Alas! Only Small steps are taken in India: Civil Aviation Medicine

Civil aviation in India is booming  – a second airport is in offing in Mumbai; Mysore airport opened for commercial flights and more tier 2 cities are preparing to connect to the regional aviation hubs; and the airfare related war of words between the airlines and the government continues. But what does it bode for the practice of Civil Aviation Medicine in India, in terms of medical assessment of pilots, airport clinics, and airlines’ medical departments?

Couple of years back, when the Medical Evaluation Centers of the Indian Air Force were overwhelmed by requests for appointments from the aspirant pilots  for medical assessment, the third Centre was set up, besides DGCA granting approval to three corporate hospitals for undertaking initial Class I medical assessment. Such interim arrangements are small steps but too little, too late.

Foremost is the need for decentralization of the medical assessment. The aspiring youth wishing to pursue flying as a career are not only required to be evaluated today for being fit for initial issue of commercial pilot license (CPL) but they should also remain fit to exercise the privilege of the license during their productive years: without disease or disability affecting their career adversely. In the short term it is likely that the Air Force’s Director General Medical Services, the medical advisor to DGCA, may continue providing succor, thus maintaining the status quo. But is there a possibility of medical assessment going out of the hands of the Air Force to the corporate hospitals or even to individual practitioners, the Designated Aviation Medical Examiners (DAME)? Would there be a need for an arbitrator in cases of disputes between the individual pilots and hospitals? It is here that DGCA has hard choices to make. Yet decisions are required to be bold and out of the box, while matching the international practices.

Increasing public pressure and the overwhelming demand in a market driven economy demands long term solutions, away from governmental controls but with a vigilant regulator in place. This may also forebode a major change in the corporate hospitals over-focussed approach of curative care towards the preventive care and occupational health. There shall be a need for them to hire Aviation Medicine specialists to run their newly commissioned aviation medicine departments meant to undertake and coordinate medical licensing, preventive care and occupational health of the aircrew under their care.   Chennai based Apollo Hospital has already hired a bright young Aviation Medicine specialist, signaling the beginning of a small change in the right direction.

With the increasing demand for better connectivity, and the Airport Authority of India in the process of commissioning several modern airports across the country, there shall be mandatory requirement for setting up Airport Clinics. This is required to provide both the emergency care and public health facilities at each airport – national or international. Public health concerns are more imperative to be addressed, particularly in view of SARS virus epidemic, swine flu threat or a recent report of a case of cholera on a US bound flight. In the absence of mandate for Aviation Medicine specialists to run these airport clinics,  existing facilities are manned by general physicians. Yet the need of the hour still remains that the specialists in Aviation Medicine man the clinics to render holistic care, both to the passengers in need as well as public health related supervision for the larger passenger safety in terms of food, hygiene and sanitation, besides the urgency of screening of suspected cases of infectious diseases. Here again, unless the Ministry of Civil Aviation or DGCA mandates, such a change seems unlikely.

The tragic crash of the Air India Express at Mangalore is a grim reminder of responsibilities of the regulator, airline and the individual. DGCA, the regulator, has the responsibility of not just balancing the work-rest schedule, the Flight Duty Time Limitations (FDTL), but also ensuring its implementation by the air carriers. This is their responsibility towards the public safety. The airlines owe their responsibilities to their pilots to ensure that the safety of the fare paying public is never compromised. Each pilot, too, has to display “personal professionalism” at all times, for his/her well-being while ensuring safety of all those flying under his/her command.    

Indeed it is here that the practitioners in Aviation Medicine can make meaningful contributions to individual well-being and aviation safety. With the ever increasing pressures on the pilots in the commercial aviation sector, it may be prudent for the airlines  to hire Aviation Medicine specialists to ensure better care of their pilots. Such airline Aviation Medicine specialists have role and responsibilities akin to that of the squadron medical officer in military aviation. He shall be responsible for rendering care at the individual level. But such care shall not be limited to the curative care alone; instead it is meant to help the aircrew, including the cabin crew, prolong their productive career by staying physically and mentally fit. Going beyond the conventional role of being the medical care-giver, he may also be called upon to handle various social and personal issues, including pregnancy, maternity and paternity leave, besides being the friend  to those aircrew undergoing emotional or personal upheavals due to operational demands and the changing family dynamics in the country. He shall also be required to be the Human Factors advisor to the Operations head in the Airline, to contribute his mite towards airline’s aviation safety policies and their implementation.

The moot point is do the airlines have their ears to the ground, or are they waiting for DGCA to bring in such regulations while the pilots remain under the pressures of operational needs, and the safety continues being overlooked!