Nov 1, 2007, IBNLive
In 4 days Mumbai has seen two doctor strikes. First it was resident doctors at peripheral hospitals in Mumbai and then it was resident doctors at medical colleges across the state. The first was a demand for higher wages and better medical equipment. And the second was purely against the government rule to impose compulsory rural internships on every course that the doctors undertook. So the rule said 2 years after MBBS, 3 more years after your post graduation and 5 years after a super specialisation. So a doctor who started his studies at 18-19 would complete his super specialization and his internship at the end of 22 years i. e. by the time he would be in his forties.
When I went out to cover this story, I went through the same gamut of sentiments. How insensitive can doctors get? After all they earn so much? How greedy of them to refuse rural practice just for the sake of the extra earning that they would get in the cities? And when I went to the hospital I could see patients who had come from as far as Madhya Pradesh to get their children and relatives treated. It only strengthened by bias. Yes, I call it a bias, because both patients and doctors were actually suffering from the same problem – policies made by people who do not understand either the profession or needs of patients.
There were patients who had been coming in regularly from far away to get treatment. Each time, some ward boy or some nurse told them it was not possible even before they could talk to the doctors. There were patients who wanted to get tests done and could not afford private labs. They were being told that the hospital did not have equipment. If daily hospital days wore out patients like this what is the point of going on a strike and further troubling the patients; I asked. And the general secretary of the striking doctors gave me a reply that I never expected. “Madam,” he said, “there have been times when we have been ready to perform an emergency operation. We knew that any delay would be dangerous. But the government has tied us up in various procedures, legalities that have to be completed by other employees who do not feel the same helplessness that we feel when we see a patient suffering because of bureaucratic delay.” It was an admission in shame. The many doctors I spoke to told me stories of how they had been denied newer and better equipment because the people they applied to saw them as only costs and not a necessity. And this is the case in cities. So what about the rural hospitals? No wonder a rural posting in every government job is considered as a punishment posting.
A resident doctor already has a difficult life. The government doesn’t give him proper accommodation where he could live comfortably with his family. So mostly he/she lives alone in the hostel. Sometimes working 3-4 days in a row with no rest. And all the time attending to patients who have already waited so long that they have no sympathy left for the doctors; which is a very natural reaction. So I argued with the doctors that if they went to work in these rural hospitals, they would be able to serve these people better and not have to face their anguished wrath. “But madam, suppose I have done my MS in surgery and I go for a 5 year rural internship to a hospital which doesn’t have any equipment, any beds, any attendants, will I be able to help the patients out there? I would end up being eaten up by guilt and helplessness everyday. Here I am, at a place where people need me but I don’t have anything to help them with. I can’t perform a surgery and so for five years I just do normal check ups and play a consultant’s role and then when I finish my posting I would have forgotten everything about surgery. So what use is my MS now?”
That gave me a new perspective on the whole issue. Until rural hospitals are well equipped, there is no point in blaming doctors not wanting to go there. What use is a doctor without his paraphernalia? He is as good as the compounder of yore who set up a mini practice after retirement by prescribing medicines he had doled out all his life over the counter. The compounder knows what could cure the patient; but would never be able to do it himself. Why not build super speciality hospitals in rural areas? Why not concentrate on making rural hospitals so efficient that a rural posting would not be considered a punishment? Why not spare the poor family from Rewa all the trouble of traveling upto Mumbai? Why not let them have a proper hospital near his hometown so that he doesn’t have to be disappointed with the behaviour of the medical staff?
Every day scores of patients come all the way from towns across Maharashtra to the government hospitals. And hundreds of them are sent away because even city hospitals do not have the services they want. I wonder when those facilities would reach rural hospitals. I wonder when the policy makers would realize that a policy is not a one line statement but a planned strategy to change lives of people. But then probably that is the very reason that they are called policy guidelines…things which would always have a loophole because they are not plans of action. It is difficult to be a doctor in India, it is even more difficult to be a poor patient; but it is very easy to be the policy maker governing the lives of both of them.