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Quackdown: India's fake doctors

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India's fake doctors. Quackdown

Feb 21st 2008 | DELHI.From The Economist print edition

The high cost of medicines bought on the cheap

BAREFOOT labourers, skinny housewives and half-naked, snuffling

toddlers wait outside a corrugated-iron and plywood shack in a Delhi

slum to see " the Bengali doctor " . Noor Muhammed, the nattily dressed

30-something inside, is indeed Bengali, but, as he cheerfully admits,

not a doctor. Yet as he makes quick temperature and blood-pressure

checks and hands out tablets—many of them antibiotics—his patients

nod respectfully, and pay.

Last month the discovery that an unqualified " doctor " , Amit Kumar,

had run a lucrative organ racket for nearly a decade caused a furore

in India. Operating from Gurgaon, a booming Delhi satellite, Mr Kumar

is accused of having paid or forced hundreds of poor people to

provide wealthy clients with kidneys. Organ-trading has been illegal

since 1994. But India has done little to curb its " quacks " , as

medical impostors are known.

India has more fake than genuine doctors, according to K.K. Kohli,

who chairs the anti-quackery committee of the Delhi Medical Council.

In Delhi alone there are around 40,000. In the teeming slums where up

to a third of the capital's population of 14m live, requests for

directions to a doctor will lead to one of many dingy clinic-shacks,

where a man who looks more prosperous than his neighbours plies his

trade with a stethoscope, a thermometer and a big pile of pills.

" They take acute patients and make them chronic, " says Dr Kohli,

citing quacks who misdiagnose, prescribe steroids as pick-me-ups, mix

their own remedies and buy cheap, out-of-date antibiotics. Their most

common error is prescribing and selling antibiotics unnecessarily.

Sandeep Guleria, a professor at the All India Institute of Medical

Sciences (AIIMS) in Delhi, says quacks have helped cause the high

levels of drug resistance in India.

Ten years ago Delhi's state government drew up an " Anti-Quackery

Bill " of which nothing more was heard. But the real problem is less

the quacks themselves than the health-care vacuum in which they

flourish. India's private health business is booming, importing

flashy technology to serve a growing middle class and

foreign " medical tourists " . But the public health system remains

skeletal. There are only 60 doctors for every 100,000 people in

India, compared with 257 per 100,000 in America. In slums, sick poor

people go to quacks because government-run clinics are too far away

and the queues too long. In many rural areas, there are no clinics.

Indeed, so essential are quacks to India's health-care system that

the National AIDS Control Organisation says it is planning to include

them in its AIDS-control programme, training them in basic care and

counselling of people with sexually transmitted diseases. Some

quacks, of course, may be perfectly responsible. Mr Noor, for

example, swears that he refers all " serious cases " to government

hospitals. How he diagnoses them is not clear.


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