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Saturday, September 12

Angels or Demons?

There is a group of people in Kerala who are on a direct competition with the attimari labourers, govt employees and private bus owners to break the record for the maximum number of strikes conducted in one calender year: the doctors!

There is another strike going on in the Medical College in Trivandrum, the umpteenth one this year, this time the reason being the Govt decision to ban private practice. All the departments are under freeze, and the patients left at the mercy of the bystanders and the nurses, but who cares?

Doctors belong to the upper strata of the society. They, being the watchdog of life, are given utmost respect, enjoy crémé social status and privileges. They are semi-Gods earning probably a fortune, especially the senior docs who earn 7-digit quids through salaries, perks, private practice and commission from prescriptions and scans.Yet some are not satisfied.

Having a flashback at the recent events with the doctors in spotlight (for the wrong reasons) exhibits the alarming consistency at which our medics abuse the respect and status showered upon them. Leave aside the ubiquitous lightening strikes, there have been rather unfortunate happenings like a senior doctor walking out from accompanying the President, the needless, silly and ridiculous tiff with the nursing staff in the Medical College (which saw them stooping to new low with distribution of propaganda leaflets to patients and relatives!! ). Have the docs of Kerala lost their self-respect?

Make no mistake about it, the life of a doc, especially early on in their career, is no rose-bed. They are given the most rigorous training in the four-and-a-half years and then starts the real torture. A medical college like Trivandrum, which has 1500 beds and 4000 patients are literally run by house-surgeons and post-graduate students. The interns do the dog-work for a paltry 4-digit stipend, sometimes 24 hours on the trot. A medical/surgical ward which accommodates 65 beds and has 165 patients at a time, is run by a couple of house-surgeons, 1 post-graduate student, and a couple of nurses. During night shift, this figure halves!! Many a times, the lives of these 165 patients rest in the hands of the lone nurse. Worse, there is no specific definition about the scope of work for each health care professional.

Don't ask what will happen if two or three patients, God forbid, get heart attacks simultaneously..

Read it together with the pressure of their studies and career, discontented and mostly-ignorant (pardon that word) patients and relatives, chronic lack of adequate medications, equipment and support, there are some very good reasons for them getting frustrated.

Medical College Trivandrum Entrance

Saying that, that is no reason for the men-of-honour to abuse their power and show off their union strength leaving the patients at God's mercy. The Govt spends over 20Lakhs of tax-payers' money to educate a single doctor from our Medical Colleges, and the docs have some serious social commitment. It seems they need to be reminded about this one fact they seem to forget.

Doctors in Kerala refuse to go out to see their patients at home, and the system and work-culture turning them even more arrogant. Ethics is not a word that many of our holy-men would like to hear. ESMA and laws like that are jokes for them because they, like any other common Kerala labourer, understand the power of labour union. How on earth could someone in this profession behave like a common coolie worker, after-all education is a virtue which brings about change in behaviour. There was even an incident a few years back where a group of  resident doctors beat up an acutely ill patient on a hospital bed! Unimaginable! That was the lowest I thought, but no..

It's becoming increasingly clear that there is a use of muscle power to get things in their favour. Part of the blame lies with the Govt which keeps our hospitals function at the most basic levels. In the event of a mass casualty the health care workers are under enormous pressure and this often breaks out as face offs with the patients and the accompanists. There have been numerous instances where physical attacks have been carried out against the doctors and this in turn resulting in a lightening strike.

The Govt in turn has chosen to keep mum on the issue instead of promptly dealing with it in a cause-factor method. Promises are made, the Police will charge a few and the issue is covered in tissue paper. It happens again, eventually. Control of relatives in our hospital settings is one major step, especially in the casualties. Hospitals must formulate a policy of zero tolerance to those who abuse their staff and should show the public that deterrents will be prosecuted. Beef up security and control in our hospital settings, for the total protection of the staff, the patients and their relatives. So that's a firm hand on one horn of the bull.

Developing our hospital infra is no easy job. Health sector is one area where Kerala is far too ahead of their counterparts in India, but we're still caught wanting at needy times. Whatever money is pumped into the system doesn't show up anywhere. CT Scanners and associated equipments bought for the Govt. Hospitals break down 'mysteriously' the next day, or surely within a week. Lack of life-saving medications and the pressure for private purchase leads to the displaced anger of the relatives towards the doctors and other health staff. So again, who is the primary culprit here? 

Professionalism is another word our Public Health System could add to its dictionary. On top of the thousand-odd students and thousands of patients, the senior doctors are burdened with the additional responsibility of administration, which drains off their mental energy completely. Its about time there is a serious revamp to our administrative set up, and the doctors allowed to do what they're supposed to do. Those MBA and MHA graduates are smart blokes on the frame, believe me!

Our social structure and environment has surely structured the way the doctors view the world outside their glasshouse. The huge difference in the work-culture and practice in a Medical College or a Private Hospital from that seen in the autonomous institution of Sree Chthra Thirunal Institute of Medical Science and Technology must be a leaf we could borrow. SCTIMST and the Regional Cancer Center host an exemplary structure, starting from a Medical Social Worker and rising to the panel doctors to review their patients. The security and safety are admirable, the hospital is clean, neat and healthy, the staff paid good salaries (unlike in the Private Hospitals) and the working environment is far better, though I'm not claiming it to be a heaven ;). But a far cry from our local set up where there is just one boss dictating terms.

Sree Chitra Institute in Trivandrum pic courtesy Satyalal
Though our Private Hospitals are good at cleanliness and support structures, there is much to be desired by the way it handles the staff. Apart from the senior doctors, the other health care professionals including the junior doctors, staff nurses and the paramedical staff are paid paltry amounts which is in gross violation with the minimum pay laws in place. Its not a secret that people work full-time for even Rs. 500/month, and how would you expect these ground-level workers not to be professionally dissatisfied, frustrated and act out? The laws in place are mere scarecrows and there is a serious lack of regulations.

Is this what we call a healthy working environment? NO, any place where the abuse of staff occurs is never a healthy work environment. You're sure to see trouble and a degradation in the quality of work.

Lack of team work is another worrying phenomenon which plagues our health system. There are far too many levels, mirroring our social strata. The doctors are in one cozy level and then comes the ground level employees. The Nurses, for the amount of selfless toil they do are always at the receiving end of the stick from all parts of their spectrum. Long shifts, unsocial working hours, short breaks, lack of holidays, miserly pay packages, unruly working environment...tell me why any educated soul should tolerate this? It is a thankless job being a nurse in Kerala, ask me, and no wonder the new graduates from our state want to run away to the West where they get respect, honour and a lifestyle which is a class apart. Same tale goes with the professionals in the Pharmacy and other Paramedical professions, but one good thing is that they're not directly involved in patient care.

Lack of flexibility and accountability adds to the deterioration of our health system.The status-quo has remained because of the rigid attitudes of the groups with vested interests. Negative media scrutiny and bad press doesn't help as well.

The Govt must make up their mind to use the iron handle in dealing with such illicit and unethical union activities at the expense of the safety of the patients. About time the medics have a serious retrospection on their tactics to bring things under their control through such unfair means.

So all's not rosy in our health sector as it may appear from outside. The treatment must begin from the highest level, and with all due respect to the doctors of our state, there must be a change the way some of you do things. After-all this is not a job every Tom, Dick and Harry could do, and when it comes to people of the highest caliber like thee, we mortals expect a bit more compassion.

Compassion?  Did I say something obscene? :P

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