Suddenly, everyone is once again talking about the elephant in the room. David Berger, of Broome Hospital, Australia, who is also a Non-Executive Director of British Medical Journal (BMJ), states the obvious when he concludes that corruption ruins the doctor-patient relationship in India. (BMJ 2014:348:g3169)
The issue of corruption in medical colleges keeps making front page/prime time news and then seems to die a silent death. We also read of kickbacks to doctors and hospitals from diagnostic and pharma companies but these too fade out. But the BMJ articles seem to be the prelude to a campaign against ‘medicine’s dirty open secret’. An editorial authored by Dr Anita Jain, the BMJ’s India Editor, along with Samiran Nundy, Dean, Ganga Ram Institute for Postgraduate Medical Education and Research, New Delhi and Kamran Abbasi, BMJ’s international editor clearly states that the BMJ plans to launch a campaign against corruption in medicine, beginning with a focus on India. (BMJ 2014:348:g4184) They acknowledge that our country is not alone, but believe that if they can defeat corruption here, it will be possible to tackle it in other countries with similar health ecosystems.
Dr Jain refers to the deluge of reactions to the articles, from across the country and overseas as well, saying that they wanted to focus more on the solutions, the next steps required to root out the menace of corruption. The editorial mentions some examples like the “transparency wall” that appeared in villages under the Mahatma Gandhi National Rural Employment Guarantee Act, where communities were empowered to monitor the disbursement of funds under the scheme and prevent malpractice. Another example cited is the Right to Information Act. Following the same logic, can we have a “transparency wall” in hospitals, where employees who do want to do right (and Dr Jain assures me that there are many who have written in) can ‘blow the whistle’ on the black sheep?
Most of the responses commend the authors for taking up the issue but Dr Jain reveals that besides the courageous few who have posted their responses with their identity, there are quite a few anonymous responses from doctors who are unprepared to “take on the system”. Right now, they are silent bystanders, but there is a growing realisation that by not being part of the solution, they become part of the problem.
She hopes that in time, these silent observers will come to see the BMJ’s campaign as a platform to rally around. The BMJ hopes that the momentum of these discussions will spur hospital administrators, senior doctors, etc. to discuss these issues, start trying to change practices in their clinics or institutions by framing guidelines or appropriate systems which detect corruption, increase awareness, and build zero tolerance to corruption so that it is understood that action will be taken against such practices.
The BMJ also hopes to get responses from hospitals and institutions which may have already put in place anti-corruption practices so that these could be highlighted. Maybe there are solutions outside the healthcare space which could be adapted and implemented. In fact, one of the responses, posted by Luca De Fiore, Italy is about the Illuminiamo la Salute (Illuminate health) Project, which was launched against corruption in the health and social sector in Italy, sustained by citizen associations working for integrity and transparency.
Dr Jain indicates that the BMJ is planning to work with individuals, institutions, groups or professional medical societies to use the momentum of generated by these articles to start discussions and see how they may propel this further. Future steps could take the form of an advocacy campaign in partnership with organisations in India. Also on the agenda is more articles along the same theme, to take the discussion forward, focussing on what institutions have done to tackle corruption, either here in India or globally. Its time for the few good men and women in healthcare to stand up and be counted.
Viveka Roychowdhury
Editor
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