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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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.