Opinion: Indian Med Students From Ukraine Provide A Red-Alert

For Indian students who left their country at a young age - just after finishing school - to study in an alien land, the Russian invasion of Ukraine has dealt a double blow. 

The first one has been that of negotiating a harrowing escape from a war zone, marked by tremendous uncertainties of finding food, shelter and transport. Much of these travails have involved students finding their way to countries in the neighborhood of Ukraine (Romania, Poland, Hungary) to catch Indian government-organized flights back to India under evacuation plans christened "Operation Ganga". The journey to the Ukrainian borders was often facilitated with the help of sympathetic locals and executives of the education consulting companies that organize the admission of students into Ukrainian medical institutions.

While the union government has patted itself on its back for these evacuation efforts, many evacuees have said that the Indian embassy did not do enough and reacted late to the seriousness of the situation. Some reports suggest that embassy personnel took at least partial credit for the assistance provided by others in arranging for food and transport to the borders.

The second blow is the state of precarity regarding options available to them now that they are back in India. Even as they contemplate their future course of action, they are often vilified in subtle and unsubtle ways with questions like: were they not unpatriotic to go abroad to study, and why is it the government's responsibility to "rescue" them. A remark by a minister mentioned that 90% of students who went abroad failed the NEET to which the Opposition reacted by asking what was the point of talking about student weaknesses at the time of evacuation. Trolls have been consistently projecting these students as spoilt, entitled, ungrateful wretches, especially those who have uttered some criticism of government agencies. Accompanying this trolling is the usual share of misinformation and provocative memes.

This whole situation reveals some sad facts. First is the stark truth that we do not have enough educational opportunities for our own students. We are simply unable to nurture the great "demographic dividend" by training, and then retaining, young people who want to be doctors. There are about 600 medical colleges (of which around 300 are government-run) in the country that offer around 90,000 seats (about 45,000 government seats) for a Bachelor's degree in medicine (MBBS), and approximately 16 lakh aspirants compete for these. The cost for the entire degree ranges from 40,000 rupees to 6 lakhs in government colleges and can range from 80 lakhs to 1.5 crores in private colleges. Only some public medical colleges can boast of decent-quality faculty and infrastructure, but even these suffer from faculty shortage and infrastructure-overloading, especially in the connected hospitals. A large number of private colleges are just teaching shops.

In contrast, East European nations like Ukraine, Kyrgyzstan, Poland, Belarus (and others) offer a decent quality of education at 15 to 30% of the cost of most private medical colleges in India. Many of these are funded publicly and have excellent infrastructure. They have credit transfer arrangements with other medical institutions in most European countries, and, in the final sense, provide a gateway for students to migrate to the "West". No wonder that Ukraine had almost 20,000 medical students from India. It is important to note that China is also a favorite destination for medicine degrees for Indian students - they offer world-class infrastructure and training at costs similar to many of the small European countries. 

The immediate challenge is to explore what can be done for these students who are back in India. Perhaps the simplest thing is to wait for the war to end. Some Ukrainian colleges have started online classes for the current semester but it is uncertain how long these will last. There is the uncertainty of when the damaged infrastructure will be restored. Some states - Tamil Nadu, Odisha, Kerala, Karnataka - have pleaded with the Union government to accommodate the returning students in Indian medical colleges. This is potentially quite messy as it will involve deciding which colleges induct these students and at what cost. Plus these measures could face legal challenges from students who did not get admission to Indian institutions through the NEET process and did not go abroad. There is already the pending matter of students who left China midway through their studies and have not been able to resume them because of the travel restrictions imposed by China. Another option may be to explore admission into non-medical but healthcare-related courses in India. The best bet may yet be looking out for transfers to other European nations - many have offered such transfers including the UAE. Ukrainian universities have agreed to help out by providing all relevant documents, and education-consulting companies are already working on possible arrangements. The cost of the transfer may be covered by special loans that the government could facilitate as a relief measure. Credit transfers will work in this case and the study done so far will not go to waste.

In the long term, the worry - as to why students are going to study in these small nations despite language barriers - expressed by PM Modi must be addressed. Even though the question raised by the PM himself was why the private sector cannot step in to expand capacity, it could also be asked why the public sector cannot do the same. After all, the record of the private sector in setting up bad-quality teaching shops is well-known. The number of colleges in India has grown somewhat rapidly since 2004 and the trend is continuing, but its magnitude is not sufficient. The growth of new government colleges has been bottlenecked by low investments (India spent only 0.96% of GDP on public health in 2018; for comparison, China spent 3%) and non-availability of faculty. The problem is further compounded by multiple factors: medical colleges need associated hospitals which is a significant additional cost; the public healthcare network - community centers, primary health care centers, public hospitals - needs to be refurbished and upgraded tremendously, otherwise graduating doctors will have low interest in joining the public healthcare system; the pay of doctors serving public institutions has to be increased significantly in order to recruit and retain them, otherwise they will simply go into private practice including the the high-paying for-profit private healthcare sector or they will simply migrate abroad after graduating. 

The trickiest nut to crack is the faculty shortage. There are few takers for medical research and teaching - most graduates want to just practice with or without a postgraduate degree. Unless regulatory structures are designed that especially incentivize doctors to aspire for faculty jobs, and college-hospital infrastructure is upgraded to facilitate academic training, this situation is unlikely to change.

However, we need to be cautious to not swing to the other extreme where lots of medical graduates are produced, but they are largely of poor quality, and therefore unemployable, while the healthcare sector is not large enough, or ready, to absorb the competent ones. This will essentially become a repeat of the conundrum we have fallen into in the engineering sector.

(Anurag Mehra is a Professor of Chemical Engineering and Associate Faculty at the Center for Policy Studies, at IIT Bombay.)

Disclaimer: These are the personal opinions of the author.