diploma in medicine and rural health care (dmrhc) course and
TRANSCRIPT
Diploma in Medicine and Rural Health
Care (DMRHC) Course and Rural
Health Practitioner (RHP)s in Assam
Prof. Joydev Sarma Controller of Examination Directorate of Medical Education, Assam and Professor of Anatomy, Gauhati Medical College, Guwahati.
Total district 27
Total villages 26,312
Total Town 125
Total Area 78,438 sq km
Total population
3,11,69,272
Rural Population:
2,67,80,516
Urban Population:
43,88,756
Primary Health Centers:
938
Total sub-centre 4604
The Background
It is well established that a major part of population of India, especially in rural areas does not have ready access to Health Services. Country’s Health Care Delivery System favours only privileged few and the urban dwellers.
The Background (Continued)
For improvement of Health Scenario of the country India joined hands with other countries of the world to sign the WHO-UNICEF Alma-Ata conference in 1978.
The conference called for acceptance of WHO goal of Health for All by 2000 AD and proclaimed Primary Health care as way to achieving “Health for All”.
The Background (Continued)
The Background to this ‘New’ Philosophy was the growing concern about the unacceptably low level of health status of the majority of world population especially the rural poor and gross disparities in health between the rich and poor, urban and rural population. The essential principle of HFA is a concept of ‘Equality in Health’,- all people should have an opportunity to enjoy good health.
The Background (Continued)
Did we achieve the Goal?
Certainly not,
although some improvement could be achieved.
In September, 2000 United Nation’s Millennium Summit adopted the declaration Millennium Development Goal by 2015.
The Background (Continued)
But question arises whether Millennium Development Goals could be achieved by us.
Let us look into our Health Scenario while only 2 years is left to achieve the goal.
The Background (Continued)
Rural and Urban Health Scenario in India & Assam in 2011 (Source-SRS Bulletin)
Birth Rate Death Rate Infant
Mortality Rate Natural
Growth rate
Total Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban
India 21.8 23.3 17.6 7.1 7.6 5.7 44 48 29 14.7 15.7 11.9
Assam 22.8 24.0 15.5 8.0 8.4 5.6 55 58 34 14.8 15.6 9.9
It can easily be inferred that the health scenario of India is still far away to reach the Millennium Development Goals.
The Background (Continued)
The Situation in Assam is still worse
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Trend of MMR in Assam
The Deplorable situation of Health in the villages of Assam
Analysis of the Problem
The sub Centres in the villages are the only Govt. Institutes for Health care Delivery in Rural areas manned by ANM and MPW.
The ANM or MPW (only one or two) is/are the only first contact person providing ‘First Contact Care’ to the rural masses.
While the ANM/MPW can provide the preventive and promotive care to the rural masses, some questions now arise regarding the curative services provided by them.
Analysis of the Problem (Contd.)
They can perform a normal delivery, but are they sufficiently trained to understand a complicated labour and what to do in such a situation?
Are they sufficiently trained or skilled to diagnose a disease and provide curative care?
Can we expect to reduce morbidity and mortality only by providing preventive and promotive care and without providing curative services by scientifically trained personnel?
Analysis of the Problem (Contd.) The answer gives us a negative picture. The Doctors are found only in the PHCs who is
not easily accessible for the huge number of suffering people in rural areas residing far away from him or residing in such areas where communication is so deplorable that a sick person cannot think of reaching a doctor in a PHC for advice.
Those who can some how manage to reach the doctor also find him overcrowded by patients coming from different villages for which the doctor cannot attend them properly. So they find the care provided by him not readily accessible as well as properly acceptable.
Analysis of the Problem (Contd.)
This is the reason why the quacks or age old healers with totally unscientific or irrational practice are still the self styled ‘First Contact Physicians’ for the most of the rural masses.
The circumstances has compelled the rural masses to take the advice of these so called physicians and thus falling victim of the situation with further deterioration of the health and loss of property.
Analysis of the Problem (Contd.)
In a country like India where most of the people are residing in the villages, where poverty, illiteracy, unemployment, malnutrition, etc are still crippling the masses we cannot think to get rid of high level of morbidity and mortality without making the curative services of Health care easily accessible and acceptable to rural masses until and unless these multifaceted problems of the society are solved.
Analysis of the Problem (Contd.)
Thus we can notice a big gap in the Health Care Delivery System - between the PHCs and Sub centers.
Organizing occasional Health Mela, Free Health Check up Camp can never be a permanent solution to bridge the gap.
Appointment of qualified doctor at sub center level is the only solution to it which is not possible at this juncture due to reasons known to everyone of us .
Then what is the Solution?
The Sub centres must be equipped with skilled man-power-
Who are trained with scientific knowledge of preventive and promotive aspects of Health Care.
Who can diagnose and treat the common ailments suffered day to day by rural masses.
Who can be produced after a short duration of training and relatively at a low cost in comparison to production of a MBBS Doctor.
Who are trained in such a orientation and legal provision that they can be engaged to practice medicine in rural areas only.
Then what is the Solution? (Contd.)
who have the basic scientific knowledge of emergency situation of a patient and can provide the primary care to an accident victim or a patient with emergency condition like unconsciousness, convulsion, severe haemorhage, diarrhoea, vomiting, shock , burn injuries, snake bite, animal bite, high fever, fracture, jaundice, myocardial infarction, CVA, etc. along with normal delivery, child care and pediatric emergencies.
Then what is the Solution? (Contd.)
Who can understand the seriousness of a disease or a complicated labour and can immediately decide to refer accordingly such cases to a doctor in nearby PHC or District Hospital after providing the primary care to the patient.
Who have the capability of understanding the magnitude of the ice-berg of health problems due to some diseases in the Community by noticing its tip only.
And thus who can successfully bridge the gap between the Sub centers and PHC’s in delivery of curative Health Care Services over and above the delivery of promotive and preventive part of the system and helping to execute the National Health Programs.
Is it possible to create such a Health Professional?
Yes, Govt. of Assam has shown the proper path way to
solve the problem.
The Solution of the Problem
It is a matter of a great hope that the Govt. of Assam has successfully come forward to search out a novel path for solutions of the problems of Health Care Delivery System in rural areas by producing a set of skilled health professionals called Rural Health Practitioner (RHP)s through introduction of a new course called Diploma in Medicine and Rural Health Care (DMRHC) course.
DMRHC course is a 3 year course with another six months period of internship training.
Clearing the hurdles of the pathway
Before introducing the course the Govt. of Assam correctly studied the legal issues regarding introduction of this new course and creation of such a new set of Health Professionals.
The Govt. at first introduced a Bill in Assam Legislative Assembly with all these issues for acquiring legal rights for this new step.
The Legal Provisions
The Act.
On 4th September, 2004 the Assam Rural Health Regulatory Authority Act, 2004 of the Assam Legislative Assembly received the assent of the Governor. It was notified on 9th September, 2004 and published in The Assam Gazette Extra Ordinary on 18th September, 2004.
The Main Objective of the Act.
To provide for the establishment of Regulatory Authority in the state of Assam to regulate and register the diploma holders in Medicine and Rural Health Care (DMRHC) and their practice of Medicine in rural areas.
To regulate opening of Medical Institute for imparting Education and Training for the course of Diploma in Medicine and Rural Health Care (DMRHC).
The Authority In exercise of the power conferred by the Act,
the Govt. of Assam constituted the Assam Rural Health Regulatory Authority on 24th December, 2004 with the Director of Medical Education, Assam as the Chairman and the Deputy Director of Medical Education, Assam as the Member Secretary.
The Authority as per the provision of the Act, later framed the rules and regulations to regulate the admission procedure, course, curriculum, examination and all other academic matters of DMRHC course as well as activities of the Rural Health Practitioners.
The Medical Institute
The Govt. of Assam on 8th April, 2005 established the Medical Institute, Jorhat for imparting the Education and Training for the DMRHC course.
The Medical Institute, Jorhat started on 7th September, 2005 with its first batch admitted for the course creating a revolution in the Health Care Delivery System of the state as well as of the country.
In the beginning Jorhat Civil Hospital was the main center for the clinical training of the students. Later it was converted to Jorhat Medical College and its Hospital is now the center for clinical training.
Establishment of Medical Institute, Jorhat was just like a pilot project
Presently work of establishment of two more such institutes is in progress – one at Barpeta
and the other one is at Silchar.
Number of seats for Admission
Total Number of seats – 100
53 seats are unreserved/General. 2 seats for each of the 26 District and 1(one) seat only for Kamrup (Metro) district where a large area is occupied by Guwahati city.
47 seats are reserved for various reserved categories.
Academic & other Qualification for Admission
Candidates from Rural areas and permanent resident of Assam only are admitted.
Must pass 10+2 Science examination with Physics, Chemistry, Biology & English.
Must pass these 4(four) subjects in the single sitting without grace mark.
The Unreserved category candidate must obtain 50% and Reserved category candidate (SC/ST/OBC) must obtain 40% in Physics, Chemistry & Biology in aggregate respectively.
Age of the candidate –17 - 24 years, in case of SC,ST, OBC - 17 - 27 years.
Previous selected candidates for admission into DMRHC Selected candidate District -wise,2011
District Name of the candidate % in PCB Remarks
Baksa Mitumani Yesmin 76.67
Parag Jyoti Rajbongshi 75.00
Barpeta Jiarul Hoque 78.67
Md. Liakat Ali Khan 77.67
Bongaigaon Jahangir Alom 77.00
Shahajul Islam 76.67
Cachar Salma Begum Laskar 72.33
Mahbuba Nasrin 66.00
Chirang Ziarul Hoque 73.67
Utpal Dev Ray 69.33
Darrang Sikha Rani Sarmah 80.33
Kusum Jyoti Kumar 78.33
Dhemaji Diptra Kanta Sensua 73.33
Dibyashri Buragohain 72.67
Dhubri Paritosh Paul 78.00
Hafizur Islam 77.33
Dibrugarh Roselini Gogoi 75.33
Rajib Rajkonwar 72.00
Goalpara Ahad Ali 75.00
Md. Noor Alom 73.33
Golaghat Angkur Jyoti Saikia 73.67
Chumpi Gogoi 73.00
Hailakandi Rajaul Karim Laskar 76.67
Maruf Ahmed 74.33
Jorhat Sujit Bhuyan 78.00
Lukumoni Baruah 75.33
Kamrup Himakshi Das 80.00
Syed Abdul Aziz 75.33
Kamrup (M) Pranamika Baishya 82.67
Karbi Anglong Prabhat Dahal 69.67
Taslima Yeasmin 69.00
Karimganj Rumana Parveen 78.67
Saleh Ahmed 72.00
Kokrajhar Sumitra Kumari Shaw 74.67
Mir Towhidur Rahman 69.33
Lakhimpur Bhaswati Dutta 82.67
Bishwa Pratim Bogohain 80.00
Morigaon Ikbal Waddud 77.00
Rabbul Alam 67.33 Physically Handicapped
Nagaon Kumar Kritartha Kaushik 83.00
Pranami Ligira 76.33
Nalbari Mamoni Begum 77.67
Debasish Baruah 77.33
N.C.Hills (Dima Hasao) Fatima Firdaus 64.33
Sagar Thaosen 58.67
Sivasagar Ujjal Kumar Nath 76.33
Mriganka Konwar 76.33
Sonitpur Sudipta Sahu 84.67
Mouchumi Baruah 84.67
Tinsukia Barna Borgohain 68.33
Bikram Gogoi 67.67
Udalguri Pranjit Baruah 77.00
Parag Jyoti Nath 73.67
Previous selected candidates for admission into DMRHC (Contd..) Selected candidate Category- wise,2011
Category Sl. No. Name District PCB Remarks
Char Area 1 Mostofa Ali Bongaigaon 75.00
2 Binod Nath Jorhat 75.00
3 Shakirul Islam Dhubri 75.00
4 Hamidul Hassan Mahmud Ahmed Bongaigaon 73.67
OBC/MOBC 1 Akash Saikia Sonitpur 80.67
2 Mriganka Borah Lakhimpur 80.00
3 Pinku Saikia Lakhimpur 78.67
4 Archana Boruah Lakhimpur 78.67
5 Ujjal Choudhury Darrang 76.67
6 Bikash Borah Lakhimpur 76.33
7 Bhaskar Bordoloi Morigaon 76.33
8 Dipanjal Baruah Nagaon 76.00
9 Himangshu Samir Saikia Morigaon 76.00
10 Jitul Kumar Darrang 75.67
11 Rimjyoti Saikia Lakhimpur 75.33
12 Biju Mani Deka Darrang 75.33
13 Tapash Choudhury Darrang 75.00
14 Gautam Deka Darrang 75.00
15 Jayanta Talukdar Nalbari 51.67 Physically Handicapped
SC 1 Himanta Sekhar Das Nagaon 75.33
2 Gouri Shankar Das Jorhat 73.33
3 Sankar Jyoti Das Nagaon 72.00
4 Abinash Malakar Kamrup 71.00
5 Sumitra Mandal Nagaon 70.33
6 Jyoti Prasad Mudoi Nagaon 70.00
7 Ganesh Sarkar Dhemaji 70.00
ST(P) 1 Debabrat Deuri Sonitpur 79.00
2 Rashmi Rekha Boro Sonitpur 73.67
3 Jayanta Sonowal Jorhat 73.00
4 Raghunath Mipun Dhemaji 71.33
5 Kapil Kutum Jorhat 70.67
6 Dewan Sonowal Lakhimpur 70.00
7 Pradeep Pawe Lakhimpur 69.67
8 Aditya Hazarika Jorhat 69.33
9 Biswajit Hazarika Dibrugarh 69.33
10 Prince Tayung Dhemaji 68.67
ST(H) Quota 1 Biplop Daulagophu Karbi Anglong 64.33
2 Antony Dewri Morigaon 60.00
3 Sombudhon Phonglo Karbi Anglong 59.67
4 Biplob Gohain Lakhimpur 58.33
5 Lanthailiu Dahengmei Cachar 58.00
TGL/Ex-TGL 1 Mitul Karmakar Dhubri 70.33
2 Abinash Makha Golaghat 64.33
3 Krishna Kisku Baksa 63.67
4 Puja Nayak Sonitpur 61.00
Moran Community 1 Jibanita Gohain Tinsukia 59.67
Mattak Community 1 Bhaskar Jyoti Gogoi Dibrugarh 70.67
Previous selected candidates for admission into DMRHC (Contd..) Selected candidate District- wise,2012
District Name of the candidate % in PCB Remarks
Baksa Anamika Deka 78.67
Dipti Bezbaruah 78.33
Barpeta Abdul Karim 83.00
Md. Mahi Uddin 70.67 Physically Handicapped
Bongaigaon Abdul Hakim 80.33
Jahangir Alam Mondal 77.67
Cachar Hasina Begam Mazumder 70.33
Anuradha Paul 70.33
Chirang Rafiqul Islam 84.67
Kalyani Sarkar 78.33
Darrang Dhanjita Borah 80.67
Himanshu Saikia 78.67
Dhemaji KABERI BARUAH 75.33
KARISHMA CHUTIA 73.67
Dhubri Mustaque Reza 80.00
Ekbal Khan 78.00
Dibrugarh NOMITA SONOWAL 75.00
PRONAMI CHANGMAI 74.33
Goalpara Abul Hashem Talukdar 77.67
Abedul Islam Bhuiah 76.33
Golaghat Manash Mohan Hazarika 85.33
Nishita Dutta 81.33
Hailakandi Shahan Ahmed Barbhuiya 72.33
Mumina Momtaz Barbhuiya 72.00
Jorhat Himashree Saikia 85.33
Bishnu Saikia 83.33
Kamrup Shohidul Islam 81.33
Pampi Kakati 79.67
Kamrup (M) Sarifuddin Choudhury 83.00
Dima Hasao Namreiliakle Pame 76.00
Monjita Langthasa 70.33
Karimganj Begom Rubaiya Nazmin 85.33
Nirupam Das 75.00
Kokrajhar Sabir Uddin Ahmed 75.67
Saddam Hussain 75.00
Lakhimpur BHAGYASHRI GOGOI 80.33
Tulika Boruah 78.67
Morigaon Janifa Islam 78.33
Doli Phukan 77.33
Nagaon Bhaskar Borah 81.33
Jyotima Phukan 80.00
Nalbari Mridul Barman 79.00
Rana Ahmed 71.00 Physically Handicapped
Karbi Anglong Biren Chauhan 72.67
Urmimala Bora 71.00
Sivasagar Lakhi Moni Gogoi 76.67
Sharmim Akhtara Hussain 76.33
Sonitpur Achyut Saikia 81.67
Nayan Jyoti Saikia 78.00
Tinsukia NILAKSHI BHUYAN 73.33
BIKASH BORSAIKIA 66.67
Udalguri Debasish Nath 72.00
Sultana Najia Hassan 67.67
Previous selected candidates for admission into DMRHC (Contd..) Selected candidate Category- wise,2012
Category Sl. No. Name District PCB Remarks
Char Area 1 Sabina Yasmin Barpeta 80.00
2 Farida Yasmin Barpeta 79.33
3 Miraul Islam Dhubri 78.00
4 Shahidur Islam Akond Dhubri 77.67
OBC/MOBC 1 Priyanka Kakoty Golaghat 81.33
2 Munindra Neog Golaghat 81.33
3 Sneha Choudhury Jorhat 79.33
4 Monuranjan Bhajani Jorhat 78.67
5 Palash Boruah Lakhimpur 78.67
6 Shrawan Kishore Gogoi Golaghat 78.00
7 Shobnom Sultana Jorhat 77.67
8 Pranjal Kr Roy Barpeta 77.67
9 Jyotika Borah Jorhat 77.67
10 Bhagya Jyoti Nath Nagaon 77.33
11 Kangkan Jyoti Nath Morigaon 77.00
12 Nabashree Hatiboruah Lakhimpur 77.00
13 Subhalakshi Devi Lakhimpur 76.67
14 Nawab Asif Ahmed Golaghat 76.67
15 Jagadish Bora Darrang 67.00 Physically
Handicapped
SC 1 Kushal Pathak Barpeta 81.33
2 Manash Pratim Borah Jorhat 75.33
3 Prasenjit Chandra Sarkar Bongaigaon 75.00
4 Paban Bania Darrang 75.00
5 Tutumani Das Nalbari 74.00
6 Ratneswar Hira Kamrup 73.67
7 Barnali Das Barpeta 72.67
ST(P) 1 Niloy Pratim Saikia Jorhat 79.00
2 Pallabi Pegu Jorhat 78.33
3 Mouchumi Deuri Morigaon 77.33
4 Sarat Sekhar Bora Golaghat 74.33
5 Puspa Jyoti Pegu Lakhimpur 73.33
6 Dimple Pegu Lakhimpur 72.33
7 Ritan Basumatary Baksa 72.00
8 RUCHIRA DOLEY DIBRUGARH 72.00
9 Jiten Doley Lakhimpur 71.67
10 Rahul Payeng Dhemaji 71.33
ST(H) 1 Annie Pame Dima Hasao 69.00
2 Joyprakash Teron Morigaon 62.33
3 Davidh Nunisa Dima Hasao 60.00
4 SABNAM SHYAM Sivasagar 59.67
5 Mary Lalnuntluong Pakhumate Dima Hasao 57.33
TGL/Ex-TGL 1 Pallab Jyoti Pradhan Sonitpur 75.00
2 Jahid Amin Jorhat 73.00
3 Jyoti Rekha Murmu Kamrup (M) 71.67
4 Jutika Das Sonitpur 69.33
Moran Community 1 SABHYAJIT MORAN Tinsukia 53.67
Mattak Community 1 KORNEL CHETIA DIBRUGARH 71.00
Teaching and Training for DMRHC course
The knowledge of Medicine is imparted to the students in a systematic way. First they are started with basics of Community Medicine along with the basic subjects like Anatomy, Physiology and Biochemistry. Gradually they are imparted the knowledge of para clinical and clinical subjects.
The course is divided into 3 phases – Phase I, Phase II and Phase III.
The Curriculum in various phases
Phase I (First year)
(a) Anatomy.
(b) Physiology & Biochemistry as one subject.
(c) Community Medicine (Part I).
The Curriculum in various phases (Cont.)
Phase II (Second year)
(a) Pathology & Micro-Biology as one subject.
(b) Pharmacology.
(c) Community Medicine (Part II)
The Curriculum in various phases (Cont.)
Phase III (Third year)
(a) Medicine & Paediatrics as one subject.
(b) Surgery including Orthopaedics and basics of Eye, ENT & Dentistry as one subject.
(c) Obs & Gynae.
Affiliation of the Course
The course was started after the recommendation of Assam Rural Health Regulatory Authority.
In 2010 the course got its affiliation from the Health University of Assam- Srimanta Sankaradeva University of Health Sciences. Since then the University is conducting the examinations of the Institute.
Training Programmes
Classes start from 9 AM and continue upto 4 PM with lunch break of one hour in between.
Theory and Practical classes are conducted in the Institute building.
Bed side clinical classes for third year students are conducted in different department of Jorhat Medical College Hospital under the guidance of respective faculty members of the institute and part time teachers of Jorhat Medical College, Jorhat.
Training Programmes (Cont.)
The 3rd year students are allotted compulsory daily duty in the department of Obs. & Gynae and Causality department of Jorhat Medical College Hospital in divided groups in rotational manner round the clock, so that they can learn handling of emergency cases as First Contact Physician.
Each student has to record minimum 20 Nos. of delivery cases conducted by himself/herself.
Training Programmes (Cont.)
Much emphasis is given in Community Medicine. The subject is taught continuously for 2 years.
The 1st year & 2nd year students are taken for periodic field visit to the near by villages for proper exposure and sensitization of health problems and health status of the rural areas.
They are trained both theoretically and practically with an aim to making them efficient in handling all health related problems in rural areas as First Contact Physician.
Emphasis on Community Medicine
Training Programmes (Cont.)
They are also made to understand the severity of any medical problems of a community or a particular individual and to refer the cases accordingly to PHCs or District Hospital without delay.
Emphasis on Community Medicine
The Teaching Staffs
The Govt. of Assam has created the following post of teachers for the Medical Institute, Jorhat.
Principal – A person not below the rank of Associate Professor of a
Medical College with 5 years teaching experience or A Govt. Doctor with Post Graduate Degree/Diploma with 15 years of
experience. The present Principal was a Govt. Civil Hospital Doctor with MD
degree in Psychiatry and had a service experience of more than 25 year before joining as Principal.
The Teaching Staffs (Cont.)
Vice-Principal – A person not below the rank of Assistant Professor of a Medical College with 3 years teaching experience
or
A Govt. Doctor with Post Graduate Degree/Diploma with 10 years of experience.
The present Vice-Principal was a Govt. Civil Hospital Doctor with MD degree in Medicine and had a service experience of more than 15 years before joining as Vice-Principal.
The Teaching Staffs (Cont.)
Jr. Teachers – 13 Nos. with minimum MBBS degree. However some of the present Jr. teachers are having post graduate diploma.
Sr. Teachers – 11 Nos. with post graduate degree for each of the main subjects of the curriculum.
Till now they are not appointed and faculties of Jorhat Medical College are rendering services as and when required as part time Sr. Teachers.
The Teaching Staffs (Cont.)
Each of the regular teachers is entrusted as in-charge of one core subject and in addition as co-teacher of one or two other subjects.
Evaluation of Students
In each of the phases the evaluation of students is done by way of periodic terminal examination namely 1st and 2nd terminal examination and one final examination.
Over and above, part completion tests are done after completion of each subject topic on regular basis.
Evaluation of Students (Cont.)
A minimum 75% of attendance in theory classes of each subject and 80% attendance in practical, tutorials, demonstration, bedside clinics is compulsory for a student to appear in final examination.
Procedure of Examination
Terminal Examinations are conducted by the teachers of the Institute.
Final Examination for each Phase is conducted by the Health University.
Theory paper in Final Examination are set by the University.
Nature of question are – Long answer type, Short answer type and Objective type of question.
Practical and Clinical Examination are conducted in the Laboratories and Hospital wards.
Oral, Viva-Voce Examination includes evaluation of management approach, interpretation of common investigative procedures, preventive aspects of disease, etc.
Examiners/Evaluators
For each subject one External Examiner and one Internal Examiner are appointed.
Internal Examiners from the Institute itself are appointed by the University as per proposal of the Principal of the Institute.
As there is no Second Institute at present therefore, external examiners are appointed from the faculty of concerned subject of Medical Colleges of Assam.
Principal of the Institute or the Senior Most Teacher is appointed as incharge of the examination.
Distribution of Marks
For each of the theory papers – 100 Marks
In case of combined subject like Physiology & Biochemistry, Pathology & Microbiology, Medicine & Paediatrics and Surgery & allied subjects the theory marks are divided into 2 equal halves.
In case of Surgery 50 marks allotted for general surgery, the other 50 marks are allotted for Orthopedics, Eye, ENT & Dentistry
Practical/Clinical & Oral – Total 50 marks in each subject – 25 marks for practical/Clinical & 25 marks for oral
Repeat Examination
Result of examination is declared before the start of the next academic session.
Repeat examination is held after 1½ / 2 months for those candidates who fail to clear any subject/ subjects.
Promotion to Higher Class
After the end of final examination of Phase – I and Phase-II students are promoted to 2nd year and 3rd year respectively.
If any student of 1st year class fail to clear any subject / subjects then he/she can appear the repeat examination for the failed subject/ subjects and if fails again then must appear for the failed subject/subjects along with the subjects of the 2nd year class at the time of Phase-II examination
Promotion to Higher class (contd.)
If a student of 2nd year class fails to clear any subject/subjects then he is promoted to 3rd year and can appear the repeat examination for clearing the failed subject of 2nd year class. But if fails to clear again then he/she is not allowed to appear 3rd year final examination (i.e. Phase – III Examination).
One must clear all subjects of 1st year and 2nd year before appearing the 3rd year final examination.
STUDENTS AT THEORY CLASSES
STUDENTS IN EXAMINATION HALL
Pre-Registration Compulsory Internship Training
After successful completion of the 3 year DMRHC course, a candidate must undergo a pre-registration compulsory internship training for a period of 6 months.
1 month in Medicine Deptt. of JMCH.
2 months in O&G Deptt. of JMCH.
15 days in Paediatrics Deptt. of JMCH.
15 days in Casualty Deptt. Of JMCH.
2 months in nearby PHC/CHC
During internship period they work under the guidance of faculties of JMCH and Sr. Doctors of PHC/CHC.
Stipend
Presently a sum of Rs.3,000/- PM is paid to each of the interns during their internship period
Registration
After completion of the internship training the candidate must apply to Assam Rural Health Regulatory Authority for Registering himself/herself as a Rural Health Practitioner.
The Registration Certificate is signed by both Member Secretary and Chairman of the Authority.
Once Registered he/she becomes eligible to practice Medicine and Rural Health Care as a RHP in the Rural Areas of Assam.
Latest Modification of Registration Regulation
Regarding registration of RHP some modification of Regulations has been made recently as follows:-
The Registration of RHP will be made initially for a period of 5 (five) years and they have to undergo refresher training every 5(five) years for extension of their registration.
Some important provision of the Act regarding RHPs.
Chapter VII. 17(6) No Rural Health Practitioner shall use the word “Doctor” or “Dr” before and after his name. However he may identify himself as Rural Health Practitioner or RHP.
Chapter VII.21 (1) No person whose name is not enrolled or has been cancelled or removed from the State Registrar of Rural Health Practitioners shall practice Medicine and Rural Health Care at any place whether rural or urban in the State of Assam.
Power and Function of RHPs as per provision of the Act.
Chapter – IX 24
a) They shall treat only those diseases and carry out those procedures which shall be outlined in the rules;
b) They shall prescribe only those drugs, which shall be outlined in rules;
c) They shall not carry out any surgical procedures, invasion, investigation or treatment, Medical Termination or Pregnancy etc, but shall confine themselves to such medicinal treatment and perform such minor surgery as may be prescribed.
d) They shall practise only in rural areas as defined in the Act;
e) They may issue illness certificates and death certificates.
Power and Function of RHPs as per provision of the Act. (Contd.)
f) They shall maintain name, address, age, sex, diagnosis and treatment records of all patients treated by them, and
g) They shall not be eligible for employment in Hospitals, Nursing Homes and Health establishment located in urban areas as General Duty Physicians involved in patient care in OPD, Emergency and Indoor Services.
Provision of Penalties in the Act.
Chapter – VIII.21.(2) Any person who contravenes the provision of sub section (1) shall be punished with imprisonment, which may extend to 6(six) years or fine which may extend upto Rupees thirty thousand or with both.
.
Provision of Penalties in the Act. (Contd.)
Chapter – X 25 - Any person who: a) Dishonestly makes use of any certificate of
registration granted to him or b) Procures or attempts to procure registration under
the provisions of this Act by making or producing or causing to be made or produced any false or fraudulent declaration, certificate or representation whether in writing or otherwise, or
c) Willfully makes or causes to be made by false representation in any matter relating to the certificate or registration issued under provisions of this Act.
shall on conviction, be punishable, with imprisonment which may extend to one year or with fine which may extend to one thousand rupees or with both.
Provision of Penalties in the Act. (Contd.)
Chapter – X - 26.
(1) No court shall take cognizance of an offence punishable under this Act, except upon a complaint in writing made by the Secretary or any other officer authorized by the Authority in this behalf by general or special order of the Authority.
(2) No court inferior to that of a Magistrate of the first class shall try any offence punishable under this Act.
Provision of Penalties in the Act. (Contd.)
Chapter – X – 28 : Any registered Rural Health Practitioners who does not strictly follow the conditions laid down under section 24 of the Act shall be liable to be-
(a) Prosecuted under the provisions of this Act and on conviction may be imprisoned for 6 months or fined with rupees five thousand or both; and
(b) His name shall be removed from the State Register of Rural Health Practitioners.
Prescribed Diseases for treatment by RHP
* Acute Bacterial and viral infections.
* Parasitic Diseases like Malaria, Filaria etc.
* Common Respiratory Diseases like RTI, Bronchial Asthama, Bronchiactasis, Haemoptysis etc.
* Common GI Problems like Peptic Ulcer, Acute Gastritis, Diarrhoea, Dysentery, Intestinal Colic, Biliary Colic, Cholera, Acute Gastroenteritis, Food Poisoning, Haematemesis, malaena, Jaundice, helminthiasis etc.
Prescribed Diseases for treatment by RHP (Contd.)
* Common cardio Vascular Problems like Hypertension, Heart Failure, Angina, First Aid in IHD etc.
* Common Uro Genital Problems like UTI, Renal Colic, Retention of Urine, STD, Orchitis,
* Cystitis, Preliminary management of Nephrotic Syndrome and Nephritis etc.
* Common problems related to CNS like First Aid in CVA, First Aid in Unconsciousness, Preliminary treatment for epilepsy, status epilepticus, meningitis and encephalitis, First Aid in Spinal injury and Head injury, Preliminary Management of Common Psychiatric Disorder etc.
Prescribed Diseases for treatment by RHP (Contd.)
* Common Musculo Skeletal diseases.
* Common skin Diseases.
* Anaemia and nutritional deficiency disorders.
* Common metabolic diseases like Gout, Rheumatoid Arthritis.
* Common Gynaecological problems like menstrual disorder, leucorrhoea etc.
Prescribed Diseases for treatment by RHP (Contd.)
* Implementation of family planning programmes like prescription of oral contraceptives etc.
* Common Obstetric problems like Antenatal and Postnatal care, PET, Eclampsia, Pregnancy induced Hypertension, Anaemia and other common diseases during pregnancy.
* Paediatrics problems like Common bacterial and viral infections, respiratory infection, common diarrhoeal diseases, common nutritional deficiency diseases, neonatal jaundice, common skin problems.
Prescribed Diseases for treatment by RHP (Contd.)
* Common infective problems of Eye and ENT, Epistaxis, Foreign body in the ear and nose.
* Common dental diseases like Pyarrhoea, Gingivitis, Carries tooth etc.
* Emergency management of any Accident, Shock etc.
Procedures that can be carried out by RHP
* IM Injection, IV Injection/infusion, Venupuncture, venesection, application of bandages and dressings, nasogastric intubation, Oxygen Therapy, catheterization, peritoneal tap, normal delivery.
Operative procedure permitted
* Repair of minor wounds by stitching, drainage of abscess; burn dressing, wound dressing, application of splints in fracture cases, application of tourniquet in case of severe bleeding from wound in a limb injury.
* Conduction of delivery, episiotomy, stitching of vaginal and perineal tear during labour, Application of IUCD.
Drugs than can be prescribed by RHP
(THE AUTHORITY MAY MODIFY THE LIST FROM TIME TO TIME)
* Antacids, H2 receptor blockers, proton
pump inhibitors, sucralfate, any other medicine that controls acidity/hyper acidity.
* Antihistaminics.
Drugs than can be prescribed by RHP (Contd.)
* Antibiotics - effective against Gram - Positive Bacteria’ Gram - Negative Bacteria; Both Gram - Positive and Gram - negative Bacteria; Gram - Positive and Gram Negative Bacteria and Chlamydia & Rickettsiae; Fungi; Protozoa.
* Antithelminthics
* Antimalarials
* Topical Drugs - Antibiotic, Antifungal, Steroid, Analgesics, Antiseptic, Topical antithistaminic.
Drugs than can be prescribed by RHP (Contd.)
* Antiviral Drugs. * Antiamoebic Drugs * Antiscabies. * Anticholinergic * Antiemetics * Antipyretics and analgesics * Antispasmodic * Enzyme preparations, Anti Flatulent. * Laxatives
Drugs than can be prescribed by RHP (Contd.)
* Oral Rehydration Solutions.
* Hematinics and vitamins & minerals, Liver Support
* Diuretics and antihypertensives
* Nitroglycerine
* Sedatives and antiepileptics
* Bronchodilators
* Expectorant.
Drugs than can be prescribed by RHP (Contd.)
* Uterine stimulants and relaxants, oral contraceptive pills.
* Surface and infiltrative anaesthesia for repair of minor injury etc.
* Antibiotic Eye Drop and ointment.
* Nasal decongestant.
* Skeletal Muscle relaxant - Oral tablet.
* Haemostatic
* Antirabies vaccine
Drugs than can be prescribed by RHP (Contd.)
* Anti Snake Venom
* Life saving drugs
Drugs under National Health Programme
can be distributed by Rural Health
Practitioners (RHP) as per guidelines of
the programme.
The Success Story
RHPs are presently working in Rural areas of Assam after appointment by NRHM with a fixed salary of Rs.20,000/- per month.
Till date total 354 RHPs have been appointed in the sub-centres as the incharge of the Centres.
They are rendering highly commendable services in the community by seeing OPD cases and conducting normal deliveries over and above normal administrative and other day to day works as an Incharge of the Centre.
The Success Story (Contd.)
Doctors and General people who were sceptical about the course and functioning of RHPs at the beginning of the course are changed now after their performance in the communities and have started accepting and appreciating their activities.
Engagement of RHPs under NRHM, Assam
Year RHP Engagement under NRHM
2009 92
2010 90
2011 79
2012 93
Total 354
Plus 72 Nos. of RHP appointed in
January,2014
Performance of 354 Nos. of RHPs
2010-11 2011-12
OPD at SC
OPD at Others
Delivery at SC
Delivery at Other
OPD at SC
OPD at Others
Delivery at SC
Delivery at Other
304463 137250 242 1968 662267 174443 4484 2730
2012-13 2013-14 (Up to Feb'14)
OPD at SC
OPD at Others
Delivery at SC
Delivery at Other
OPD at SC
OPD at Others
Delivery at SC
Delivery at Other
819415 83584 11415 1042 949254 25908 14367 677
Total (Up to Feb'14)
OPD at SC
OPD at Others
Delivery at SC
Delivery at Other
2735399 421185 30508 6417
2
6
7
14
22
24
27
28
29
33
35
56
77
91
10
1
10
6
11
9
16
8
19
7
21
8
23
7
24
4
25
1
25
6
25
9
26
0
26
3
26
6
27
5
27
8
28
3
28
9
29
1
29
4
30
0
30
6
31
9
32
8
33
4
33
7
34
1
34
6
34
7
34
7
3
18
33
52
93
13
4
17
8
21
1
24
2
29
5
34
4
45
5
65
9
93
9
1,2
32
1,5
46
1,9
13
2,5
50
3,2
17
3,9
57
4,7
26
5,4
01
6,1
32
6,7
45
7,4
73
8,3
68
93
09
10
24
7
11
42
5
12
68
2
13
89
6
15
03
2
16
14
1
17
05
6
17
97
1
18
78
9
19
91
4
21
20
5
22
55
8
23
89
9
25
40
7 27
21
1 29
07
2
30
50
8
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Jul/
10
Au
g/1
0
Sep
/10
Oct
/10
No
v/1
0
Dec
/10
Jan
/11
Feb
/11
Mar
/11
Ap
r/1
1
May
/11
Jun
/11
Jul/
11
Au
g/1
1
Sep
/11
Oct
/11
No
v/1
1
Dec
/11
Jan
/12
Feb
/12
Mar
/12
Ap
r/1
2
May
/12
Jun
/12
Jul/
12
Au
g/1
2
Sep
/12
Oct
/12
No
v/1
2
Dec
/12
Jan
/13
Feb
/13
Mar
/13
Ap
r/1
3
May
/13
Jun
/13
Jul/
13
Au
g/1
3
Sep
/13
Oct
/13
No
v/1
3
Dec
/13
Jan
/14
Feb
/14
RHP Performance (Cumulative Trend) Up to February 2014
No of SCs where Delivery Occurred(CUMULATIVE)
No of Deliveries(CUMULATIVE)
2
6
5
11
17
15
17
18
12
19
20
43
59
69
70
75
87
14
9
15
7
18
4
19
5
19
2
20
1
17
7
18
7
18
4
19
6
19
4
22
6
21
2
22
3
22
6
22
7
22
3
22
2
22
0
25
8
27
0
27
3
27
3
28
5
31
0
31
1
28
6
3
15
15
19
41
41
44
33
31
53
49
11
1 2
04
28
0
29
3
31
4
36
7
63
7
66
7 74
0
76
9
67
5
73
1
61
3 7
28
89
5
94
1
93
8
1,1
78
1,2
57
1,2
14
1,1
36
1,1
09
91
5
91
5
81
8
1,1
25
1,2
91
1,3
53
1,3
41
1,5
08
1,8
04
1,8
61
1,4
82
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000Ju
l/1
0
Au
g/1
0
Sep
/10
Oct
/10
No
v/1
0
De
c/1
0
Jan
/11
Feb
/11
Mar
/11
Ap
r/1
1
May
/11
Jun
/11
Jul/
11
Au
g/1
1
Sep
/11
Oct
/11
No
v/1
1
De
c/1
1
Jan
/12
Feb
/12
Mar
/12
Ap
r/1
2
May
/12
Jun
/12
Jul/
12
Au
g/1
2
Sep
/12
Oct
/12
No
v/1
2
De
c/1
2
Jan
/13
Feb
/13
Mar
/13
Ap
r/1
3
May
/13
Jun
/13
Jul/
13
Au
g/1
3
Sep
/13
Oct
/13
No
v/1
3
De
c/1
3
Jan
/14
Feb
/14
No
of
SC A
ND
No
of
De
live
rie
s
Month
RHP Performance (Month Wise Trend) Up to February 2014
No of SCs where Deliveryoccurred(MONTHLY)
Number of Deliveries(MONTHLY)
Number of OPD cases treated by RHPs (provisional)
Till Feb,2014, 31,56,584 Nos. of OPD cases were treated by the RHPs in the Sub-Centres & other centres.
The breakup is as follows:
2010-11 = 441713 Nos.
2011-12 = 836710 Nos.
2012-13 = 902999 Nos.
2013-14 = 975162 Nos. (upto Feb,2014)
Some photographs showing different activities of the students of
Medical Institute, Jorhat & RHPs
Health Check up camps by Students and Faculties in Rural Areas
Health Check up camps by Students and Faculties in Rural Areas
Students taking information from the families in the Tea Estate
Our Experiences
Service of the RHPs is the only successful solution for the present crisis of Health Care Delivery System in the rural areas. Their services are easily accessible and acceptable by the Rural masses and have effectively bridged the gap in the system in those areas where they are working.
The general public are happy for their services. People know that they are not the substitute of MBBS Doctors but they are acting as supplementary to the health care delivery staff in the community.
What we learnt from the last eight years of activities?
Our Experiences (Contd.)
Right now they have been appointed on contractual basis through NRHM. Their permanent or regular appointment by creation of new posts for them in due course of time would certainly help to uplift the health status of the rural masses.
Our humble submission
Each and every state of India may adopt this programme.
To begin with immediately – Medical Institute may be established in a District Hospital for which a very negligible amount of budget provision shall be required only for construction of class rooms, laboratories and demonstration rooms. Superintendent of the Hospital may act as Principal. The doctors of the Hospital particularly with PG Degree/ Diploma may be entrusted the job of teaching for which they may be paid an honorarium only.
Our humble Submission (contd.) Doctors with PG Degree in medicine can teach
Physiology & Biochemistry, Pharmacology, Community Medicine, General Medicine.
Doctors with PG Degree/ Diploma in Paediatrics can teach Physiology & Biochemistry, Pharmacology, Community Medicine, Paediatrics.
Doctors with PG Degree/ Diploma in O&G can teach Obstetrics and Gynaecology.
Docotrs with PG Degree in Surgery can teach Anatomy, Orthopaedics, Basics of Eye & ENT, General Surgery.
Doctors with PG Degree/ Diploma in Pathology can teach Pathology and Microbiology.
The other Doctors may be involved in tutorial/ demonstration/ practical classes.
Our humble Submission (contd.)
Teaching and training must be systematically done right from the basic subjects like Anatomy, Physiology & Biochemistry along with Community Medicine.
No clinical class should be started before imparting knowledge of basic subjects.
Imparting the knowledge of clinical subjects without knowledge of basic subjects shall produce persons with confused knowledge of clinics compelling them to become quacks only.
Conclusion
Execution of such a programme is a very difficult task or rather impossible without a strong political will.
Raising public awareness, awareness amongst Doctors and Paramedical Staffs shall help in proper execution of the Programme.
