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மருத்துவக் கொள்ளையர்களை என்னசெய்யப் போகிறோம்?

20161215155234ரு பாமரனின்  பார்வையில், “மருத்துவம்  என்பது நோய்களைக்  குணப்படுத்துவதற்கான கலையும்  அறிவியலும்  ஆகும். மருத்துவமனை என்பது ஒரு சேவை மையம். மருத்துவர் என்பவர்  உயிரைக்  காக்கும்  கடவுள்”. இப்படித்தான்  தொடக்கத்தில்  மருத்துவமும்  பண்டுவ முறைகளும்  மருத்துவர்களும்  இருந்தனர். அறத்தின்  பால்  தன்னலம்  இன்றி பிறர்  உயிர்  காத்து, தன்னிடம்  வரும்  நோயாளிகளைக்  குணப்படுத்தும்  குணவான்களாக இருந்தனர்.

 சேவைத்  துறையில்  பணப்  புழக்கம்  அதிகரித்த போது மருத்துவர்களும்  சற்று தடுமாற தொடங்கினர். இதன்  விளைவு, தன்னிடம்  வரும்  நோயாளிகளை தங்களின்  தொடர்  வாடிக்கையாளர்களாக வைத்துக்  கொள்ள முனைந்தனர்.  ஆனால்  எப்போது பெரும்  முதலாளிகளும்  அதிகார வர்க்கமும்  மருத்துவத்  துறையை கையில்  எடுத்ததோ அப்போதே இந்திய மருத்துவக்  கழகங்களும்  மந்தியைப்  போல கண், வாய், செவிகளை மூடிக்  கொண்டனர்.
 
 சேவைத் துறைகளில் பெரும் மூலதனத்தைக் கட்டுபாடின்றி அனுமதித்தால், எப்படியெல்லாம் அது பேயாட்டம் போடும்? என்பதற்கு உதாரணம்தான் மும்பை கோகிலாபென் திருபாய் அம்பானி மருத்துவமனை. நாட்டின் அதிநவீன மருத்துவ மனைகளில் ஒன்றான கோகிலாபென் திருபாய் அம்பானி மருத்துவமனை ரிலையன்ஸ் குழுமத்துக்கு சொந்தமானது. அனில் அம்பானியின் மனைவி டினா அம்பானியின் நேரடித் தலைமையில் இயங்குவது. ‘இந்திய மருத்துவப் பராமரிப்புத் துறையில் இருக்கும் இடைவெளியைக் குறைப்பதே எம் மருத்துவமனையின் முக்கிய இலக்கு’ என்று மருத்துவமனையின் அதிகாரபூர்வ இணையதளத்தில் முழங்குகிறார் டினா. ஆனால், அம்பானி மருத்துவமனையோ  மருத்துவத் துறையின் அடிப்படை அற நெறி கட்டுமானம் எதுவோ அதையே பகிரங்கமாகச் சுக்கு நூறாக உடைத்தெறிந்திருக்கிறது.

 மருத்துவர்களைத் தரகர்களாக்கும் திட்டத்தை ஆரம்பித்து, அதற்கு விண்ணப்பங்கள் அச்சடித்து, மருத்துவர்களுக்கு இலஞ்சம் கொடுப்பதை அதிகாரப்பூர்வமாக நடத்தியிருக்கிறது அம்பானி மருத்துவமனை. தங்களிடம் வரும் நோயாளிகளிடம், ‘அம்பானி மருத்துவமனைக்குச் செல்லுங்கள்; அங்கே உங்களுக்கு நல்ல சிகிச்சை கிடைக்கும்’ என்று வெளி மருத்துவர்கள் ஆளை அனுப்ப வேண்டும். 40 நோயாளிகளை அனுப்பி வைத்தால் 1இலட்சம், 50 நோயாளிகளை அனுப்பி வைத்தால் 1.5 இலட்சம்,75 நோயாளிகளை அனுப்பி வைத்தால் 2.5 இலட்சம் என்று ஆட்களின் எண்ணிக்கைக்கு ஏற்ப அதிகாரப் பூர்வமாகவே இலஞ்சம் கொடுத்திருக்கிறது அம்பானி மருத்துவமனை.

 இப்போது ஒரு கேள்வி எழலாம்; ஊரில் எங்கும் நடக்காத விசயமா இது? உண்மைதான்.. தவறுகள் சம்பிரதாயங்களாகி விடும் காலத்தில் இருக்கிறோம். நோயாளிகளுக்கு பரிந்துரைக்கும் மருந்துகளுக்காக மருந்து நிறுவனங்களிடமிருந்து ‘அன்பளிப்புகள்’ பெறுவதில் தொடங்கி பரிசோதனை நிலையங்களுக்கு நோயாளிகளை அனுப்புவதற்காக அந்த நிறுவனங்களிடமிருந்து ‘ஊக்கத்தொகை’ பெறுவது வரை மருத்துவத் துறையில் கையூட்டும் ஊழலும் சாதாரணமாகிப்  போனது உண்மைதான். எனினும், அம்பானி மருத்துவமனை விவகாரத்தில் ஒரு  முக்கியத்துவம் இருக்கிறது. கையூட்டையும் ஊழலையும் அதிகாரபூர்வமாக்கும் முன்னுதாரணம் இது. ஒரு ஊரில் திருடர்கள் பெருகிவிட்டார்கள் என்பதாலேயே திருட்டை சட்டபூர்வமாக்க முடியாதல்லவா?

 தமிழில் முதன்முதலில் மருத்துவதுறை ஊழல்களை உள்ளிருந்தே அம்பலப்படுத்திய மருத்துவர் கே.ஆர்.சேதுராமன் ஆவார். தன்னுடைய ‘போஸ்ட்மார்ட்டம்’ நூலின் முதல் அத்தியாயத்தின் முதல் பத்தியில் குறிப்பிடும் விசயம் இது.

 ‘‘…மனிதாபிமான அடிப்படையில் சேவை செய்வதுதான் என்னுடைய பிரதான நோக்கமாக இருக்கும். அதன் மூலம் கிடைக்கும் பணமோ இதர சலுகைகளோ எனக்கு இரண்டாம் பட்சம்தான்… என்னிடம் வரும் நோயாளிகளைத் தேவையற்ற பரிசோதனைகள் செய்ய பரிந்துரைக்க மாட்டேன்; பரிசோதனைக் கூடங்களுக்குப் பரிந்துரைக்கவோ சிறப்பு சிகிச்சை நிபுணர்களிடம் உயர் சிகிச்சைக்கு அனுப்பவோ காசு வாங்க மாட்டேன். நோயாளிகளை என்னிடம் ஈர்த்துவர முகவர்கள் யாரையும் நியமிக்க மாட்டேன்… என்ற உறுதிமொழியை ஏற்று கையெழுத்திட்ட பின்னரே மருத்துவப் படிப்பை முடிக்கும் ஒவ்வொருவரும் இந்திய மருத்துவ கழகத்தால் மருத்துவர்களாக அங்கீகரிக்கப் படுகிறோம். ஆனால் நெஞ்சைத் தொட்டு சொல்லுங்கள், எத்தனை மருத்துவர்கள் இந்த உறுதி மொழிகளை கடைபிடிக்கிறோம்?” என சுமார் பன்னிரண்டு ஆண்டுகளுக்கு முன் மருத்துவர் சேதுராமன் சக மருத்துவ சமுகத்தை நோக்கி இந்த கேள்வியை எழுப்பிய போது கூட இந்தியாவில்  ஊழல் இவ்வளவு மோசமானதாக இல்லை. இன்றைக்கோ இந்திய மருத்துவத் துறையில் ஊழல் சந்தி சிரிக்கிறது.

 பொதுவாக உலகெங்கும் மருத்துவத் துறையில் புரையோடியிருக்கும் ஊழலை பட்டியலிடும் ‘பி.எம்.ஜெ’ இதழ்  இந்தியாவின் நிலைமை படுமோசம் என கீழ்க்கண்டவாறு சுட்டிக் காட்டுகிறது. ‘சுகாதரத்துறை என்பது ஊழலுக்கு உற்ற உறைவிடமாகிறது. உலகம் முழுக்க, சுகாதாரத்துறையில் செலவிடும் தொகை 10 முதல் 25 விழுக்காடு வரை ஊழலுக்கே போகிறது. நாட்டின் வளர்ச்சியைப் பொறுத்தும் சுகாதாரத்துறை  திட்டங்களைப் பொறுத்தும் கையூட்டும் ஊழலும் மாறுபடுகிறது. அமெரிக்காவில் 2011இல் மட்டும் 8,200 கோடி டாலர்கள் முதல் 27,200 கோடி டாலர்கள் வரை போலிக் காப்பீட்டுத் திட்ட ரசீதுகளால் மோசடி செய்யப்பட்டுள்ளது. எந்த நாட்டிலுமே இந்த துறையில் ஊழல் இல்லாமல் இல்லை. மருத்துவர்கள் இந்த ஊழலைத் தடுக்க தவறி விட்டனர். சிலர் அதற்கு உடந்தையாகவும் இருக்கின்றனர். எல்லாவகை ஊழல்களிலும் திளைக்கும் இந்தியா சுகாரத்துறை ஊழலிலும் முக்கிய இடம் வகிகிறது’ என்று இந்திய மருத்துவத் துறையில் நடக்கும் தில்லுமுல்லுகளைத் தோலுரித்துக்  காட்டியுள்ளது. 

 இது வெறும்  ஊழல்  அல்ல; உயிர்  விளையாட்டு. மேலும்  மருத்துவத் துறை எண்ணற்ற நோயாளிகளின் உயிருடனான விளையாட்டு என்பதைத் தாண்டி, மருத்துவர்களிடமிருந்தே மருத்துவத்  தொழிலைப் பறிக்கும் பேரபாயம் ஆகிவிட்டது என்கின்றனர், இன்னமும் மனசாட்சியை விற்றுவிட்டாமல் நேர்மையைக் கட்டிக் காக்கும் மருத்துவர்கள்.  ‘எப்போது நோயாளிகளைப் பரிசோதனைக்கு அனுப்பி வைக்கத் தரகுமுறை அறிமுகமானதோ, அப்போதே எதற்கெடுத்தாலும் பரிசோதனைக்கு அனுப்பும் பழக்கம்  மருத்துவர்களிடம் பரவத்  தொடங்கி விட்டது. இதன் மோசமான பின் விளைவு என்னவென்றால், இன்றையத் தலைமுறை மருத்துவர்கள் பலருக்கு நோயாளிகளிடம் பேசி, அவர்கள் உடலை பரிசோதித்து, அவர்கள் நோயைக் கண்டறியும் ‘கிளினிக்கல் எக்ஸாம்’ முறையே பரிச்சயம் இல்லாமல் போய்விட்டது. ஒரு சாதாரண வைரஸ் காய்ச்சலைக் கண்டறியக் கூட பரிசோதனை நிலையங்களை நாடும் ‘லெபராட்டிக்கல் எக்ஸாம்’ உதவி அவர்களுக்குத் தேவைப்படுகிறது. விளைவு, மருத்துவரை விடவும் பரிசோதனைக் கருவிகளும் பரிசோதனை நிலையங்களும் ஆற்றல் படைத்தவை ஆகி  விடுகின்றன. மருத்துவருக்கும் நோயாளிகளுக்கும் இடையிலான பிணைப்பு அறுந்துவிடும் நிலையில், பெரும் முதலீடுகளுடன் மருத்துவமனைத் தொடங்குபவர்கள் மருத்துவர்களை வெறும் பரிந்துரையாளர்களாகவும் தரகர்களாகவும் ஆக்கி விடுகிறார்கள். வியாபாரிகளின் கையை நோக்கி மருத்துவம் சென்று கொண்டிருக்கிறது’ என்கின்றனர் மனிதநேயமிக்க மருத்துவர்கள்.

 உலகெங்கும் ஆண்டுக்கு 7.2 இலட்சம் கோடி டாலர்கள் சுகாதாரத் துறைக்காக செலவிடப்படுவதாகச் சொல்கிறது உலக சுகாதார அமைப்பு. இதில் 10 முதல் 25 விழுக்காடு தொகை ஊழலில் செல்கிறது என்பது வெறும் பொருளாதாரம் சார்ந்த சிக்கல் அல்ல. ஒரு பாமரக் குடும்பம் தன்  அனைத்து மகிழ்ச்சியையும் இழக்க இன்றைக்கெல்லாம் அந்த வீட்டுக்கு ஒரு நோயாளி போதும். அதிலும் புற்று நோயாளிகள், சிறுநீரக நோயாளிகள் என்றால், உடலும் மனமும் துடிதுடிக்க அந்த குடும்பமே வலி சுமக்க வேண்டும். தம்முடைய பல நாள் உழைப்பின் மொத்த பலன்களையும் மருத்துவமனை மேசைகளில் கொட்டி, அறியாமையைச் சுமந்து பரிதவித்து நிற்கும் இப்படிப்பட்ட அபலைகளிடம் நடத்தப்படும் ஊழல் கொடூரமான கொள்ளை.

 இந்திய மருத்துவத் துறை ஊழல் புற்றால் சீழ்பிடிக்க தொடங்கியதன் அறிகுறி இது. இதுவரை சிக்காமல் ‘தொழில்’ நடத்திய இத்தகைய கொள்ளையர்களை இனங்கண்டு தண்டிக்கப்பட வேண்டும். இந்திய மருத்துவக் கழகம் இனியும் வழக்கம் போல் வேடிக்கை பார்க்கலாகாது; நாமும்தான்.

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