intellectual doctor to solve their ailments. Today nearly 50% of seats are set for Reservations. It seems counterintuitive to rights of equality in healthcare services. Currently, in a private medical college, 33% of the seats go to government quota, 10% to NRI, 15% to institutional category and the remaining 42% are for private quota. One half of the 42% quota is reserved for general merit individual (GMP).”

However, is it a one generation phenomenon? What about thousands of years of deficit? “Reservations are aimed at addressing the needs of providing justice and opportunity to backward classes. Thus they must be designed at for a finite time-bound and planned manner with focused time-bound goals. Alternatively, this would not pave the way to collapsing healthcare quality parameters. Yardsticks of Reservations today that only map the surnames, and not the DNA of needy (whatsoever his caste, creed or religion) may miss the very reason they are created. It serves as a tool for disservice to healthcare. A policy that focuses on reservations without the focus of improving the quality of healthcare systems may not yield the goal of achieving good quality doctors," he says.

An Eye to the Future

Time is running short for India. In research on India published in The Lancet, youth suicide rates are high on the global scale: 18.6 suicide deaths per 100,000 boys and men age 15 to 29 and 12.7 per 100,000 girls and women.

Shamnad Basheer, professor, Nirma University says that merely having reservations for underprivileged SC/ST communities will not work. "As several studies have shown, disadvantaged students often find it challenging to fit into an institutional environment where the vast majority of students are from privileged backgrounds. In particular, they find it challenging to follow classes in high-level English. As often happens in law schools, where there is a significant premium on mastery over the English language, given that lawyers have to be wordsmiths. So, these reservations need to be complemented by academic and social support programmes,” he says.

At IDIA (Increasing Diversity by Increasing Access to Legal Education), Basheer and his team select and groom students from various underprivileged communities to become leading lawyers and community leaders. There is a three-pronged mentorship programme for the students with mentors from within the law school as well as outside. They provide intensive academic support through their volunteers and even through engaging faculty at these law schools. Probably, this is a model that can be replicated in medical schools too.