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BODHI: Contuining medical education for healthcare workers

By Sandhya Srinivasan

For 20 years, Dr PK Sarkar has been publishing bulletins and magazines to provide doctors and patients unbiased and objective information on drugs and rational therapy. His journals are fiercely independent, even if that means a hand-to-mouth existence

The three-storeyed building is tucked away in a bylane in Lake Town, a satellite township of Kolkata. Construction work on the roof may have disrupted the household's life upstairs, but the office on the ground floor is in perfect order. The shelves are filled with piles of magazines, neatly ordered and labelled according to the date of publication. There is a table, a lamp, a telephone, a computer and a thick accounts ledger. All the basics, but no frills. This is the office of the Bulletin on Drug and Health Information, or BODHI. Since 1994, BODHI has been published every two months to inform general practitioners all over India on rational drug therapy.

"Medical education in India is not geared to the community's needs," explains Pijus K Sarkar, editor of BODHI. "At least not to the needs of the vast majority that is Bharat. But this is not unusual. The ruling class, in a class-divided society, must have its cake. Medical education is meant to staff the private sector, the big hospitals. Doctors do not learn the art of clinical examination and taking a detailed history; they depend on tests instead. We blame them for not going to work in the rural areas, but they are not trained in such a way that they could possibly work there. Their training has deprived them of the means to diagnose illness. BODHI was set up to give a practical education to general practitioners, nurses, pharmacists - all those providing healthcare."

Pijus K Sarkar was born in what is today Bangladesh. "My father was a school teacher in Dhaka," he says. "He came to Kolkata, became a bill collector in a coal depot, then an innkeeper. His brother looked after cultivation in the village, and the two travelled back and forth." The young Pijus Sarkar was placed in a boarding school in Kolkata. After graduation, he got into medical college, passing out in 1965, after which he received a research scholarship to do a PhD in pharmacology. Eventually, he became a teacher in pharmacology.

"I was working hard, giving all of myself for my students, when one day I asked myself, 'Who am I teaching?' Most of these students will become part of the system. As soon as they graduate, they will simply staff a medical system which does not care for the poor."

Since he asked himself that question, Pijus Sarkar has tried to find the answer, over and over again. At one time, it uprooted his family and shifted them to the marshes of the Sunderbans delta, where he and his wife, Krishna, a nurse tutor, ran a hospital and trained health workers. "We had to leave for personal reasons," he says. "But it was an important experience for me." He went back to teaching at the medical college, from where he retired as director of the Calcutta School of Tropical Medicine a few years ago. (During the last 16 months of his service he was also director of drugs control, West Bengal.) Krishna Sarkar went back to working as a nurse tutor and then nursing superintendent. She retired as assistant director of health services, West Bengal.

But Pijus Sarkar found another way to make a difference. For almost 20 years he has published bulletins and magazines to educate doctors and, more recently, to educate patients.

BODHI, set up in 1994, is a product ofthe rational drugs movement that started in the 1980s. This movement led to the setting up of the All India Drug Action Network (AIDAN), a group of organisations concerned with the need for a rational drug policy. AIDAN has been fighting for the availability of essential drugs at affordable prices and for the withdrawal of irrational and dangerous drug combinations.

"The majority of doctors may want to do good," Dr Sarkar explains. "But they cannot because they don't have the right information. And they are not ready to gather information - after all, they don't need to! It is only today that doctors are running scared because of the Consumer Protection Act, but this is mostly for surgical mishaps. Few people will ask why five drugs are given when two will do."

BODHI is directed at all healthcare workers and works to provide "relevant, unbiased and objective information on drugs and rational therapy". To safeguard its independence, it does not accept advertisements or donations from the drugs and medical equipment industry, but is run entirely on readers' subscriptions which cover only production costs while almost all the work is voluntary. BODHI is a member of the International Society of Drug Bulletins (ISDB), an international body of independent bulletins on drugs and health and Dr Sarkar is an elected executive committee member of the ISDB.

A recent issue carries an editorial on practical problems in general practice; therapeutic guidelines for gastrointestinal problems with information on the relevant drugs and when they should - and should not - be used; laboratory investigations to diagnose diabetes and follow-up the patient; a review of drug treatment for diabetes; case studies with questions and answers spelling out the possible diagnosis for patients with various symptoms and the rational steps towards diagnosis and treatment. The material is gathered by Dr Sarkar from various academic journals and books and adapted for the use of medical practitioners in India.

BODHI lives a hand-to-mouth existence, with a small but committed subscriber base -- about 40% are life subscribers. It has survived on this small membership and the occasional bulk subscription. Some years ago, UNICEF-Orissa ordered subscriptions for medical officers in Orissa. Subscription rates are kept as low as possible, just enough to cover the basic costs of printing, postage and employing part-time staff for data entry, page-making and accounts. The office space is in Dr Sarkar's residence. The bulletin goes out to general practitioners all over India, with most subscribers concentrated in West Bengal, Maharashtra and Gujarat.

"Much of the information on drugs in India is influenced by the drug industry," says health activist Anant Phadke who views Dr Sarkar's work as exemplary. "BODHI is one of the few publications devoted to doctors' continuing medical education which does notreceive any drug company advertisements. (Others include Drug, Disease Doctor and the Journal of Rural Paediatrics.) As BODHI is run entirely on subscriptions and small donations, it has no obligation to the drug industry and has been able to publish critical scientific information on medicines, their side-effects and their uses."

"But BODHI is not as well-known as it should be; it has not entered the mainstream medical profession," notes Dr Phadke. "It should be introduced to medical doctors across the country. We should have an anthology of article collections for easy reference. And we need a second generation of doctors to contribute and take over the substantial editorial work that Dr Sarkar has been doing for more than a decade."

Indeed, it is an uphill battle. "I haven't taken a holiday in 20 years. We could stop publishing, it's so much labour." Sometimes Dr Sarkar feels tired of it all. And then he thinks up a new idea and takes off with it, and this gives him enough mental energy to keep his other ventures going strong.

The problem, he argues, is that doctors don't want to know their subject because they don't need to. "Our experience is that doctors are not ready to have information because their clients are ignorant. Doctors will not gather information unless it enhances their incomes - or they are forced to learn. Now, if we get patients to ask questions, that will put pressure on doctors. We have to create that compulsion."

That idea gave birth to Ashukh Bishukh, in 2000. Ashukh Bishukh is in Bengali and reaches twice as many people as BODHI does. And it is addressed not at health providers but their patients. "It contains information about disease and public health, about what tests are needed and what are not, which drugs are needed and which are not. The idea is to create a consumer demand for rational treatment."

Both BODHI and Ahsukh-Bishukh are published by the Foundation for Health Action, a not-for-profit, non-funded trust. Neither publication accepts advertisements.

There are other efforts in the pipeline. One is a plan to provide basic training to unqualified doctors in the state of West Bengal. "Unqualified practitioners are providing a service to the poor, the rural poor depend on them completely. But these providers are not equipped with the right information. We must give them some training to make their services more effective, less hazardous."

Support or subscribe to BODHI by writing to P K Sarkar, Foundation for Health Action, 254 Lake Town, Block B, Calcutta 700 089. Tel: (91 33) 2534 4878. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

InfoChange News & Features, April 2006