Dr. Satendra Singh

MBBS Curriculum Updated After 22 Years, but Barely Mentions Disability

The Medical Council of India and the Union health ministry have both been asked to re-examine the curriculum and include a component on disability rights.

New Delhi: After 22 years, medical students in India have an updated curriculum that is due to roll out in August 2019.

India produces around 90,000 doctors every year, with 63,250 undergraduate medical seats, and 34,950 post graduate medical seats.

But the new curriculum skates over the issue of disability and disability rights.

This comes in spite of the 2016 legislation on the Rights of Persons with Disability Act, which says that curriculum in universities, colleges and schools should include information on the rights of people with disabilities.

MCI told to redraft the curriculum

According to two documents with The Wire, the Medical Council of India (MCI) and the Union health ministry have both been asked to re-examine the curriculum and include a component on disability rights.

In March, the Delhi commissioner for persons with disability has written to the health ministry about the issue.

In the letter, the commissioner says that there needs to be a “shift from the medical approach to the rights based approach to disability.” He points out other deficiencies – the new curriculum does not make MBBS students aware of key provisions of this 2016 law for disabled people’s rights, neither does it give students the “human rights perspective” to disability.

A second letter on the same issue was sent to the MCI from the national chief commissioner for persons with disabilities. Here too, the commissioner asked the MCI to look into the points raised by Satendra Singh, a doctor with locomotor disability, and take all stakeholders into consultation on it.

Also Read: Ministry to Safeguard Rights of Disabled Defends Order Discriminating Against Them

The multi-volume new curriculum has been written by doctors at leading institutions such as KEM Hospital (Mumbai), Government Medical College (Kottayam), Christian Medical College (Ludhiana) and AIIMS (Delhi).

How is the new curriculum silent on disability?

These letters about changing the curriculum have come about due to the work of Dr Satendra Singh, a doctor with locomotor disability at GTB Hospital, Delhi. He wrote to the state and national commissioners for disability, alerting them to the issue.

“We often complain that doctors don’t understand patients with disabilities. I have seen people with disabilities often go to a doctor with an ailment but doctors focus only on their disability instead,” said Dr Singh.

This is not a holistic approach, he says. “Disability is so vast and people with disabilities have very different needs. Treatment options are already there, but we now need a human rights approach.”

In his letter, he alerted authorities that “disability competencies are not adequately represented” in this new curriculum.

Also Read: Health Ministry Delay on NEET Criteria Leaves Disabled Students in a Lurch

In fact, in the 94 page booklet on ethics, disability is mentioned only once.

The word ‘dignity’ is not used at all, in this new curriculum, even though that is one of the core tenets of the Rights of People with Disability Act.

The curriculum itself still refers to the repealed legislation for mental health from 1987, whereas India has a new Act as of 2017. It also uses outdated language such as ‘differently abled.’

What does Indian law say on education about disability?

The Rights of People with Disabilities Act, 2016 has two sections relevant to this issue.

Section 39 says that the government should ensure that “the rights of persons with disabilities are included in the curriculum in Universities, colleges and schools” and that there should be “orientation and sensitisation at the school, college, University and professional training level on the human condition of disability and the rights of persons with disabilities.”

Section 47 says that there should be a component about disability for doctors and nurses, and in fact for all schools, colleges and University teachers as well as for para-medical personnel, social welfare officers, rural development officers, asha workers, anganwadi workers, engineers, architects, other professionals and community workers.

Health Ministry Delay on NEET Criteria Leaves Disabled Students in a Lurch

With the Medical Council of India and the Union health ministry yet to finish updating the guidelines for the upcoming exam, candidates with disabilities have no clarity about how to proceed.

New Delhi: With time running out for applicants for medical college entrance exams this year, the health ministry says it is still deliberating on key guidelines which can affect the chances of candidates with disabilities.

In 2018, the Centre had issued a brochure on the NEET exam for medical college entrances. It explained that candidates with disabilities were eligible to apply, in keeping with the spirit of the Rights of Persons with Disabilities Act, 2016.

A number of candidates with disabilities applied to give the exam only to be told in mid-2018 that the terms for eligibility were different – the Medical Council of India had by then come out with draft guidelines which created a number of problems for India’s disabled community.

Also read: NEET Silence on Revised Admission Norms Leaves Students With Disabilities in the Dark

Even more inconveniently, disabled candidates who successfully clear the exam can still be rejected. The government wants their “functional competence” to be assessed only after they study, pay for, write and pass the exam.

Candidates only have until the January 31 to get their corrected applications in.

No clarity

But the Medical Council of India and the Union health ministry have yet to finish updating the guidelines.

Two MCI officials said they have finished updating the guidelines by taking feedback from various stakeholders who had objected to provisions in it. “MCI had a recent meeting on this. We have forwarded it on from our side to the health ministry,” said one senior official at MCI.

Another said that according to the Indian Medical Council Act, 1956, “MCI is not supposed to finalise anything, we can only make recommendations to the Union government. It is not our responsibility.”

But two health ministry officials working on medical education said the MCI should speak up about whether the guidelines have been finalised or not. One official said that the Directorate General of Health Services (DGHS) is also reviewing the guidelines. More so, yet another committee was constituted to examine them.

These developments have led to panic for candidates with disabilities.

“The aspiring students do not know if they are at all eligible to sit for these exams in the general category or the disabled category,” says Dr Satendra Singh from the collective Doctors with Disabilities. “Thinking they are eligible, many of them had applied. The MCI’s guidelines are against the 2016 Act. Now the government is not clarifying their status.”

Also read: Data of Hundreds of Thousands of NEET Candidates Leaked Online, Put up for Sale

While the MCI has to draft the guidelines, factoring in much of the feedback from the public, it is the responsibility of the health ministry to finalise them. But with the government still taking its time over the guidelines, disabled candidates have been left in a lurch.

How do the draft guidelines discriminate against people with disabilities?

In 2016, the parliament passed the ‘Rights of the Persons with Disabilities Bill, 2016.’ There were only seven recognised disabilities until then, but the new law expanded the number to 21. The new list included locomoter disabilities, dwarfism, mental illness, intellectual disabilities, autism spectrum disorder, cerebral palsy, muscular dystrophy, multiple sclerosis and thalassemia. It also included acid attack victims and people cured of leprosy.

Although the NEET brochure for 2019 repeatedly says that people with disabilities specified in the 2016 Act are eligible to apply for the exam, the MCI’s guidelines have prescribed exclusions that activists see as arbitrary and unfair.

First, the guidelines exclude a number of people from being allowed to write the exam. For example, the draft guidelines say that people with a visual impairment, hearing impairment, dyslexia of more than 40% disability, will not be eligible to give medical entrance exams. It says people with blood disorders which give them a disability of more than 80% will not be eligible.

More so, those who do give the exam will be filtered once again upon clearing it.

NEET Silence on Revised Admission Norms Leaves Students With Disabilities in the Dark

Affected students and parents demand that the admission process be halted till the changes are reflected and a panel of doctors from each disability category formed to evaluate individual cases.

The past two years have seen students with disabilities knocking on the doors of various courts to gain admissions in medical colleges after clearing their medical entrance examinations under the National Eligibility cum Entrance Test (NEET). During the same period, courts have rejected various discriminatory guidelines by the Medical Council of India and AIIMS, Delhi experts against persons with disabilities vis-a-vis medical entrance examinations.

The NEET (Undergraduate) 2019 information booklet that released earlier this month, however, reflects neither the updated information nor the amended laws. This has led to a confusion among students with disabilities about whether they are eligible for and should apply for these examinations at all.

A paediatrician whose child has learning disability, said on the condition of anonymity that the Supreme Court had last year allowed admission in medical courses for such students as they fall in the category of 21 disabilities covered by the Right to Persons with Disabilities Act 2016.

“These children have learning disability and cannot read like other children do. However, there are different techniques by which they learn. By the time they reach the age of 17 or 18, their learning abilities become crystallised. So they are able to appear for competitive examinations as well,” she explained.

She added that while the government has set a 40% parameter to be considered disabled, the issue with learning disability is that it cannot be quantified. Yet, she said, the Supreme Court upheld the rights of such students for admission but NEET has failed to clarify whether they qualify to appear for the tests.

Determining eligibility of each student with disability necessary

A professor at a government medical college in Tamil Nadu who is seeking admission for his visually impaired child said he had written to authorities on the status of various categories of disability but failed to evoke any response.

Speaking on condition of anonymity, the professor added that as per existing guidelines, there is no scope for admission in such cases. “However, the Supreme Court had last year provided admission to such students. So I am thinking of applying for the examination for my child and later fighting it out in court if the need arises,” he added.

He said another area of concern, is whether the decision on who qualifies under the disability category is taken by just one person in the Medical Counselling Committee. “Ideally, there should be a panel for each category. Even the Supreme Court had constituted a panel when it gave admission to a low-vision student last year.”

Activists approach Ministry, other authorities for clarification

With the last date of submitting the admission forms being November 30, disability rights activists have approached the Ministry of Health and Family Welfare as also various authorities for clarity on the issue.

Talking to The Wire, Dr. Satendra Singh, founder of Doctors with Disabilities: Agents of Change, said students suffering from various kind of disabilities and their parents have been impacted by the opaqueness around the admission process. “It is discriminatory for the National Testing Agency to start the online application process for NEET 2019 as there is no clarity yet on guidelines for candidates with disabilities. This will give undue advantage to non-disabled candidates.”

Singh also charged that the brochure still contains the old details of disability assessment boards that exist in the metro cities. He said these were increased to nine after court intervention.

The disability rights activist said a need to broaden the assessment boards was felt as the All India Institute of Physical Medicine and Rehabilitation had denied examining candidates with specific learning disabilities. However, he said, the details of the new boards are missing from the brochure. According to Singh, the brochure is also silent on the eligibility of 20 disabilities mentioned in the Rights of Persons with Disabilities Act 2016. He said it only has a proforma on page 97 for Disability Certification.

The Doctors with Disabilities has, in a letter marked to the National Testing Agency, the Medical Council of India, the Ministry of Health, the Medical Counselling Committee and the Department of Empowerment of Persons with Disabilities, pointed out that that there was incomplete information about the admission criteria on Ministry of Health, MCI and Medical Counselling Committee websites.

Parents confused

“I have been receiving calls from worried parents who want to know if their wards even qualify to appear for the medical entrance examination under NEET. There are doctor parents whose children are suffering from minor visual disability. They do not qualify as per the old guidelines but made the grade under the revised ones and as per the recent court orders. So there should be clarity on this from the authorities,” said Singh.

In the case of the candidates under PwD category, he said, the MCI guidelines mention that “Five percent seats of the annual sanctioned intake shall be filled by candidates falling under Persons with Bench Mark disabilities as per MCI Guidelines/Regulations in accordance with the Rights of Persons with Disabilities Act, 2016.”

“If the seats reserved for the persons with disabilities in a particular category remain unfilled on account of unavailability of candidates,” the guidelines say, “the seats would be included in the annual sanctioned seats for the respective category.”

Singh said while candidates are required to consult the website of MCC (www.mcc.nic.in) and MoHFW (www.mohfw.nic.in) for latest information in this regard, these sites still show the old MCI guidelines.

“These guidelines by the Medical Council of India on admission of persons with specified disabilities were controversial,” said Singh, pointing out that Indian Journal of Medical Ethics had published articles on how they were “unfair, discriminatory and unlawful”.

Writ petitions were filed against these guidelines in the Supreme Court to amend these. As many as 75 doctors with disabilities had also petitioned the Central government to quash these MCI guidelines.

Thereafter, Singh said, the Ministry had on the directions of the Supreme Court set up a high-level committee and amended controversial MCI guidelines. “They also took into consideration the representation of 75 doctors with disabilities. The amendments were produced before the apex court based on which many candidates with disabilities got admission into MBBS.”

Singh also recalled how these amended guidelines too were set aside in case of Ashutosh Puruswani, a low-vision candidate, who was granted MBBS admission despite objections by the MCI and the AIIMS medical board. However, he said, “these modified MCI guidelines are yet to be ratified and approved by the Ministry and the MCI Board of Governors (BoG).”

Stating that the Board meeting is still due, Singh said under the existing circumstances it is discriminatory on the part of the National Testing Agency to start the online application process for NEET 2019. He demanded that the process be halted till all the information is uploaded.