"Need for Expert Medical Guidance for Military Selection & Training," Says Col. IVS Gahlot, Former CO, MH Khadakwasla

Col. IVS Gahlot (Retd), a former CO, MH Khadakwasla spoke to MVI on the need to understand and follow advice of military medical professionals as part of the selection and training process of soldiers & officer cadets.

Editor's Note :

This article was published by MVI on 25 Apr 2021 .

It is now being republished due to its relevance in the present times due to the 'su moto ' hearing on 18 Aug 25 by a bench of the SC about the 500 medically boarded out cadets from our military academies .This article is an interview of Col IVS Gahlot that throws ample light on various technical matters about the selection and training systems of recruits and cadets . Col Gahlot, being a military doctor, has vast knowledge not only about medical and physical fitness aspects as required in the armed forces but also has rich experience of being the CO ,MH Khadakwasla, NDA where he dealt with medical care ,health and well being of cadets and more importantly the physical injuries that they sustained during training that often resulted in many of the affected cadets being medically boarded out . His exposure as MO of a Recruiting Office gave him exposure and experience of our recruitment system for jawans. His appointment as Director Medical (ECHS Scheme) at MoD " Delhi gave him complete knowledge and experience about our ex servicemen contributory health scheme as applicable to all ranks of ex servicemen .

Hence, this interview contains a lot of valuable information that needs to be read and grasped by those concerned with the 'su moto' case about cadets being deliberated in our apex court and get a holistic picture about our prevailing systems of selection and training . The present case in the SC must be seen against the backdrop of what Col Gahlot has said in his Answers to the 10 probing Questions that MVI asked him in Apr 2021 .

Editor MVI

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Introduction

Mission Victory India (MVI) is indeed grateful to Col. IVS Gahlot (Retd) for giving this interview despite his hectic schedule. I personally interacted with Col. Gahlot when he was CO MH Khadakwasla and we had several interactions with then Commandant Armed Forces Medical College (AFMC), Air Marshal Keshav Rao and his concerned staff when they were setting up the AFMC Sports Medicine Wing. We also discussed several issues in context with imperative need of expert medical advice during training at NDA with then Deputy Chief Integrated Defence Staff (DCIDS) Medical, Lieutenant General Salgotra.

Many issues were addressed at behest of Air Mshl. KS Gill, then Comdt NDA and later by then Dy Comdt National Defence Academy, Major General Ashok Ambre (later Lt Gen and Quartermaster General) who made some effective and revolutionary changes to correct many serious flaws and shortcomings. During the short tenure of Air Mshl. Bhaduria (now Chief of Air Staff) as Comdt those positive changes continued. Col. Gahlot was a witness and integral part of all the positive changes that took place and hence writes about it authoritatively. A lot of water has since flowed down the rivers Mula and Mutha and there have been several ups and downs at NDA.,

Presently I am led to believe that for the past several months numerous positive changes have since taken place at NDA. However, there has been a great set back to the training curriculum due to Covid 19 pandemic that has not spared NDA. Notwithstanding, all that has been stated by Col. Gahlot may or may not hold ground anymore. The sole purpose of this interview is to bring to the fore the true state of affairs that prevailed a few years back and the concerted and collective efforts made by so many to improve the state of affairs and rectify the glaring flaws in the larger interest of the organisation. It is hoped that a lot of issues have since been addressed and things are far better now ?

It is hoped that this bold interview is taken in the right spirit by all concerned and several medical officers, especially sports medicine doctors and former Physical Training Officers (PTO) of not only NDA but the Indian Military Academy (IMA) and Officers Training Academy (OTA) too who have observed training of cadets so closely and minutely, do endorse and support what Col. Gahlot has brought out painstakingly through his answers. Views, comments, observations, and suggestions are welcome to take this debate forward.

Colonel IVS Gahlot (Retd), a former Commanding Officer of the Military Hospital (MH) Khadakwasla spoke to Mission Victory India on the need to understand and follow advice of military medical professionals as part of the selection and training process of soldiers and officer cadets especially at the pre-commission training academies (PCTA).

Excerpts from the conversation…

Q1. What is the aim, purpose, and criteria of medical fitness for military personnel?

Ans: Firstly, we need to understand the term ‘medical fitness.’ The word ‘fitness’ necessarily means ‘quality of being suitable’ and medical certainly means ‘related to health’. ‘Health’ as per the World Health Organisation (WHO) definition has three dimensions: physical, mental, and social. The Indian definition includes the fourth dimension of ‘spiritual health’. Hence, when we talk of medical fitness, it is essentially ‘the ability to sustain in all types of atmospheric, environmental, and psychological challenges, irrespective of the exposure being favourable or adverse (physical, psychological, social, or environmental) conditions.

The aim of medical fitness in the military context is to find out by examining & assessing a person to effectively identify one’s ability to sustain exposure to any type of adverse condition and overcome the physical or mental challenge and hardship during arduous conditions or severe weather conditions and difficult terrain topography experienced during training and on deployment during war, conflict or any adverse conditions faced.

The purpose of medical fitness is to examine in detail (including laboratory and radiological investigations for officer cadets ) to assess the level of health during initial recruitment prior to their selection and subsequent monitoring and maintenance of the laid down health parameters required for military personnel during their training and service life. This includes all aspects of fitness whether physical, mental, social, and spiritual faculties and ensure efficient functioning under all type of adverse or unfavourable/ favourable situations and conditions.

The criterion of medical fitness is clearly laid down standards in the office manuals that are available with the concerned administrative and medical authorities such as the Recruiting Directorate, Regimental Centres and SSBs. These pertain to the physical standards such as height, weight and chest circumference and expansion, anatomical normalcy, and optimal functionality of all physiological parameters within acceptable limits, social background of an individual, mental state as in the psychological robustness and ability to remain stable without any deterioration. The medical examination standards are near identical for officers/cadets and soldiers/recruits with only a marginal difference in eyesight/ophthalmology standards.

Q2. How are the laid down medical fitness parameters enforced for recruits and officer cadets during their respective selection and recruitment procedures?

Ans: As aforementioned, the medical fitness parameters are almost same for officers/cadets and soldiers/recruits barring slight variances in the eyesight/ophthalmological parameters. These are even more stringent standards for those applying for military aviation roles.

For officer cadets’ the entire body is examined by a host of specialists and experts in their respective medical fields. The medical specialist examines all systems of the human body except eye (Ophthalmology), ear-nose-throat (ENT) and gynaecological functions (for female candidate).

During selection of officer cadets at SSBs the psychological aspect is evaluated by a psychologist who is the part of the SSB. The surgical specialist examines all systems of the human body to detect any of the physical problems and disabilities, the medical specialist (Physician) examines the various physiological systems. Similarly, the eye specialist conducts the candidate’s ophthalmological examination while an ENT specialist is responsible for the ear, nose, and throat examination to detect and declare as reason for rejection as per laid down parameters. The gynaecologist examines female candidates/personnel. Physical fitness standards are different for officer cadets as compared to recruits in respect of height and weight parameters.

Q3. Is medical fitness intrinsically linked with physical fitness in the military context?

Ans: Yes, physical fitness is an important and essential part of medical fitness and therefore intrinsically linked. A simple ratio of height and weight (Body Mass Index) is checked to determine whether person is underweight, normal weight or overweight, malnourished, normal, or obese. Overweight, obese, or undernourished officer cadets and recruits are declared medically unfit and placed under low medical category (LMC).

Q4. What is the difference between the acceptable medical standards for officer cadets and recruits? Are they the same? If not, what is the rationale behind the distinctions?

Ans: The acceptable medical standards are not the same for both categories. As aforementioned the eyesight/Ophthalmology standards for officer cadets are marginally lower than recruits. Officer cadets are allowed  (-)2.5 Dioptre for both eyes whereas parameters for personnel below officer ranks (PBOR) are higher. Furthermore, there are different acceptable parameters amongst Indian Army, Indian Navy, and Indian Air Force personnel. The standards of the navy and air force officers are significantly higher with regards to colour vision. Military aviators as aforementioned have even more stringent standards in line with their occupational specialty. These standards are determined taking into consideration the type of activities/proficiencies that is expected and hence acceptable in the various categories.

Q5. Are you aware of the laid down physical standards for selection of recruits at the open rallies and officer cadets at the Services Selection Boards? Should there be different physical standards?

Ans: The physical standards for recruits and officers’ cadets are marginally different. This is as explained earlier is because of the different roles that the category of personnel are expected to perform. It may be appreciated that the criteria of selection of an officer cadet have other elements associated with their academic and scholastic capabilities, which are paramount for the type of training that they will be subject to. These criteria are significantly higher from a soldier recruit. However, these standards are subsequently the same for trained soldiers (combatants) and their officers. The standards for Physical Proficiency Tests (PPT) and Battle Physical Efficiency Tests (BPET) remain same for soldiers and officers. Also, the physical standards for the enrolment of recruits are different based on their native area of recruitment.

Furthermore, regimental differences in standards also exist, for instance the Guards Regiment have their own standards of height for their General Duty (GD) soldiers as compared to other regiments of the Indian Army. The minimum height and chest requirement for GD soldiers hailing from Punjab, Haryana, Delhi, Chandigarh, Rajasthan, West UP, Agra, etc are 170cm and 77cm, respectively, whereas for Gorkhas, and recruits from the nation’s Northeast, Garhwali, Kumaon (Hilly) regions a relaxation of five cm is acceptable. Similarly, there is a two cm relaxation for candidates coming in from Lakshadweep as well. The height requirements for Sikhs, Rajput’s, etc are even higher than those from any other race. Weight parameters are based on acceptable height and weight of candidates with minimum and maximum upper and lower limit as per height/weight recruitment tables. The candidate’s chest must be fully developed and be a minimum 77 cm with minimum five cm expansion.

Wards of ex-servicemembers and serving soldiers are given slight relaxation for height, weight, and chest circumference, however BMI standards remain unchanged for all. Physical standards for officer cadets are different, for instance the NDA’s army wing has a minimum height requirement of 157 cm while the air force wing has a parameter of 162.5cm.

Q6. It has been learnt that during training the morbidity and wastage rates of officer cadets is significantly higher than that of recruits. What are the reasons for this difference?

Ans: There has been a gradual reduction in injuries over time as may be seen from comparable data available with effect from 2011, 2012, 2013 & 2014 especially related to stress fractures and other injuries among cadets at the NDA. This speaks volumes about the preventive and corrective measure instituted and being observed during that period.

I can tell you based on my professional experience when I was the Commanding Officer (CO) of Military Hospital (MH), Khadakwasla, that morbidity amongst NDA cadets was much higher than recruits of Bombay Engineering Group (BEG), Kirkee. I was called to examine the possible cause of training related injuries and offer possible corrective measures by the then Commandant BEG, Kirkee. The advice was accepted and contributed to the reduction the morbidity amongst their recruits’.

Common conditions amongst NDA cadets and recruits identified were community living, community messing for food and prescribed training schedule for both categories. Although community living is common factor, the cadets have small cabins in big buildings with common corridors and toilets/washrooms at both ends with their cabin’s doors opening to these corridors. Structured training as per schedule issued for both recruits and cadets. However, the cadets also have ‘Un structured training’ too unlike the BEG recruits.

Q7. Do you feel that with introduction of mandatory physical tests at the SSBs the morbidity and wastage rates of officer cadets would decline?

Ans: Introduction of mandatory physical tests at the SSBs may or may not reduce the morbidity and wastage rates of officer cadets. The effect of the same will be clear only with time. However, let us study and know the system of training of cadets at the NDA. The age of entry ranges between 18-21 years, adolescence, during which body grows and a boy becomes a man upon passing out.

An adolescent boy requires energy and nutrition for the purpose of base line nutrition essential for the healthy growth of all organs, limbs and for the adequate repair of day-to-day damage and lastly to sustain the insanely rigorous, physical, and mental activity which one undergoes as a cadet. So, conducting physical tests at that tender age may or may not affect the body of a cadet. Also, it is feared that too stringent a level of physical testing will render quite a few candidates rejected, which may be at the cost of academic/scholastic/intellectual levels that are essential for future military leaders.

Now let us discuss the point on rigorous physical training. Physical training at the NDA may be bifurcated into structured training, (which includes both official and unofficial training) and unstructured training, (which too consists of both official and unofficial training practices). Structured official training is as per the official training program, while structured unofficial training is conducted by instructors (Ustads) for ‘toughening up’ physically weak cadets.

On the other hand, unstructured official training is conducted by senior cadets in the name of squadron’s reputation while unstructured unofficial training is conducted by senior termers at night. All academy passed out cadets and officers know what I am referring to. Can we call this unstructured and unofficial training as what it truly is i.e., Ragging? 

On top of all these meals are missed by the cadets in the name of, training and toughening, restricted timing for meals, punishments by senior cadets, officials (Ustads) during meal timings, sickness, weakness, etc.

So, we can well imagine how these so-called cadets of academy survive. In fact, during my tenure as CO MH, Khadakwasla we physically counted the unused plates in cadets mess for all three meals for 7 days and the outcome was surprising, approximately 1,000 meals were missed per day out of 6,000 meals (2000 cateds×3 meals per day).

 The biggest culprit is the Cross-Country run which is planned without application of mind by Training Branch/Physical Training Team (PTT). The cadets are put under severe physical stress and strain of running rounds in the name of training, punishments, endurance, toughness, etc.

Hence, factors contributing towards physical injury, stress fractures leg bone fractures, fatigue, etc are, young, tender, and growing age of adolescents, poor nutrition due to aforementioned factors, harsh physical training both official and unofficial structured and unstructured .

In conclusion I would say physical tests at SSB level may marginally affect the morbidity and wastage rates. But it will surely condition the minds of cadets regarding type of physical training and activities expected during training period. Furthermore, it is recommended that candidates may train themselves before joining the academy and lastly only those cadets will join academy who are mentally and little physically prepared to undergo the routine of academy.

Q8. Do you feel that imparting and spreading knowledge of physical education, principles of physical training, sports, fitness, and combat medicine amongst military personnel, especially officers would lead to overall improvement in the medical and physical fitness of tri-service personnel?

Ans: Yes! Imparting and spreading knowledge of physical education, sports, fitness and combat medicine amongst officers and men is essential. One can say that the training of trainers is a must! All trainers need to forget what used to happen during their days of training at the academies! This is an emerging science and continual upgradation of capabilities is a must. Also, it will not be out of place to mention that structured exposure for all officers to basic health sciences and qualifying the same through test/examinations is a need of the day as is mandatory in merchant naval academy. Health economy, health intelligence and troops health management must be recognised as an important dimension in modern day military science.

At least a structured training on above topics/subjects for two-three months need to be imparted to all officers and staff (PBOR) before appointing them as instructors. These instructors should be independent of parent academy’s administration (NDA, IMA, OTA, etc) otherwise it will not lead to anything but a waste of time, money, and energy of government & personnel.

Why do trainers need to be trained? Well, firstly to make them understand that they have a role in officers’ training be it physical, mental, social, and spiritual in nature. Secondly, they must understand that unstructured and unofficial training (Ragging) is harmful for the cadet and their families as well when permanent damage is caused to the cadet. Lastly mental robustness is equally important, but methods be well defined and be part of official curriculum.

Q9. What in your view are the glaring shortcomings in the Indian Army that adversely affect both medical and physical fitness? How should they be overcome?

Ans: In my view many shortcomings adversely affecting medical and physical fitness amongst the officers (and JCO/ORs). These are

●    the lifestyle choices of the modern youth who partake in less physical activities,

●    eating of junk food, smoking, alcohol, drugs.

●    limitation in physical mobility due to the ubiquitous mobiles in hand

●    the Social strata from where cadets are being selected (low socio-economic strata or lower middle-class background with-basic physical weakness, poor nutritional background, or economic background.

●    Other stressors include easy mobile and video communication. 

●    Communication of domestic trivial issues leading to avoidable stress amongst already emotionally taxed military personnel while on deployment.

●    Societal and economic stress which arise from self, familial or spousal comparison of their financial prospects with reference to their civilian counterparts.

●    Perceived degradation in allowances/ prestige in rank and file as a comparison to equivalent at all levels in other governmental /non-governmental employment, vis a vis level of risks/commitments.

●    Environmental stress of postings in arduous climatic conditions such as being deployed in high altitude areas, where it is hilly, freezing and oxygen is limited or deployments in extremely hot areas such as arid desert environments are direct operational factors affecting the health and wellbeing of military personnel.

Professional stress faced by officers arising from an emphasis on academics for instance at the Staff College, Higher Command Course (HCC), National Defence College (NDC) etc having a direct link with promotion has also been seen to affects the physical, medical, and emotional health of armed forces officers. To add on to this, promotions and (academic) qualifications and not linked with operational performance, this distinction serves as a major flashpoint. Hence the solution lies in promotion being linked only with performance of the year. Not on additional marks for academic qualifications.

Some changes in the lifestyle of officers such as the reduction in the amount of routine paperwork could perhaps be incorporated. Nowadays written evidence is required for every order, where it is perceived that valuable time is wasted doing mundane and unnecessary paperwork even during games periods. Regular PT and games should be conducted for all so everyone can participate in physical training. It is not necessary that everyone only plays games, they may also exercise or do any other recreational activities like Yoga, jogging, walking etc during the PT and games period.

Q10. With a view to empower Indian Army officers to enhance their medical, physical, and cognitive fitness what would you advocate incorporating in their selection process, training methodology and service period?

Ans: A psychological (mental) assessment be done initially during training and after passing out. The actions of an officer may be analysed periodically by his juniors! A 360-degree assessment to have a check on negative personality traits. A young defence aspirant must know cause of rejection/selection. It has been seen that young boys are rejected without giving them cause for rejection. Hence, system of selection not only be fair, but it should be visibly transparent.

Training methodology must be revamped. There is plenty of published work on this in service literature and in external publications.  The most important avenue for reform is the training of trainers. Furthermore, only structured official training be allowed and there be transparency in military selection and training. There needs to be moral and ethical education enforced by example Lastly, during training privileges of seniors need to be avoided.

About the Interviewee

Colonel (Dr) IVS Gahlot, (Retd) is a Bachelor of Medicine, Bachelor of Surgery (MBBS), Doctor of Philosophy (PhD) in Medical Anthropology. He holds post graduate diplomas (PGD) in human rights, hospital administration and a Master of Personnel Management. During his time in the Army Medical Corps, he successfully underwent the Medical Officers Senior Command Course in which he received an Instructor Grading.

Some highlights from his time in service include his appointment as Officer Commanding (OC), Medical, National Cadet Corps (NCC), Allahabad between 1996-2000, CO MH Khadakwasla, Pune; Recruitment Medical Officer (Rtg MO) to the Branch Recruitment Office at Berhampur, Orissa between 1994-96, and lastly as Director Medical (ECHS Scheme) at MoD

He is presently the CEO & Medical Director of 150 bedded Super-Specialty Park Hospital, Faridabad, Haryana and has been responsible for setting-up and running 160 bedded Super-Specialty Hospital at Bhatinda, Punjab.