No Medical College, Insufficient Recruitment, and Unfavourable Service Conditions: Why Mizoram is Suffering from a Shortage of Doctors

13 July 2017
The blockade of National Highway 54 at Kolasib was the most recent of frequent protests in the state against the lack of doctors.
HT Photo

In 2005, Samuel Lalhruaizela, an 18-year-old resident of Aizawl, in Mizoram, secured admission to the Mahatma Gandhi Institute of Medical Sciences at Sevagram village in the Wardha district of Maharashtra. At the time, he told me, he had neither heard of the medical college where he had been admitted, nor the area in which it was situated. Lalhruaizela recalled what the dean told his father and him when they visited the university: “You’ve come a very long way.” Indeed, they had. The state of Mizoram does not have a medical college—all aspiring medical practitioners from the state are compelled to travel outside their home state to study.

Lalhruaizela told me that although he knew how to read the Hindi script, the only words he knew at the time were hathi (elephant) and mej (table). He added that he was still unsure whether it was he or his classmates who had a bigger culture-shock after their interactions: he was frequently asked whether Mizoram had televisions in the state and whether the state actually did not have “even one medical college.” Lalhruaizela said he understood why it was unusual for them, considering the fact that Wardha, despite being one of the smaller districts in Maharashtra, had two medical colleges. “It didn’t matter how much I tried to make them understand we aren’t too backward. A state that doesn’t have even one medical college, after all, just can’t be perceived to be a developed state,” he said.

Mizoram suffers from a severe shortage of doctors in the state, especially in rural areas. The state’s health minister, Lal Thanzara, has attributed the absence of a medical college as one of the reasons for the same. In early June 2017, this issue of a shortage of doctors in the state flared-up in the Kolasib district. The state government’s health department issued an order transferring a surgeon from Kolasib to another town, Serchhip. Dr Zothansanga Zadeng, the surgeon from Kolasib whom the government proposed transferring, is the only surgeon at the district’s government hospital. The surgeon at Serchhip had recently been shifted to Lunglei town because the surgeon there had died. At a press conference on 9 June, Thanzara told the media that the state government’s rationale was that since another surgeon was currently employed at Kolasib under the National Health Mission—the central government’s flagship health-sector initiative—the town would accept Zadeng’s transfer. But that was not how it turned out.

On 6 June, a joint action committee comprising the Kolasib district units of Mizo Zirlai Pawl (MZP) and Mizo Hmeichhe Insuihkhawm Pawl (MHIP)—the state’s apex students’ union and womens’ body respectively—and several civil society organisations launched an indefinite blockade on the National Highway 54, the state’s main lifeline for essential commodities. According to a press release issued by the JAC, the town did not have a surgeon on a regular basis since 2008, when a surgery specialist was transferred out. It stated that although a replacement was found in July 2013, he too had left to pursue higher studies just a month later, and the town only had a new surgeon, Zadeng, since March 2015. Gaby Ngente, a close relative of Zadeng, told me that the residents of the district also virtually put the doctor under house arrest—the JAC’s volunteers kept a watch over him for weeks to prevent him from leaving, although his movements within the town were not restricted.

Four days later, the blockade was lifted after the state government withdrew the transfer order. A compromise had been struck: at the press conference, Thanzara said that the townspeople of Serchhip, the chief minister’s constituency, were willing to have the NHM surgeon at Kolasib instead of Zadeng. However, the blockade had exacted a major toll: fish was almost impossible to find while vendors were beginning to run out of eggs in the markets of the state’s capital Aizawl. Most filling stations had shut and put up signs declaring that the stations had “No Diesel” and “No Petrol,” and the prices of cabbages and tomatoes had doubled. (All these items are trucked in from neighboring Assam through NH 54 since Mizoram produces little of most food items and does not produce fuel.)

But as was apparent from the reasons for the blockade, such essential items of daily use were not the only scarce things in the state. Mizoram is facing a medical crisis—its government cannot set up a medical college because the Medical Council of India denied permission for the same for not complying with central government regulations; the state has failed to recruit doctors at its government hospitals; and the doctors present in the state are reluctant to be appointed as government doctors due to poor infrastructure and service conditions. The blockade of NH 54 was just the most recent of frequent protests in the state against the lack of doctors.

In April, student groups and non-governmental organisations in the state’s eastern town of Champhai launched protests demanding more doctors in the district hospital. The demonstration turned violent when protestors set five vehicles parked near the deputy commissioner’s office on fire and pelted stones at the office building. The protests died down after the government assured the protestors that their main demand—seeking the posting of a pediatrician at the hospital—would be met by rotating doctors posted at different parts of the state to the hospital on a weekly basis until a doctor could be hired and posted there permanently. According to Lalbiakzauva, the president of the Champhai sub-headquarters of the Young Mizo Association—a voluntary organisation in Mizoram that has members in almost every household in the state—a pediatrician was only posted to the town in the first week of July.

In October 2016, a town named Tlabung in Lunglei district witnessed protests similar to those in Kolasib. The state government had issued an order directing the transfer of a doctor currently posted in Hnahthial, a town in the same district, to Tlabung. The residents of Hnahthial, however, were holding the doctor under effective house arrest—as  the residents of Kolasib had held Zadeng. Dr Lalrengpuii Ralte was the only doctor, apart from a doctor on contract with the NHM, in Hnahthial’s community health centre (CHC)—government-run sub-divisional hospitals below the district level. But the residents of Tlabung, where malaria is a year-round problem, were simultaneously demanding that Lalrengpuii join its hospital. The tussle only ended after Lalrengpuii’s family requested Hnahthial’s residents to allow her to leave, because her inability to do as ordered by her superiors could end up adversely affecting her career.

That month, the shortage of doctors also became a flashpoint in Ngopa, a large village along the highway connecting Mizoram and southern Manipur. Local groups headed by the village council—the state’s equivalent of a panchayat—along with other village residents, were protesting because at least six villagers had died because there was only one doctor at the CHC there. The first couple of deaths—of a pregnant woman and her unborn child—occurred because the doctor was away on training and the rest because he was transferred on 30 September without a replacement. In mid December, after the protestors threatened a blockade of an inter-state highway connecting Manipur and Mizoram, the state government posted a doctor in the village.

The recruitment of doctors into the state’s government hospitals is conducted by the Mizoram Public Service Commission (MPSC), a constitutional body that conducts the recruitment process for the state’s civil services and recommends eligible doctors to the state government.  According to the annual reports of the commission that I accessed at its office in Aizawl, there have been only seven recruitment drives for doctors in the past two decades. In the first six drives, between 2003 and 2015, a total of 161 doctors were recruited, while the seventh recruitment process is currently ongoing.

Lalzirmawia Chhangte, the MPSC secretary, told me that the commission is looking to recruit 26 more doctors for the state-funded system in the ongoing recruitment process. He added that there were 152 applicants for the 26 jobs advertised by the commission, and 28 of them did not appear for the interviews. This seems to suggest that although there are doctors present in the state, they are reluctant to be empanelled with the state government’s hospitals. According to a senior government doctor, who was an expert member in a panel conducting the ongoing recruitment and who requested not to be identified, the candidates “know there is a severe shortage of facilities and equipment in many places, especially rural hospitals.”

However, the availability of proper medical care at government hospitals is necessary for ensuring affordable health care and also because access to private hospitals, which are mostly located in the bigger towns such as Aizawl and Lunglei, is difficult to reach for residents of remote areas of the state. “There is also a dismal record of proper service rules among doctors employed with the government. It’s no secret,” the expert member continued. “I have a feeling many of the doctors realised this and changed their minds at the last minute.”

I spoke to a doctor at a government hospital in Aizawl who was transferred to Champhai a few years ago, and requested not to be identified, about the reluctance among doctors to work in rural areas. “The problem with our service rules is that there is no clarity about when and where we get posted, and how long we stay there,” he told me. The doctor continued, “What this leads to is that everyone becomes reluctant to be transferred to rural areas, not just because life is harder there, but because there is no place that offer better returns for our services than the state capital.”

In addition to the unsuccessful recruitment drives, the absence of any medical college in the state compounds its medical crisis. In 2004, the government announced that it was setting up a medical college named the Mizoram Institute of Medical Education and Research in Aizawl (MIMER). In India, a state government or university desirous of establishing a medical college must make an application to the union health ministry in accordance with the terms of the Establishment of Medical College Regulations, 1999. As per the regulations, the health ministry sends the application to the Medical Council of India, which assesses the application and conveys its recommendation regarding the application to the health ministry. The ministry, in turn, takes the final decision regarding the establishment of the medical college.

In April 2014, the union health ministry entered into a memorandum of understanding with the Mizoram government to set up the first medical college in the state. According to a report published in The Telegraph in January 2015, the MIMER received a grant of Rs 100 crore from the central government and was slated to begin its academic session in August that year, from a temporary campus at the State Referral Hospital in Falkawn village near Aizawl. According to the state health department’s website, the union health ministry could not allow classes to begin because the two hospitals at which the college was proposed to be established—Aizawl Civil Hospital and the State Referral Hospital—are more than 10 kilometres apart, which is in violation of the 1999 regulations. The website notes that the state government proposed expanding the State Referral Hospital at Falkawn and applied for another MCI inspection. The MCI is yet to respond to the government’s latest application.

According to a senior doctor who is part of a high-level government committee attempting to establish the MIMER, the college would go a long way in addressing the shortage of doctors in the state. He requested not to be identified, citing the reason that the MIMER had become a political hot potato between the state’s political parties. “If and when the MIMER does start operations, we aim to have a hundred seats there, of which we will likely have at least 30-40 seats for Mizo students,” he said.

However, the doctor added that a medical college was “not a magic wand” that will solve the state’s shortage of doctors. “There simply needs to be more effort by the government in recruiting doctors to the public health system,” he said. “Doctor recruitments are carried out only once every few years. It should be done much more frequently.”

In India, the National Entrance-cum-Eligibility Test determines the admission into all medical and dental colleges across the country, for both government and private institutions. The admission into the colleges is based on a system of quotas, according to which, small states such as Mizoram, where there is no medical college, are allotted a certain number of seats in medical colleges in other states. Without these quotas, it would be difficult for aspiring doctors from Mizoram to gain admission into medical colleges because of the limited seats available and the high fees at private colleges.

Zodingliana, a joint director of the technical wing at the state government’s higher and technical education department, told me that the state presently has a total of 38 quota seats for admission into medical colleges and 11 quota seats for admission into dental colleges. “We’ve asked for extra quotas regularly, but we never get them,” Zodingliana said. “It’s difficult, of course, to get extra seats for our students in colleges located in other states, but we keep trying, and we keep getting rejections.” “Unless the planned medical college starts functioning, it seems this is all we can do,” he added.

Zodingliana told me that his job is to ensure that students from Mizoram who are eligible to gain admission in various medical, engineering and other professional colleges outside the state are well-prepared and to aid them in completing all the necessary formalities. He added that the admission process under the NEET changed for the examination in 2017 by opening online applications for it.

As a result of the new system, Zodingliana continued, 846 students converged at the department’s office this year for assistance in enrolling for the nationwide examinations. The staff helped them fill up the e-forms and assisted in the payment process. He added that the actual number of applicants from the state could be even higher. He said: “The number of students who came to us for assistance does give you an idea about how many students want to get into the medical profession, and how we are unable to meet that demand.”

Keywords: healthcare Mizoram doctors medical infrastructure medical college