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Monday, August 25, 2014

Rural Postings for Doctors : Their resistance is illogical and futile.

One of the reasons I voted for the BJP, other than of course the fact that Narendra Modi had caught my imagination (the fact that I used to be a Modi hater from 2002 to 2012 notwithstanding), was the ass-licking appeasement policies of the previous government which I felt were anti-doctors in addition to, of course, being anti national.

My world view has evolved a great deal over the course of my 5 year journey in MBBS. From being a strong supporter of socialism (perhaps that's why I took up medicine in the first place), almost being a borderline communist sympathiser at times, to recently becoming a little right leaning. A part of this transition has been the realisation that the world we live in is not ideal, ideologies falter and collapse when personal benefits come in conflict, and that a logical argument can easily be distorted to shield a particular individual or group of individual's self interests and selfish intensions in the name of larger hardships of community; which, therefore, will always continue to persist and the gaps will always ever widen. Internship, of course, was the turning point, but the process may have begun earlier.

Facebook discussions now-a-days have gone from being one liner, pull your leg-blow my trumpet comments to literally large - Long answer monologues and discourses. This may partly be a sign of our individual maturity or we may probably have learnt to use the platform for appropriate and relevant matters with age.

When the proposal for compulsory rural postings came up last year, the Gymkhana organised a debate. I was a part of the team that was "against". We were supporting not serving poor people, not giving health to the diseased, running away from responsibilities, not repaying the debt of the society. In short, being selfish, immoral and arrogant and defending it too.

But, lecture hall debates end up in lecture halls and have no more importance.




I had a end stage full blown AIDS patient in the ward. Sending his blood work would be a very frightening experience. I am not judging him or chastising him, but just the amount of precautions to be taken and the anxiety of an accidental prick would make it all the more difficult. But, it was managed. Accidents do not happen if one is careful.

Then one day there was someone who looked like a priest by the patient.  I was happy to see him. Nothing consoles a patient more than a reading from a holy scripture when he knows that his time is running out. I was more happy, that his family members had accepted him, knowing full well the social stigma associated with his disease.

As I continued with the blood collections I couldn't help but be astonished by his mutterings.
"Shaitan is ke shareer se nikal jaa. Holy spirit kehta hai iske shareer se nikal jaa!" And these were the only 2 sentences he kept on repeating for all the ten minutes that I was by his bed side. I between the feeble man would try and say "Nikal Jaa!!"

 I felt like telling him, that your CD 4 count is only 24. Is baar to shaitan nahi nikalega, agli baar shaitani mat karna! I don't judge him for an act in his past, but this is and should be unacceptable.
Was it an exorcism being performed in a hospital? I have seen discovery channel documentaries about such things being done, especially in case of rabies, trying to force feed water to a person who had lost the ability to drink. The discomfort then would, logically be extrapolated as resistance by the devil. But, in 2014?

A few years ago I had seen a patient with herpes. He had taken medicine for a week and so would obviously be cured. But his sister took him to some Baba who swept a broom over his vesicles and then when they went away she proclaimed that the Baba had cured him. So much for our Acyclovir!

A man would stand outside the KEM arthritis opd entrance with "Bhallo ka baal and Whale ki haddi". As patients would crawl out with their painful joints he would entice them, dupe them and tie a Bhalloo ka baal around their arm and a Whale ki Haddi around their throat. If only it was that easy, wouldn't all pharma companies market bear hair? All natural and no side effects.

These are instances where they only eat away our credit, at least patients take the treatment. But, there are many other instances where such beliefs prove counter productive especially in psychiatric illnesses. Psychiatric illnesses where time of patient contact is perhaps the most important determinant of successful outcome. People would rather kill their patients doing woo-doo and what not, but never take them to a psychiatrist. And it is not just the poor, but rich (cast, community, creed, colour, gender no bar) more often who engage in such hoolabaloos.

Indians are spiritual. And our spirituality is often misguided, as much as Hitler's nationalism was misguided.

Its been a year since Dr. Dabholkar, an anti superstition activist was murdered. No arrests have been done. More importantly, no anti-superstition law has been passed. Communities take to roads demanding reservations, cities come to a standstill fighting corruption, police commissioners get transferred if a rape occurs in a remote corner of their jurisdiction, but no noise is raised, rather political parties shout down a legislation that would have corrected a very wrong that is routed in the community.

"Matters of belief"  is a very wide based argument, misused often. May be reintroduce Sati, hadn't Britishers interfered with out faith then?

When I hear the argument that every Indian is Hindu, I don't feel like refuting it.Don't they walk with a mouthful of saffron and spit and colour every corner available in shades of orange to red. Perhaps, it's animal instinct, just as dogs can't let go of their affinity for car tyres.

As much as you tell a patient that he has to throw the cotton swab in the red bag, even be polite enough to point it out to them. Yet, you can always see from the corner of your eye that it goes right under their cot. Blood soaked cotton swab, the most fertile medium for the most notorious germs to grow, stocked up under 70 beds in each ward.

We raised points of unavailability of medicines, of poor security conditions (especially for our female colleagues), the fact that resident doctors go on a strike almost 4-5 times in a year because some short tempered relative vents his ire on a treating doctor. Such instances occur in civic hospitals with in-house security cops, the rural scenario is left to one's imagination. We've all had experiences with those guys with running noses demanding 'INJJESHUN'. And last, but not the least, also about bad roads and no ambulances in rural areas. 

The persistent counter from the jury was "So isn't that your responsibility? Will you run away?"

Non-medicos (except medico's parents, spouses, children and immediate kin) have unexceptionally high expectations of social service from medicos. Partly our seniors have been responsible for that. They managed to keep high moral standards when everyone around was faltering. It is expected that the police will not lodge an FIR even if a murder takes place without first taking Gandhiji's blessings. But, doctors have always sacrificed their personal lives for the sake of strangers and made their sufferings their own.

Today, these expectations have sky rocketed to unreal heights perhaps infringing into administrative and executive domains. Thinking that doctors going to the villages will bring medicines and roads is perhaps acknowledging us for more than what we can do. Dr. Dabholkar was a Medical doctor, not a Ph. D. in sociology. Forget his life, did the society stand with him in his death?

This is why I feel, that the medico's resistance to rural postings is illogical. Without the periphrenalia that we require, we will be useless. But, it may not be wrong to look at it as a year long paid vacation in the greenery and heart of nature. We have been living sleep deprived existence since we were 15, perhaps this is our gift at 24!

Its true that our opposition is because we can foresee that this exercise will be futile, that it will breed in more corruption into the field, that sending demotivated cadres will in fact be counter productive, that the nation will eventually loose its cream to the brain drain.

But, when people want only to be beaten by broom sticks, tie Bhaloo ka baal and Whale ki haddi, and look towards us a potential tool to win them elections, so be it.

So guys, just chillax!

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