Mental health crisis in India
1
1303 students went overseas, including 14 women, and most students chose to travel in pairs or small groups. 9 went to universities at Bristol, Sheffield, Dundee, Glasgow, Edinburgh, and York in the UK; 9 to Harvard Medical School, Miami Children’s Hospital, Baylor College of Medicine in Texas, and the Walter Reed Army Medical Centre in Washington DC in the USA; 8 to India; 4 to Egypt; 9 to Malaysia; and 2 to Canada. The programme provides an opportunity for both student and faculty to compare the medical training offered in Oman with that available elsewhere. We have found that students have greater opportunity to practise their clinical skills in other developing countries whereas in North America fear of malpractice suits may result in restricted access to patients. Students who spent their electives in non-English-speaking European countries had language difficulties, especially with older patients, although medical staff were usually fluent in English. High costs are the greatest impediment to an elective programme. Our university funding is obtained from three main sources-large commercial companies, organisations already sponsoring students, and personal initiative by individual students. Cost determines destination and an elective in the USA is three times as expensive as one in India. Some universities will not accept foreign students without reciprocal arrangements and collaboration seems to be the only solution if the programme is to flourish. Exposure to a different culture was potentially difficult since many of our students had not previously travelled outside Oman. Conversely, the benefits to be gained in terms of personal development and broadening experience are enormous. The second group to embark on this programme were more relaxed and confident and determined to get the most out of the experience. This is summed up by two female students who spent their electives in the UK: "medicine in Dundee, paediatrics in York, and picnics everywhere". M Jeans, G F D Heseltine Sultan Qaboos University, College of Medicine, Muscat, Sultanate of Oman 1 Jeans M, Heseltine GFD. Setting up an overseas clinical elective programme in a new medical school. Med Educ (in press). SIR-In your editorial you ask whether electives are for purpose or a picnic. The British Medical and Dental Students’ Trust makes a substantial contribution to seeing that the grants it gives to medical and dental students only go to those with a serious educational purpose. A panel including students assesses the applications and takes paticular note of those with well thought out protocols supported by a dean’s or clinical tutor’s recommendation. The Trust draws its funds from a number of donors including the Medical Insurance Agency and the Wellcome Foundation. It also provides an assessment service for some bodies who do not have the facilities to process applications. J W Brooke Barnett, Chairman British Medical and Dental Students’ Trust, Mackintosh House, Glasgow G2 4EH, UK Mental health crisis in India SiR-The Supreme Court of India has decided that mentally ill patients lodged in jails throughout the country should be sent to the nearest place of treatment and care (Lancet Sept 11, p 670). In India there are about 10 million persons with serious mental illness. About 250 000 new seriously ill patients join this pool every year.1 There are only 20 571 beds in mental hospitals.2 Thus only 1 in 50 seriously ill patients has the chance of a bed. With 2500 psychiatrists and 600 psychiatric nurses in the country,! the doctor/patient, and nurse/patient ratio for seriously ill patients is 1 to 4000 and 1 to 17 000, respectively. The government of India spent 10 million rupees in their seventh five-year plan,3 but the average expenditure on each seriously ill patient in five years was a mere US 3 cents. The inevitable conclusion is that there is a serious lack of infrastructure, manpower, and budgetary support. As pointed out in your report, most of these patients have been abandoned by their families. Many of them are too dangerous to be cared for in a general hospital or at home, and will probably need long-term hospital care. We fear that when released from jails, and in the absence of adequate treatment facilities, these patients will have to fend for themselves. Whatever little shelter and food is now available to them will disappear. Until mental health facilities improve and society realises its obligation towards the mentally ill, the judgment seems to have given for most patients a desperate choice. Shashi Kant, L R Murmu Departments of Community Medicine and Surgery, All India Institute of Medical Science, New Delhi 110 029, India 1 Director General of Health Services. National mental health programme for India. New Delhi: Government of India, 1982: 4-6. 2 Ministry of Health and Welfare. Health information of India: 1991. New Delhi: Government of India, 1992: 155. 3 Director General of Health Services. National mental health programme: a progress report (1982-1990). New Delhi: Government of India, 1991: 11. On sexual harassment SiR-Were it not for The Lancet (Sept 11, p 627) I would not have asked myself whether I have been sexually harassed at work. Now I know; I have been, repeatedly and in clear violation of the Bill of Rights. Often upon entering my workplace I have been assaulted by olfactory stimuli dispersed in a premeditated manner for the sole purpose of pushing me into a frame of mind not conducive to clinical productivity. Such stimuli were regularly followed by acoustic signals and continuous displays of visual messages and movements of my co-workers of the other sex, all combined to arouse an undesirable (to me) state of covetousness. Hairdyes designed to catch my eye, moist lips enhanced with lush colours, vistas of bared necks, arms, shoulders, and legs all had to be endured. Mammary bodies have been brought into my field of vision in their natural condition and in artificial modifications. Along hospital corridors they would walk in front of me employing various muscle groups for the distraction of me rather than for locomotion. A combination of olfactory, acoustic, and visual stimuli in trying to attract the male is universal in the reproductive behaviour of mammals. But it is seasonal; only in the human female is the ability and willingness to engage in sexual play and copulation divorced from the capability to conceive. The great myths and epics of mankind are witness that this continuous desire to be attractive is an endless source of conflict. Society has tried a variety of schemes: it sequestrated the female, forbade her to look attractive, covered her so that only her eyes were visible, silenced her. But to no avail. In the 20th century, and starting in the US, the human female has proceeded to "liberate" herself from being a property, subject to the caprice of the male. She can now, probably for the first time in the animal kingdom, ignore him. Yet she still wants to be attractive to the male-and when he responds, especially at their place of work, she sues. For thousands of years great injustice has been done to the female, and there is a long way to go before the sexes are truly equal. But, if male response to female attraction is to be
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Transcript of Mental health crisis in India
1303
students went overseas, including 14 women, and most
students chose to travel in pairs or small groups. 9 went touniversities at Bristol, Sheffield, Dundee, Glasgow,Edinburgh, and York in the UK; 9 to Harvard Medical School,Miami Children’s Hospital, Baylor College of Medicine inTexas, and the Walter Reed Army Medical Centre in
Washington DC in the USA; 8 to India; 4 to Egypt; 9 toMalaysia; and 2 to Canada.The programme provides an opportunity for both student
and faculty to compare the medical training offered in Omanwith that available elsewhere. We have found that studentshave greater opportunity to practise their clinical skills in otherdeveloping countries whereas in North America fear of
malpractice suits may result in restricted access to patients.Students who spent their electives in non-English-speakingEuropean countries had language difficulties, especially witholder patients, although medical staff were usually fluent inEnglish.High costs are the greatest impediment to an elective
programme. Our university funding is obtained from threemain sources-large commercial companies, organisationsalready sponsoring students, and personal initiative byindividual students. Cost determines destination and anelective in the USA is three times as expensive as one in India.Some universities will not accept foreign students withoutreciprocal arrangements and collaboration seems to be the onlysolution if the programme is to flourish. Exposure to a differentculture was potentially difficult since many of our students hadnot previously travelled outside Oman. Conversely, thebenefits to be gained in terms of personal development andbroadening experience are enormous. The second group toembark on this programme were more relaxed and confidentand determined to get the most out of the experience. This issummed up by two female students who spent their electives inthe UK: "medicine in Dundee, paediatrics in York, and picnicseverywhere".
M Jeans, G F D Heseltine
Sultan Qaboos University, College of Medicine, Muscat, Sultanate of Oman
1 Jeans M, Heseltine GFD. Setting up an overseas clinical electiveprogramme in a new medical school. Med Educ (in press).
SIR-In your editorial you ask whether electives are for
purpose or a picnic. The British Medical and Dental Students’Trust makes a substantial contribution to seeing that the grantsit gives to medical and dental students only go to those with aserious educational purpose. A panel including students
assesses the applications and takes paticular note of those withwell thought out protocols supported by a dean’s or clinicaltutor’s recommendation. The Trust draws its funds from anumber of donors including the Medical Insurance Agencyand the Wellcome Foundation. It also provides an assessmentservice for some bodies who do not have the facilities to processapplications.
J W Brooke Barnett, ChairmanBritish Medical and Dental Students’ Trust, Mackintosh House, Glasgow G2 4EH, UK
Mental health crisis in India
SiR-The Supreme Court of India has decided that mentally illpatients lodged in jails throughout the country should be sentto the nearest place of treatment and care (Lancet Sept 11,p 670).
In India there are about 10 million persons with seriousmental illness. About 250 000 new seriously ill patients join thispool every year.1 There are only 20 571 beds in mental
hospitals.2 Thus only 1 in 50 seriously ill patients has the
chance of a bed. With 2500 psychiatrists and 600 psychiatricnurses in the country,! the doctor/patient, and nurse/patientratio for seriously ill patients is 1 to 4000 and 1 to 17 000,respectively. The government of India spent 10 million rupeesin their seventh five-year plan,3 but the average expenditure oneach seriously ill patient in five years was a mere US 3 cents.The inevitable conclusion is that there is a serious lack ofinfrastructure, manpower, and budgetary support.As pointed out in your report, most of these patients have
been abandoned by their families. Many of them are toodangerous to be cared for in a general hospital or at home, andwill probably need long-term hospital care. We fear that whenreleased from jails, and in the absence of adequate treatmentfacilities, these patients will have to fend for themselves.Whatever little shelter and food is now available to them will
disappear. Until mental health facilities improve and societyrealises its obligation towards the mentally ill, the judgmentseems to have given for most patients a desperate choice.
Shashi Kant, L R MurmuDepartments of Community Medicine and Surgery, All India Institute of MedicalScience, New Delhi 110 029, India
1 Director General of Health Services. National mental health
programme for India. New Delhi: Government of India, 1982: 4-6.2 Ministry of Health and Welfare. Health information of India: 1991.
New Delhi: Government of India, 1992: 155.3 Director General of Health Services. National mental health
programme: a progress report (1982-1990). New Delhi: Government ofIndia, 1991: 11.
On sexual harassment
SiR-Were it not for The Lancet (Sept 11, p 627) I would nothave asked myself whether I have been sexually harassed atwork. Now I know; I have been, repeatedly and in clearviolation of the Bill of Rights.
Often upon entering my workplace I have been assaulted byolfactory stimuli dispersed in a premeditated manner for thesole purpose of pushing me into a frame of mind not conduciveto clinical productivity. Such stimuli were regularly followedby acoustic signals and continuous displays of visual messagesand movements of my co-workers of the other sex, all combinedto arouse an undesirable (to me) state of covetousness.
Hairdyes designed to catch my eye, moist lips enhanced withlush colours, vistas of bared necks, arms, shoulders, and legs allhad to be endured. Mammary bodies have been brought intomy field of vision in their natural condition and in artificialmodifications. Along hospital corridors they would walk infront of me employing various muscle groups for thedistraction of me rather than for locomotion.A combination of olfactory, acoustic, and visual stimuli in
trying to attract the male is universal in the reproductivebehaviour of mammals. But it is seasonal; only in the humanfemale is the ability and willingness to engage in sexual play andcopulation divorced from the capability to conceive. The greatmyths and epics of mankind are witness that this continuousdesire to be attractive is an endless source of conflict. Societyhas tried a variety of schemes: it sequestrated the female,forbade her to look attractive, covered her so that only her eyeswere visible, silenced her. But to no avail.
In the 20th century, and starting in the US, the humanfemale has proceeded to "liberate" herself from being a
property, subject to the caprice of the male. She can now,probably for the first time in the animal kingdom, ignore him.Yet she still wants to be attractive to the male-and when he
responds, especially at their place of work, she sues.For thousands of years great injustice has been done to the
female, and there is a long way to go before the sexes are trulyequal. But, if male response to female attraction is to be
