January 14, 2008

Doctors, made in China

If Russia was the destination of choice in the 1980s and 1990s for Indian students who could not make it into medical colleges in India, China has now emerged as the hot favourite. Last year, for instance, nearly 3,000 Indian students took admission in medical colleges in China.

Still in its relatively early years, the trend has already hit a minor roadblock. After complaints from several students who went in the earlier batches about some of the medical universities not having enough professors to teach them in English and about the curriculum, the Chinese government stepped in this year to specify that only 30 medical colleges identified by it can admit foreign students. The medium of instruction will be English in all these colleges.

Of these 30 colleges, only 24 let in foreign students in 2007-08. The total number of seats in these was just about 2,095 for all foreign students, which would include students from Pakistan, Sri Lanka, Bangladesh, Afghanistan, Saudi Arabia, Ghana and Nigeria, though Indians constitute the bulk.

In 2003, the year after the Delhi High Court ordered that students going abroad would need eligibility certificates issued by the Medical Council of India (MCI), 1,595 certificates were issued. Since then the numbers have been climbing steadily, from 2,500 in 2004 to 4,557 in 2006. MCI admits that the bulk of these students is going to China followed by a dwindling number going to Russia.

Russia is not as popular as it once was since it is far more expensive than China, where an MBBS course costs just Rs 5 lakh to Rs 8 lakh. These apart, Mauritius has just one college and there are six or seven in Nepal that take in Indian students. In 2007, only 3,500 certificates were issued, which could be because of the cut in the number of seats in China.

How good is the medical education these students are getting in China? While MCI expresses concern about the quality of education in some Chinese universities, the fact remains that in the Times Higher Education Supplement's (THES) 2006 listing of top 100 biomedicine universities in the world, three universities from China figure while there is just the IITs from India at 62nd place. Beijing or Peking University is eighth in this list, followed by Tsinghua University at 75th place and Nanjing University at 86th place. Of the top 400 universities listed by THES in 2007, seven are from China and two from India, IIT Bombay and Delhi University. Most of these world-class universities in China figure in the list of 30 universities that China has opened to foreign students.

MCI secretary Lt. Col Dr ARN Setalvad (retd.) felt that while in India a medical college would be allowed to take in 100-120 students depending on how much capacity their facilities could handle, in China, they would take 200-300 students or more. "Obviously, if you take in more students you can offer education at cheaper rates as overheads come down. But what about the quality of the education," wonders Dr Setalvad. In the case of colleges in Nepal and Mauritius there are no problems as the medical education in these countries is in English and is modelled after the Indian system.

"The scale of operation in these colleges is beyond what the officials here can imagine. The infrastructure is massive and so they can take more students. They don't build for just a 100 students like we do here, but for 300-400 students or more," says Sanjeev Kumar of Saraswati Online, an agency for nine medical universities in China that sends about 700 students to China every year. Students from India studying in colleges echo his views. "You would be amazed if you see the infrastructure here. It is as good if not better than most private medical colleges in India. In terms of training it might not be as good as AIIMS. But it is not fair to compare it with AIIMS, which is the best in our country. Then why not compare AIIMS with the best in China like Beijing University or Shanghai Medical University? "asks Gautam Singh, a medical student in China.

Of the total number of foreign students in these medical universities, over 90% are said to be from India, with the rest coming from Pakistan, Bangladesh and Sri Lanka. With the surge in demand from Indian students the Chinese universities have been gradually hiking the fee. "In 2004-05, the fee was in the range of $1,700-2,000. Now in many universities it ranges between $3,000-4,000. It is expected to increase further next year," says Kumar. It could also be over $5,000 per year in the best university, Beijing University, which would still amount to just over Rs 10 lakh. Gautam also points out that since the students paid in dollars, with the falling value of dollar, the amount will not increase all that much.

In India, most students hail from Andhra Pradesh, followed by Kerala and Tamil Nadu. There is a big rush from West Bengal, Assam, Jharkhand and the North East too. There is not much rush from Delhi and Punjab, but Uttar Pradesh is fast catching up. Saraswati Online alone has sent about 400 students from UP over the last four years.

"Parents are being taken in by the rosy picture painted by agents of the various Chinese universities. Did any of them bother to find out if they are any good? Did they take the government's permission before sending their children? If things go wrong they have to bear the brunt of it. We even have students studying medicine in Romania and Tanzania. Who knows what the quality of education there is! Our laws say that as long as they can clear the screening test after completing MBBS they can practise in India," explains Setelvad, adding that parents misconstrue any warning issued by the MCI as the council's attempt to help private medical colleges in India.

The hardest hit by Chinese colleges seem be the Indian private medical colleges, some of whom charge Rs 20 lakh per seat. "The medical colleges in China are a blessing for the middle class in India, who cannot afford such a high fee. Many in the government favour private medical colleges. Hence they are trying to run down the medical colleges in China," says Dr N Laddha of UMCS in Maharashtra, another agency sending students to China.

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