I have a relative who was born and brought up in Rajasthan's capital, Jaipur. He often proudly says that he paid a monthly fee of Rs 18 for his MBBS course. When he did his Master of Surgery (MS), he received a substantial monthly sum with which he could even support his family. Today, he is a leading surgeon in Kuwait.

This week, the National Eligibility cum Entrance Test (NEET) results came out. I was happy that a girl I knew could score good marks. Given the NEET rank Sapna has, she would be able to get admission to a government medical college in the National Capital Region (NCR). In other words, she would be able to fulfil her dream of becoming a medical doctor.

Sapna is the eldest of four sisters, and she grew up in a children's home, which took care of her education, boarding, and lodging until she reached the age of 18. It is one more testament to the need for such homes, which the then Chairperson of the National Commission for Protection of Child Rights (NCPCR), Priyank Kanoongo, sought to close down.

Incidentally, I wrote a column or two questioning his rationale, which is reportedly part of a petition filed in the Delhi High Court. To return to Sapna, she is the daughter of indigent parents. Her father has cardiac issues, and her mother is illiterate. She secured good marks in both the 10th and 12th Haryana Board examinations.

Last year, she appeared for the NEET examination but could not secure a good grade. She learnt that clearing NEET required practice. In other words, she needed to attend a coaching centre. That is exactly what she did to become eligible to study medicine. She is lucky in that she received the right counsel and the support to go to a coaching centre in Rajasthan.

The point to be noted is that NEET is beyond the reach of tens of thousands of students who live in villages. They have to shell out a large sum of money to get coaching in such places as Kota in Rajasthan, where it is a large-scale business. Most students cannot afford it, and their dreams of becoming a doctor will remain just dreams.

NEET has become compulsory for admission to any medical college. Is that good? I once visited St. John's Medical College in Bengaluru, where the chairman, a priest, showed me in his room a large map of India. When he pressed a button, tiny bulbs denoting several places on the map began flickering. "Go and check those places. They are all remote areas of the country where doctors from this college — mostly nuns — serve."

I remembered a visit to a Catholic hospital at Baramulla, very close to the border in Kashmir, where I met a doctor and reader of this magazine. She was a gynaecologist who has helped in the birth of thousands of children in the Valley. They all treated her like their own mother. After all, the babies saw her, not the mother, first!

For once, I understood why some seats were reserved for the Religious at St. John's. There is some quota for Christian students at the Christian medical colleges at Vellore and Ludhiana. To avail of it, the students have to sign a bond under which they will have to serve in a mission hospital in a place like Sehora in Madhya Pradesh.

The irony is that some of them are ready to pay Rs 25 lakh and more to free themselves from this obligation. This reflects the pathetic condition of healthcare in India. As I write this, television channels are busy reporting the arrival of 110 Indian medical students from Urmia University of Medical Sciences in Urmia, Iran.

They were taken to Yerevan in Armenia to be airlifted to India. They have harrowing tales to narrate about the situation in Iran following the Israeli attack. It was only after the attack began that I learnt that there were 1,500 Indian students in Iran pursuing their medical education. Most of these students are from Jammu and Kashmir.

Three years ago, it required the Russian attack on Ukraine to learn that there were thousands of Indian medical students there. It was a gargantuan task for the government to bring them safely back to India. Most of them were from Kerala. When COVID-19 struck the world, it was believed that it had its origin in China. There was a scare when a few Malayali students doing their MBBS in China returned to Kerala for their vacation.

Of course, I personally knew about Keralites going to China for medical education, as one of my own relatives — now practising in Dallas in the US — did her graduate medical studies there. A friend's daughter did her MBBS from a medical college in Nepal, which did not have a hospital of its own. Every week, they would be taken to the district government hospital for their practical training.

Compared to Iran or Ukraine or Nepal or China, India has better medical infrastructure. On June 16, a new hospital was inaugurated in Karunagappally, a small town in southern Kerala, known as the Krishna Institute of Medical Sciences (KIMS). It has state-of-the-art equipment for diagnostics, key-hole surgery, kidney and liver transplants, etc., that cost the management over Rs 100 crore.

There are many such hospitals all across India. There is no disease or surgery which Indian doctors can't handle. When Prime Minister AB Vajpayee underwent a knee-cap replacement operation, it was an Indian doctor practising in the US who came for the surgery. The British public healthcare system is managed mostly by Indian doctors and nurses.

Yet, why do Indian students go to places like the Philippines, where medical colleges are run, allegedly in makeshift buildings? The reason is not far to seek. There is a woeful shortage of medical colleges and, correspondingly, medical seats in India.

Altogether, there are 780 medical colleges with a total of 1,18,000 MBBS seats. Out of them, 55,000 are in government medical colleges, 48,315 in private medical colleges, and the rest in autonomous institutions and central universities.

The figures may appear impressive, but for the kind of population India has, they are grossly inadequate. The World Health Organisation (WHO) expects every nation to have at least one doctor per 1,000 people. We do not have even one for every 1,500 people.

India's population is expected to reach 1.476 billion by the year 2030.

To cater to such a staggering population, we should create an additional 2.07 million doctors. There are no signs of any urgency to create so many medical seats. Unfortunately, the government is no longer building new medical colleges. The growth is in the private sector, which is driven by profit.

One reason why Indian students go abroad for medical studies is the high cost of it in India. If Sapna is unable to get a seat in a government medical college where the annual fees are about Rs 20,000, she will have to opt for a private medical college where the fees will be about Rs 1.5 lakh per month. In some colleges, the amount is higher.

Forget Sapna; it is unaffordable even to middle-class students. In Ukraine, Iran, the Philippines, etc., an Indian can do his studies at half the cost. Now, you know why they land up in a remote college in a country like Iran, from where the government has to airlift them when calamities like war occur.

In India, it is the Medical Council of India (MCI), now known by another nomenclature, that governs medical colleges. The rules governing this body were drafted in the fifties and sixties. To get recognition for a new medical college, it has to fulfil certain criteria. There should be a certain number of classrooms with specific sizes and number of fans and desks.

The rules also specify the size of the built-up area, the campus, and the number of faculty, which works out to about 140 for 100 students. The rules also say that there should be so many X-ray machines for so many departments like obstetrics and orthopaedics. As a practice, most medical colleges can accommodate only 100 students. At the extreme, they can admit only 150.

If doctors are paid the salary they deserve, running a medical college is not very profitable. What is the solution? In cities like Delhi, Mumbai, and Kolkata, one can see higher secondary schools functioning in multi-storied buildings with no playground of their own. The students are periodically taken to public parks and grounds.

In other words, rules have to be amended to suit the situation, as underscored by the saying: one size does not fit all. Medical science has undergone a metamorphosis over the last few decades. For conducting brain surgery, it is no longer necessary to break the skull.

Recently, I underwent a procedure whereby I could see the tiny blocks in my veins on a screen, which were removed using heat like the one produced in, say, a microwave oven. No, I was not taken to an operation theatre. Instead, a corner bed in the ICU was used for the process, which I can vouchsafe was successful.

There is no need for a giant X-ray machine that produces a large negative, which has to be processed like a film. Today, the X-ray report can be seen by the doctor in either black and white or colour on his computer. This obviates the need for a large room to keep the x-ray machine and other paraphernalia.

During the COVID-19 lockdown, my wife and I had to consult a doctor via video call. She prescribed medicines which we ordered on the phone, and they were supplied at home. That is how I realised how practical telemedicine is. During the lockdown, classes were held online in many schools. A specialist doctor sitting at his home or clinic can give a lecture on, say, bronchitis using an application like Zoom or Google Meet.

Artificial Intelligence is already playing a big role in life. I saw the first computer in Bihar at the AN Sinha Institute. It was as big as a washing machine, and it could handle only a few kilobytes of data. Today, my mobile phone can process a million times the data it could handle.

We need to change the rules to allow medical colleges to admit more students. AIIMS admits only 100-plus students a year. It has infrastructure and manpower that allow an intake of double or triple the number. In fact, this is true about most of the medical colleges. If their capacity is doubled, 1,18,000 more students can be admitted to the MBBS course. This will drastically bring down the fees charged by private medical colleges.

There will also be no need for as many students to go abroad to study medicine. There will be no need to airlift students when wars suddenly erupt in various corners of the world. The country will benefit in many ways.

Today, 27 infants per 1,000 live births die. Similarly, 93 mothers per 100,000 live births die. The infant and maternal mortality rates have improved considerably since India attained independence. For a nation which has the world's fourth-largest GDP, even the death of a single infant or mother is unacceptable.

Allowance also has to be made for the fact that doctors are concentrated in urban centres, and there is an acute shortage of them in rural areas.

If India is to become a true global healthcare power, it must democratise access to medical education. That means revising outdated regulations, investing in government institutions, harnessing digital technologies, and expanding seat capacity without compromising on quality. It is not just about producing more doctors—it is about ensuring equitable, affordable, and timely healthcare for every citizen. A healthier India begins in the classroom, not the casualty ward.