Interview: Why medical courses in non-English languages will burden students and create barriers

The Madhya Pradesh government on October 17 released three medical textbooks translated into Hindi as part of its move to introduce the language as the medium of instruction for the Bachelor of Medicine and Bachelor of Surgery, or MBBS, degree.

This is in line with one of the central aspects of the National Education Policy, 2020, to promote Indian languages as the medium of instruction in higher education. The National Medical Council is in talks with the education ministry and other stakeholders to introduce the teaching of medicine in other regional languages as well. Doctors’ associations, however, have criticised the move as “retrograde”.

Scroll.in spoke to Dr S P Kalantri, Director Professor of Medicine at MGIMS and Medical Superintendent of Kasturba Hospital, Wardha, on the implications of teaching modern medicine in multiple regional languages.

One of the main reasons cited in favour of teaching medicine in regional languages is that a vast majority of students who have been schooled in their native tongue are unable to access medical education because of the language barrier. Your comment.

Partly true. Students from vernacular schools have perennially faced this challenge – mastering Medicine in a language they have difficulty reading, writing, understanding or speaking. Therefore, when they enter medical school, they face a dual challenge: conquering a language they are not confident in and getting a grip on the vast syllabi.

Students educated in an English medium school start with an advantage, but if our decades of experience is anything to go by, within a few months the gulf between the two categories of students vanishes. The students who come from non-English schools do as well as – if not better than – their counterparts who boast of their command over spoken and written English. It requires a bit of an extra effort, but students realise that the time spent on bridging the gap is worth it. Many students with such backgrounds go on to become great teachers, researchers, public health activists and physicians.

As a corollary, votaries of this move also say that rural India continues to face a shortage of doctors because doctors refuse to serve in rural, remote areas, and that if students from these areas are able to access medical education, they will be, as trained doctors, more favourably disposed to serving in these places.

This is a myth. I do not buy the argument that students from rural India are more likely to go back and serve the rural populations because they came from villages. I teach at MGIMS, a 53-year-old medical school located in a village. Until NEET [the National Eligibility cum-Entrance Test for admission to undergraduate medical courses] arrived, [we] scrupulously reserved four of the 64 seats for MBBS admission for students coming from rural backgrounds.

Yet, our experience shows that very few students who availed this opportunity and privilege went back to serve the villages after obtaining their MBBS or MD. Today, doctors go to small towns, not by choice but because of competitions they face in the big towns or the bonds they have to serve. Given a choice, a fresh graduate from a medical school, rural or urban, will opt for a city and not the village.

What challenges do you foresee in the teaching and learning of medicine in Hindi and other regional languages?

The Indian Constitution recognises 22 official languages. India is a multilingual country: a multiplicity of languages spoken in India. With medical admissions not restricted to a region, students speaking diverse languages learn medicine in medical schools.

As an example, a Tamil-speaking student obtains admission in a medical school in Maharashtra, where the medium of instruction is Marathi. And the teacher knows only English and Punjabi. How would the teacher and students interact in a language, none of them are familiar with? Instead of easing the burden, we shall end up adding one more – mastering a language you never learnt until you entered medical school.

Medicine has a rich history, but few of us realise that so does its vocabulary: fifty-eight per cent of medical terms are from Greek, 22% from Latin and 3% from English. It would be well-nigh impossible to translate Greek and Latin into Hindi or Telugu. Also, the Hindi in the textbooks is an alien language when compared to the Hindi we actually speak.

Wouldn’t the employability of such doctors in areas outside their state also be called into question? Wouldn’t their mobility be severely restricted and therefore their growth as physicians/clinicians/researchers?

Absolutely. If faculty at AIIMS Delhi is transferred to AIIMS Hyderabad and subsequently moves to a medical school in Bhubaneswar, do you expect them to master a new language every time they seek a new job? The older you get the more difficult it is to learn to speak French like a Parisian.

A vast majority of medical, pharmacology literature, journals and other publications are in English. How will this potentially impact students learning medicine in their regional language?

The dominance of English in international academic publications has increased manifolds during the last few decades. The vast majority of indexed science journals, including those previously published in other languages, have shifted to English. Journals prefer English to acquire a broader international authorship and readership and to reach higher impact.

Medical students are now expected to ride the wave of globalisation, while addressing regional problems during their training in the medical school and subsequent practice. Medical researchers might face great problems publishing their research in reputed international journals such as Lancet, BMJ and JAMA [Journal of the American Medical Association] because of language barriers. This will also promote a culture of ghost writers, which the researchers would have to seek, if they wish to have their original research published.

The vast majority of high-impact journals are in English. Let us not ignore the costs in time and effort, since medical researchers trained in non-English languages shall need more time to turn in their papers into a standard English language version, often relying on professional translators or ghost writers. Researchers know very well the striking differences in acceptance rates for non-native compared to native authors as well as longer processes of revision and resubmission. This adds to the costs and lowers the productivity of researchers who are non-native-English speakers.

I don’t see “pure” regional textbooks; instead, there will always be hybrid books that contain both English and the regional terms. Medical terms and terminologies are always in English – the organs, tissues, muscles, nerves, cells, enzymes, drugs, and diseases have English names.

As an example, the arm muscles are called latissimus dorsi, pectoralis major, serratus anterior and extensor digiti minimi. [The] Madhya Pradesh government recently released textbooks for three subjects in Hindi for MBBS students. I was surprised to see the title of the anatomy textbook “The Upper Limb”. The words have not been translated, merely English has been replaced by devnagari script. How would this help students?

Considering all the pros and cons of both scenarios – of continuing medical education in English or offering medical education in regional languages – what in your opinion would be an ideal balance?

Use of national languages would facilitate the communication and education process and health promotion. I suggest that medical schools should continue to teach in English. Producing and translating reference materials in regional languages would take enormous time, skills and efforts. Let’s make haste slowly.

Many children in India grow up in a bilingual environment. Teachers can also turn bilingual when they explain concepts in classrooms or at the patient’s bedside – a practice normally followed all over the country. Bilingual approach might help teachers connect their students with the local culture, and in addition to the science part, the students will learn the soft part – empathy, compassion, and kindness.

China, Japan, Germany, Ukraine, Russia are often cited as examples of countries that teach medicine in their respective languages. To what extent is this true and the comparison with India fair?

China, Japan, Germany, France and Italy are some examples of countries that have progressed and prospered in their native languages.

Except in eastern Europe and China, medicine is taught in English. English is a global language, a language of the internet. By hastily implementing regional languages in medical education, we might dilute the quality of medical education, intensify the language barriers and trigger divisive emotions.

This strategy might also seriously limit the options of students seeking to study in the western countries. As an example, students have to take The International English Language Testing System [IELTS] test – the world’s most popular English language proficiency test for higher education and global migration.