College of Nursing
Christian Medical College, Vellore-4

Graduation 2010 – Chief Guest Address

NURSING  EDUCATION  IN  INDIA

It gives me great pleasure to share this auspicious day with you all.  Both for teachers and the students who are graduating today, it is a day of fulfillment.  It is also a day when one will have to part ways and for the students to go out into the real world which will offer them huge opportunities to test their capabilities and realize their aspirations.

It is appropriate to recall and recommit ourselves to the great Florence Nightingale, Dr. Ida Scudder, … who so inspired generations of nurses.  The need to have such icons is even more important today when we are increasingly getting engulfed with values that seem to measure success only by the money one has made in life.  I must compliment the CMC Vellore to abide by their founding principles of imparting a value based education where knowledge and skills are imparted alongside those of compassion and service.

These are challenging times for us. Disease burden in increasing and getting more complex with the emergence of infections in newer forms and lifestyle diseases like diabetes, hypertension, mental health and cancer etc. Coping with the changing demographics is yet another challenge - 40% of our population is below 25 years and the elders are also living longer due to better nutrition and access to timely care.  Each of these diseases and age groups require specialized care that is getting highly technology based.  While technology can enable more accurate diagnosis, for optimal outcomes it needs skilled and competent persons.  And the third important factor of our times is the huge demand for good quality care and the ability and willingness of people to pay for it.

These challenges are putting great pressure on the health system in India.  Over the years, we failed to recognize and foresee the situation that we are witnessing today.  There is a substantial demand for health services but we have only half the infrastructure and human resources.  The greatest constraint today for India is the non availability of human resources-doctors, nurses, technicians, therapists, counsellors and above all good and dedicated teachers.  So even as we recognize the need for well trained human resources, nurses in particular and are willing to establish more colleges and schools, we do not have the faculty.  We have an acute shortage of nurses in India.  We estimate a requirement of 10 lakh nurses against which we have about half.  We need an estimated 10,000 faculty to work in the institutions to bridge this demand.  Globally there is an estimated requirement of about 70 lakh nurses.  With the rapid expansion of demand for health services and the push factor from the medical tourist industry and the pull factors from developed countries, there is an urgent need to expand both the quality and quantity of nurses in India so that such demand can be converted into a win situation where we can generate employment and empower women by getting them into the workplace.

To expand nurse training to meet this demand, Government of India allocated a substantial budget of Rs.3000 crores during the current plan.  265 schools of nursing are being established with 85% financial assistance from Government of India in those districts which has no nursing  school resulting in a huge shortage of nurses.  It is easy to make the buildings but, as I said, the challenge is finding teachers required to impart skills, knowledge and right attitudes.  I am truly impressed with the huge expansion of nursing education in Vellore-not just in numbers but more importantly in the variety of courses being offered.  Vellore is acknowledged as a center of excellence.  It thus needs to be a leader in helping the country in three ways – 1.By increasing the number of nurses being trained; 2. Designing faculty development courses to increase the availability of teachers to work in the nursing schools and colleges being established; and 3. In devising such a system that motivates nurses to stay and work in India and not go abroad.  The tragedy is that our best trained nurses go abroad and are not available for us.  The only way to resolve this problem is by producing nurses in large numbers to meet our domestic and external needs.

Nurses are critical to patient outcomes.  We have yet to fully internalize the nursing profession into medical care and develop the concept of team work as a core element of institutional care.  So long as medical treatment was in solo settings, nurses did not matter.  But now with technology driven hospitals, care has to be multidisciplinary and by teams of doctors, nurses and technicians working as a team with shared responsibility.  Delegation of responsibilities to nurses and other cadres would relieve the doctors to attend to actual treatment and also treat more patients.

Be it teams or individual competencies, the defining element is training at the school and at the workplace.  Unfortunately, the most neglected area has been training.  While we have pockets of excellence, we also have a lot of substandard and poor quality of training being imparted in institutions with no faculty.  We have so commodified education that the training of our doctors and nurses is inadequate and very often appalling.  Competency building is mostly at the workplace and at the cost of patient comfort.  In a leading hospital I witnessed the poorly trained nurses unable to draw blood or fix an IV set without creating a huge amount of discomfort to the patient.

With a view to standardize training of doctors, nurses and paramedical staff, the Ministry of Health is now seeking to establish an autonomous body called the National Commission for Human Resources for Health.  This body has been envisaged to not only bring together on one platform all the disciplines of medical practice and science but also have standards and norms that are enforced throughout the country.  This is radical way of regulating medical and nursing education and over time will also throw up high quality technical leadership.

Of great concern is the falling standards of nursing practice in the country.  It is the attitudes of our care givers be they doctors or nurses, that bothers the patients.  I recently lost my sister to cancer.  She was being treated in a leading hospital in Delhi.  And I saw the amount of suffering she went through due to poorly skilled nurses who knew very little about palliative care, not to talk of the doctors.  From not wearing gloves and pushing needles to banging doors and talking and chatting loudly.  Somewhere, people forget what they have been taught and instead imbibe the bad practices.  Part of the reason for such insensitive behaviour, particularly in public hospitals, is the high workload.  There is no doubt that we need to pay our doctors and nurses better, provide a more conducive workplace and a respectful environment.  Yet, one cannot absolve oneself like this. Considering that the choice of joining the profession or the job is ours we have a duty to do our best.  We need to also look for excellence and achieve perfection in whatever we do because it is only then that we actually value and respect ourselves.  In whatever we do and wherever we are we need to give our best, nothing less.  This is how I have always conducted myself and therefore have today retired with a great sense of satisfaction and good will.

All these are factors that are often spoken about in seminars but we need to translate into policy and practice.  CMC needs to show leadership in this matter and help develop policy papers based on good quality operational research.  These would be invaluable in the 12th five year plan that is now being formulated.  Institutions like CMC need to be more actively engaged with the national planning processes and cannot leave the future of the medical and nursing professions only to the Medical and Nursing Councils.

Secondly, I would like to take this opportunity of telling the nurses graduating today that they are entering into a great profession where they have the blessing of truly serving those in need.  Such an opportunity is not available to all.  I always felt particularly blessed when I was posted to the health department.  It is only in this job that I have been able to see what that means.  I cannot ever forget the smile of the old woman when her IOL operation was successful and she was able to see.  What a miserable life she had, unable to go to the toilet or eat her food, bathe, move about etc.  as she had no one to help and had to wait till evening when her children would come back from work.  In India we have almost 10% of our old people bedridden and in need of help.  It is with this in view that we have created posts for nurses and health workers to do home nursing under the geriatric care program.  What an experience it is whenever I go to the ART centers and see young 20 year old girls widowed, infected with HIV with a small baby also infected.  All she wants is to live on for her child and keeps on hoping that somehow her child will survive.  I know that in both these programs I had a role to play in expanding access to IOL surgeries and ART treatment and this has certainly made me feel very humble.

You are very fortunate persons because whatever you do everyday, you are only alleviating pain and giving life.  Can there be a greater way of living.  Doctors and nurses working in public hospitals may not be making much money but that is compensated by this great sense of fulfillment of saving lives.  I often wonder at those who spend their entire life to accumulate wealth.  I have never understood how one can spend 30 crores to make a house to live in when that money could as well have been used to set up 10 hospitals.  Why would anyone need 130 cars? Or how does one wear a suit costing 55 lakhs?

I then wonder what education is all about?  If education cannot make one sensitive to ones environment and the poverty that surrounds us then of value is it?  If the only value in life is to make money then one need not study – a paan wallah or a drug peddler makes over 3 to 5 thousand a day.  Having a decent house, education and access to the basics that go to enhance the quality of life is the right of everyone and one must certainly aspire for that.  But then, thereafter, one has to have a higher purpose to make life more meaningful.  I had a boss who would give away half his salary to those who wanted to study and dedicated his entire life to improve the quality of life of the marginalized populations.  He is the one who showed me what poverty in this country was like.  I met a young 18 year old working for no salary and against a loan of 200 rupees taken by his grandfather for household needs.  Such persons were called bonded labour.  In 1976 when I had just joined service, emergency was declared and a law passed banning such bonded labour.  And I was put in charge of implementing this Act.  I actually came across almost 3000 such accounts.  Recently when my boss passed away, there were more than a thousand people – mostly poor from far away districts coming in buses to attend the funeral.  Not many can be so dedicated but we can always draw inspiration from such persons and try to mould ourselves accordingly:

Finally, I would like to say that as you go along, life will keep giving you choices and options.  Some will be attractive but not ethical.  I pray that you will always have the courage to do right and do well, that you will so live your lives that you bring credit to yourself, your institution, your teachers and above all your parents.  And I hope that you will become like my boss, serving he less fortunate and being an inspiration to your juniors.  I would like to end by wishing each of you all the very best in life.

 

Ms. Sujatha Rao,
Former Secretary to the
Ministry of Health and Family Welfare,
Government of India.