Physiotherapy was brought under the Rehabilitation Council of India (RCI) vide a notification dated October 13, 1998. ``This was a major setback for qualified physiotherapists in the country,'' views Dr Vishwa Prakash Gupta, phy- siotherapist at the All India Institute of Medical Sciences, New Delhi, and organising secretary of IAP. ``By clubbing physiotherapy with rehabilitation, the government seriously undermined the professional status of physiotherapists, besides creating avenues for quacks to prosper,'' he says.

RCI covers some 17 technical and medical fields, with no stand-aloneguidelines for any of these streams. By bringing physiotherapy under the purview of RCI, ``rehabilitation workers have been encouraged to poach into physiotherapy without due certification and experience,'' Gupta says.

Physiotherapy is quite different from rehabilitation. Rehabilitation is for patients who are already suffering from some form of disability. Whereas, physiotherapy is meant for saving patients from disability arising out of any disease. ``Only 3 per cent of the physiotherapists work in rehabilitation programmes,'' he adds.

The importance of the profession can be gauged from the fact that it covers treatment of trauma/diseases and weaknesses in all stages of health-care delivery systems for all age groups. It helps patients with diabetes, hypertension, heart problems, eye, ear, nose and lung problems, bed-ridden patients, those with arthritis, fractures, post operative complications, paralysis, etc. Yet, the profession has not been recognised by the government as a separate system ofmedicine.

Dr Sarla Passi, senior physiotherapist at Safdarjanj Hospital, New Delhi, and chairperson of IAP, says that there are vested interests that have scuttled the professional growth of physiotherapists in India. ``The medical fraternity has people with larger-than-life ego. They have seen to it that physiotherapists in government hospitals get a raw deal,'' she says.

Passi feels that government hospitals could have set up separate OPDs for physiotherapy. ``But, that would given the physiotherapists autonomy in their work, which the hospital administrators did not want,'' she adds.

In the absence of a statutory body for physiotherapy, there has been no regularisation of service conditions for government employed physiotherapists, and no standardisation of education in physiotherapy.

``Every government hospital sets its own rules regarding physiotherapists. Posts are created at the whims of the administrators. Certain posts are left vacant for years, even when there is dire need of additionalmanpower,'' she says. ``Promotion is nearly non-existent for physiotherapists,'' she adds. Passi herself received just one promotion in her 35-year stint with Safdarjung Hospital.

Such an atmosphere has had a debilitating effect on the professionals. Gupta refers to a survey conducted by IAP in 1996 which revealed that 58 per cent of physiotherapists on graduation took up overseas assignments, 25 per cent set up their own practice and a mere 17 per cent joined the government service. Because of this, government hospitals are faced with severe shortfall of physiotherapists. Unfortunately, their place is being taken up by retired army `potas', the term for physical occupational therapy assistants.

``The government has allowed retired `potas' to join government hospitals as full-fledged physiotherapists and are placed at par with those who have secured a degree in physiotherapy,'' says Passi.

She wonders why the `potas' have been given this opportunity when the army itself does not trust their competencein physiotherapy.

Many other loopholes exist for want of a monitoring mechanism in the practice of physiotherapy. ``Sometime back the government initiated the training of medical rehabilitation workers (MRWs) who were supposed to go to the peripheral regions to render their service after their 10-month training. But, these people, instead join various private medical centres in the cities as technicians, and double up as physiotherapists, though they possess just a 10th standard certificate. The government has knowingly allowed this malpractice to happen,'' says Passi.

Gupta says that the central problem lies in that physiotherapy is covered under three separate ministries--health, family welfare and HRD, with no coordination among them. ``A statutory council for physiotherapy would have solved all these problems,'' he reiterates.

The Delhi government, at the instance of Dr Harshvardan, former health minister of Delhi, notified on October 12 the setting up of a council for physiotherapists in the state.``However, with the change of government, this notification is under review,'' says Gupta.

``States like Karnataka, Orissa, Maharashtra, Bihar have been moving towards setting councils for physiotherapy. But, the RCI Act has stalled the progress,'' he adds.

Whatever has been achieved so far in this stream is due to the untiring efforts of IAP. The association is recognised by the World Confederation of Physical Therapy. Last year, it held seven camps for over 2,000 patients. ``This year we wanted to expand our programmes, but we have been handicapped by lack of manpower,'' says Gupta.

``IAP will be organising many free physiotherapy camps, seminars and other scientific activities which will definitely prove to be useful for quality health care to the fellow citizens of all age groups,'' he concludes.