VYAPAM SCAM

Vyapam's hidden costs: Broken dreams and a health system staffed by dodgy doctors

The systematic manipulation of the medical exam process over at least a decade means that there are at least 2,000 doctors with questionable aptitude treating patients.

In 2009, Poonam Sharma finished school and turned her thoughts to medical school.

The daughter of a junior police officer, Sharma left home in Shivpuri, in the northern reaches of Madhya Pradesh, for Gwalior, home to coaching centres that promise to help candidates crack all kinds of entrance exams. She enrolled for a year-long coaching programme and began studying for the medical college entry tests in earnest.

It was an intense, immersive time. “I studied for 14 hours every day," said Sharma, who was 19 at the time. "I would stay up studying till 2 every night."

However, it soon became clear that something was wrong. “Some students were very sure they would make it," Sharma said. "They said they had paid money: Rs 12 lakhs if they were in the general category and Rs 3 lakh-Rs 4 lakhs if Scheduled Caste or Scheduled Tribe.” On the morning of the exam, around 4am or 5am, she said, a white van picked up these students and took them to the exam centre. "We later learnt that they had been given the question papers to read," she said.

Sharma did not make it in her first attempt. She re-enrolled for coaching, tried again the next year but failed one more time. The third year, given the straitened financial conditions of a family with five daughters and a son, she studied on her own but did not get a seat despite scoring 162/200. The cutoff that year was 164.

In the fourth year, she tried once more and landed up as number 6 on the waiting list.

Failure, again.

The struggle

It took five years of persistence for Sharma, a slender waif of a girl with a defiant face, to finally bag a government-quota seat in a medical college at Indore. She secured her place in 2014 only after the Madhya Pradesh Pre-Medical Test was scrapped and admissions to medical college began to be conducted through the All India Pre-Medical Test.

The period she was trying to get into medical school was the time Madhya Pradesh's Vyapam scam had warped competitive dynamics in the state's medical entrance exams and other tests too.

At the best of times, the medical entrance exam conducted by the Madhya Pradesh Vyavsayik Pariksha Mandal, or Vyapam, is intensely competitive. Out of 50,000 or more applicants each year, Madhya Pradesh selects around 700 medical students . However, the number of available seats fell as a set of people  with political links subverted the system in myriad ways – leaking question papers; bringing bright students from as far away as Uttar Pradesh and Bihar to impersonate actual candidates and take the exam for them; manipulating examination roll numbers to get their clients to sit behind these brighter students (some of whom were toppers from previous years) and copy from them; and manipulating the answer sheets.

It's still unclear how many candidates made it to medical school using these approaches. As Paras Saklecha, a former independent MLA who has been raising the Vyapam issue from 2009 onwards, said, “Madhya Pradesh's investigations have not focused on all the different forms of fraud.” While the use of impersonators and other kinds of manipulation are being scrutinised, question paper leaks, for instance, are yet to be studied.

Said Sharma, “We thought we were competing for 700 seats but were actually trying for maybe 100-200 seats.”

 What Vyapam did to aspiring doctors

This heightened scarcity hurts genuine students. Sharma had to try for five years before she got into medical school. It was a struggle that went beyond studying. When one of the kingpins was arrested and found with a list of candidates who had paid for their seats, she filed cases against the government asking for those on the waiting list to be given these places. She even went on three hunger strikes to press for this– the longest which lasted eight days.

Others gave up on trying to obtain MBBS degrees and opted for dentistry, ayurveda or homeopathy instead. One of the friends of Anand Rai, one of the key whistleblowers, became a veterinary physician. Some abandoned their medical aspirations entirely. The daughter of Abhay Chopra, one of the litigants in the matter, is now doing a company secretary course.

Yet others, says whistleblower Rai, went into depression. To make sure their preferred candidates got through, those manipulating the system gave their clients such high marks that they would always be at the top of their respective categories – general, OBC, SC or ST. This left students feeling that no matter how hard they prepared, they would always fall short of the cut-off.

At least one student, from Sehore in Madhya Pradesh, committed suicide, said Poonam Sharma. “Preparing for these tests, bachche pagal ho jaatey hain," she said. "You do so much work that you forget festivals. And when you do not make it, after spending all these years after school only preparing for medicine, what do you do?”

Paras Saklecha, the independent MLA, agreed:“Some of those students felt they had let their families down.”

It's not clear at this time how many candidates succumbed to depression or committed suicide. Saklecha told Scroll he is trying to collect those numbers.

Others, concluding there was no other way to get in, paid the touts. In some cases, Saklecha said, families had to borrow to pay the touts. This is one of the more striking aspects of Vyapam. Students who had made it into medical school would contact candidates and offer to broker deals for them too.

That said, the students who paid up are now in a real spot. As investigators review the admissions process, some students ave been expelled. Others are afraid of being found out.

It is hard to not marvel at how badly the state has failed these students, says RTI activist Ajay Dube. “First, the touts and the fixers subverted the system such that they couldn't get in," he said. "And then, when the state decided to show it was taking action, it went after the students,” he said. The bigger names are not even being questioned, he added.

What Vyapam will do to the health system

The costs of Vyapam go beyond the lives of individual students.

At Indore's prestigious Mahatma Gandhi Memorial Medical College, a head of department told Scroll on the condition of anonymity that in the last seven or eight years, he has seen a drop in the quality of students. "They are not as keen as the earlier batches," he said. "They do not ask as many questions. In the process, we do not enjoy teaching as much as before.”

This was corroborated by a fresh postgraduate from the college. It was always easy to spot these students in class. “They would be silent in class discussions, in chats after tests about how we answered questions," this student said. This, predictably, spawned fresher forms of corruption. Some faculty members, said Rai, began charging to pass these students in the annual exams.

Some specialiations have suffered more than others, the student said. Given that people paid as much as Rs one crore to get in, they also seem to have defined the specialisations that were deemed most lucrative: “Radiology, psychiatry, opthalmology, orthopaedics and dermatology were the most prized.”

What are the long-term implications of all this? By not cracking down – wilfully or otherwise – on the Vyapam scam, the Madhya Pradesh government headed by Shivraj Singh Chouhan has created conditions where an unknown number of doctors with poor aptitude for medicine will go out and practise.

A former secretary of the Indian Medical Association's chapter in Bhopal said, “To be a good doctor, you need the ability to analyse, to link symptoms and diseases. The ability of students to do this is falling.” The postgraduate student said something similar. These students, he said, “cannot clinically appraise patients. They recommend investigation – MRI scans, etc – before they can diagnose.”

The absolute number of bad students entering the state's healthcare system is anyone's guess. Vyapam ran for close to ten years. If even 200 students paid to get in, that is 2,000 dodgy doctors entering the healthcare set up of a state which, according to a news report that quoted state planning officials, has no more than 30,000 MBBS doctors. A more detailed enquiry – spanning all years and all modes of subversion – might see that number climb.

Spreading through the state

Some of these students, said the postgraduate student, came from families of rich doctors. They will join the family practice. Others, he said, will move to the large hospital chains. Hardly anyone wants to do independent practice these days, he said.

It gets worse. “Someone who came into medicine using unethical means and having paid a lot of money might do anything,” said whisteblower Rai. Perhaps clinical trials without informed consent, perhaps something else.

A lot depends on the rigour with which the Vyapam scam is dealt. At this time, the government is cracking down on a handful of cases, suspending students who paid to get their seats. But, as the postgraduate student said, his batchmates who were expelled still have their degrees. One of them is seeing patients, he said.

Which brings us to the most astonishing thing about Vyapam. India is a country with a low doctor-population ratio. According to the World Bank, in 2012, India had 0.7 doctors for every 1,000 patients. By contrast, Switzerland had 4 and Cuba had 6.7. The figure in Madhya Pradesh is five times lower than the national average. Despite this, the state government allowed the scam to continue for so long, exposing a weak system to further risk.

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