The Evolution of Medical Education and Practice in Goa
S. D. Nadkarni
Evolution is a continuous process, and in this article, it is shown how Goa, a state on the western coast of India, has witnessed this change and evolved in the field of medical science throughout the past five centuries.
1. Pre-Portuguese Era:
Though no confirmative data is available, it is universally accepted that medical practice (healing) was family oriented, by families of Vaidya. Vaidya was a popular and respected person. Those who treated the kings and their families were known as Raj-Vaidya’s. Amongst them there were different cadres as far as treatment was concerned, yet the source of medicaments was common, obtained from herbal origin (roots, bark and leaves of trees). They also used bhasma and churna in addition to decoctions made in their ‘rasashalas’ (laboratories or place for making preparation) This practice continued for generations. Some healers from different affluent families would usually treat patients gratis. We have a well-reputed family of Vaidya’s from Antruz Mahal of Ponda Taluka, the authority among them is Dr. Dada Vaidya, whose statue proudly stands at a prominent place in Ponda. In the capital city Panaji, there is a prominent road named after him. In the villages, a particular person used to give medicines to needy persons. Neither the identity of the medicine was disclosed nor was the efficacy scientifically established. Even nowadays, in certain parts of Goa, vaidyas still distribute local medicines and powders, wrapped in paper commonly used for illnesses such as jaundice. Yet they do not charge fees to the patient. In the local language slang this medicine is called “Gaonthi or Zadpallyachem Wakhad.” Elsewhere in the state, people are not qualified to practice this under the name of Ayurveda, which is an ancient science in its own place of prestige (Ayur–Life, Veda– Knowledge.)
2. Era of Scientific Medicine:
Goa can boast of its place with pride as far as scientific medicine is concerned. Goa under the Portuguese rule had the privilege of being in the first place in Asia where hospital-related medical treatment was initiated in the year 1512, when the first hospital was opened known as “Hospital Real do Espirito Santo.” This was in Old Goa where at present, there is the shrine of Saint Catherine’s chapel. It was run by Jesuit priests. In the year 1600, a spacious two-storey hospital building was constructed that could accommodate 3000 beds. There are references made to this hospital in the accounts of illustrious travelers to Goa at that time. Francois de Pyrard, Le Blanc and others who quoted phrases such as “It was the most beautiful and best equipped hospital in the world.” The city had a population of about 4,00,000. One epidemic of small pox or plague could have wiped out the entire city. Survivors migrated. Subsequently Hospital Real was transferred to Panvelim in the year 1765.
In addition to this main hospital others were started such as, “Hospital de Todos os Santos” founded in the year 1547 by a voluntary institution called “Santa Casa de Misericordia,” where treatment was given gratis irrespective of race, creed, or caste, and “Hospital Nossa Senhora de Piedade” maintained by the Viceroy which merged with the previous one in the year 1784 and was shifted to Ribandar until it was transferred to Bambolim Medical Complex. The benefit of these hospitals was derived by the population of the“Velhas Conquistas,” a group of four districts of Central Goa. The “Hospital de S. Lafaro” opened in 1530 for the benefit of patients suffering from communicable diseases and specially for lepers, run by government that was closed down in 1840 and finally the smallest “Hospital dos Pobres” founded by Fathers of the Society of Jesus, attached to Colegio de S. Paulo, a University, with about 3000 students coming from different parts of Asia was also run by the same society.
In Goa under the Portuguese rule before its liberation most of the hospitals and health centres managed to provide health care as well as sanitation to urban areas that were covered under municipalities. There was no institution such as the Panchayat. In far flung areas, the population was deprived of scientific medical facilities. They were at the mercy of healers and devout persons who distributed roots, leaves, powders, and poultices. A prominent person in the area would be appointed as the Juizo Popular (special executive magistrate) as also Regador (present post of Talathi) who provided information, issued necessary certificates to the person in their respective area to enable them to obtain necessary facilities depending on their socio-economic status. There where persons appointed as Cabo de Policia, equivalent to the village headman for a similar purpose.
Hospital Central the only general hospital that functioned in Panaji, could be called teaching hospital as it was attached to a teaching Institution School, the first of its kind in Asia, “Escola Medico-Cirurgica de Goa.” Its capacity was then 100 beds. The other general hospitals were run by voluntary organizations such as Ribandar Hospital established on 13th December 1867 and Asilo Hospital in Mapusa with 70 beds founded on 6th November 1867. Regional hospitals each with a 10-bed capacity each at Ponda, Sanguem, Sanquelim, and Vasco-da-Gama and two quarantine (isolation) hospitals for infectious diseases, located at Reis Magos and Collem, having 8 and 12-bed capacity respectively were started. Also (tuberculosis) TB Sanitorias in Margao, Santa Inez, and a third at Corlim were started. Likewise, a leprosy hospital at Macasana, and a psychiatry hospital established in Chimbel in the year 1931, and subsequently shifted to Altinho, Panaji in 1957: (Institute of Psychiatry and Human Behaviour). There was also a Hospital Militar, a military hospital, which also still exists in Campal. Details are not known, and it probably served the defense personnel as the name suggests.
3. Medical Education Post-Liberation from Portuguese:
Health education and practice continued to change. The post-liberation period from 1961 to 1963 was ‘status quo ante’ as the Government of India recognized the services as one of the best in the country. An important milestone was upgrading the Escola Medico Cirurgica de Goa (EMCG) to a full-fledged Medical College in the year 1963 (from the continental system to the Anglo-Saxon). The transition period was full of difficulties concerning teaching different subjects, space constraints, lack of proper teaching staff etc. The departments were on makeshift basis, yet, with the coordination and collaboration of the staff members of EMCG and deputationist visiting professors from Bombay University College, the situation eased. The first batch of students moved from pillar to post as everything was different. The visiting faculty did an excellent job of bringing this institution to its present state.
The health and sanitation of Goa was under the “Direçao de Saude,” today known as the Directorate of Health Services. Then, they had a blood bank and a vaccine institution which are now discontinued. The Goa Medical College (GMC) was formally inaugurated by the Union Health Minister, Dr. Sushila Nair, in September 1963. The director of EMCG, Dr. Pacheco Figueiredo, was made the first Dean. The college was yet to be recognised by the Medical Council of India (MCI). GMC was affiliated to the University of Bombay. Dr. Savlaram G. Vengsarkar was appointed as the Project Officer for the formation of a full-fledged GMC complex with Hospital Central and Ribandar Hospital as teaching hospitals during the upgrading process. A statement made by Dr. S. Nair during her inaugural speech was that on the west coast of our country, GMC would be elevated as the 9th research institution in the country. Dr. Bala Subramanyan became the next Dean during this transition. Dr. SG Vengsarkar pursued the matter of making GMC part of a larger complex, with the Ministry of Health. Dr. Duarte Monteiro, the architect of the renovation and upgrading process from EMCG to GMC (old), was the liaison between GMC and the University of Bombay. The process continued with further addition and development of various departments until it was shifted to Bambolim. Currently, GMC admits not only Goans but also North Kanara and South Maharashtra graduates/post graduates for training who then go on to continue practice in different talukas/cities in Goa as well as many overseas jobs.
Many tertiary care hospitals were started in Goa such as Vrundavan, Vintage, Apollo Victor, SMRC Nusi hospital. Further, many nursing homes such as CMM Polyclinic were also started in all cities which were known to give good services to patients. Currently, Goa is a chosen health tourism state. Recently, a hi-tech hospital with the latest amenities has been commissioned at Vasco-da-Gama, besides so many other small nursing homes in various talukas of Goa.
Consequences and Factors Influencing the Impact of Medical Practice in Goa:
Many of the alumni qualified from EMCG chose to go to Bombay Municipal Hospitals for post graduate training in various disciplines. Some chose either general medicine, ophthalmic and surgical practice in different cities of Goa. Some were looked upon as specialists. There were Health officer who practiced privately after duty hours. These facilities existed in talukas. The villages remained underprivileged as far as health facilities were concerned. After graduation from EMCG, sometimes there resulted a saturation point of more graduated doctors with not enough vacancies or opportunities for further placement. Many a graduate had to work in government offices such as Sub-registrar cum Civil Registrar, Administrator of Communidades, and other offices, till a vacancy was created. Sometimes, by the time a post was available many had left medicine to take up a business instead, such as mining or agriculture.
As said earlier, evolution is a continuous process. GMC could evolve in the coming years into one of the best if it is properly managed. Government facilities in the health sector are usually the best as they serve large numbers of people and it is affordable and partly gratis.