Out of thousands of things taught at school, there is one which is powerfully embedded in my head. While doing a letter-writing exercise, we were asked to write a letter to the city municipal authorities complaining about the increasing amount of garbage being thrown on streets. After checking our notebooks the teacher lauded our efforts, but said she was disappointed with one aspect. All of us had been quite enthusiastic in complaining and describing the concerned problem to our heart’s content, but ‘not one had suggested a solution’. What she said then should actually be one of the most universal rules of human conduct: You get the right to complain about a problem in the society only when you can also offer a solution to it, however small it may be.
A few days back we saw a piece in this magazine describing the ‘malpractices’ that go on in a government hospital. The title ‘A Year as a Doctor’s Apprentice’ belied the content; expecting a tidy narration of the wonderfully tumultuous and bittersweet journey of a medical internship, one was disappointingly treated to a monotonous tirade of complaints and accusations. Exposing the generic deficiencies in a system is commendable, but specifically pointing to a single hospital and narrating only one side of a mind-blowingly complex social problem is abominable and a disservice to the general reader. The problems described in the article are blanket issues, spanning most hospitals (both government and private), in India as well as many other countries. No balanced discussion of the issues featured in the said article, and no attempt was made to investigate the possible reasons behind their existence. Society is quick to pounce on such ‘juicy’ stuff, and that is exactly what happened. Hundreds of positive articles about doctors and hospitals must have appeared in this magazine before, but they were never noticed outside; the said article, however, was enthusiastically covered in a national news website. Thus, as has happened most of the times with this country’s doctors, only the flip side of the story reached the layman. The saddest part here was that a doctor facilitated it with both hands.
The paramount lacuna in that piece is the presence of hyperbole ad nauseam, which sends out a completely inaccurate message. ‘Nobody wants a patient admitted in their own ward’. Painting the entire creed of resident doctors with the colour of just a handful among them is indigestible. ‘Pregnant women are beaten like anything’. That is a statement more disdainful than the supposed act. I have studied and worked for over six years at the hospital where this ‘third degree torture’ allegedly happens, and I proclaim that it is a tremendously laughable overstatement. While describing his internship, the writer says ‘For one whole year you have to suffer both physically and mentally’. There’s only a tiny problem there: ‘I suffered’ should have been in place of ‘you’. Almost two hundred doctors do their internship at that and at other government hospitals every year, and for most of them it is a wonderful, enriching and enlightening experience. What shocked me the most was, although the writer claims to have been at the hospital for a full year, I didn’t come across any mention of the ‘malpractice’ and ‘physically and mentally disturbing’ events of patients’ relatives manhandling and beating up doctors and other hospital staff. Or of patients themselves offering bribes to everybody from the ward-servant to the medical officer to get their ‘unethical’ work done. Unwittingly or on purpose, the author gives credence to the general attitude of the society and politicians that the sufferings and inconveniences of Indian doctors are absolutely insignificant, and that their only job is to act as scapegoats whenever any health related issue goes public.
When people talk about the widespread corruption in politics, one common argument is that politicians come from the society itself, and since most people are always greedy and selfish, that is naturally reflected in the political class. It is a fair argument, and it applies to doctors too — though fortunately to a much lesser degree. The issues raised in the article are too complex to be tackled in small write-ups. But for the sake of discussion, let’s consider the ‘batting’ and ‘increased workload’ aspects. This is not as simplistic as it looks. It happens (SOMETIMES, and through SOME doctors) consequent to an amalgamation of a few to many of several unique facets of the Indian health system: a gargantuan population to be served, an impotent decision-making political class prone to trivializing public health, corrupt government systems, the extremely laborious residency schedule of doctors, woefully inadequate number of doctors and nurses, too less hospitals, far too less facilities in the too less hospitals, and even among those, awfully too less ‘functioning’ facilities. If the matter was as simple as saying ‘A government hospital is not expected to show such a behaviour towards the poor; wasn’t it bloody built for the poor?’ the issues would have been successfully tackled and ended decades ago.
The American author Mark Twain once profoundly said: ‘There is no sadder sight than a young pessimist.’ It is indeed distressing when young torchbearers of a profession do not devote at least as much thought and energy to solving the problems in their professions as they give to blabbering about them. A world with millions of people around is never going to be perfect or right. But we should surely try to create at least small pockets of perfection and virtuousness so that the cumulative balance of thoughts and deeds of all people never tilts to the wrong side. In fact in the very hospital referred to in the said article, there are countless examples of such resplendent halos of morality, ethics and compassion which have, despite corruption and administrative apathy, kept the hospital sublimely illuminated all the time. We find resident doctors who are favourites among patients, kind of their rockstars: whenever the patient sees her or him entering the ward, they instantly feel fifty per cent better. There are professors in that hospital who are legends in themselves: with a wealth of experience and phenomenal medical knowledge they make it sure that despite all the deficiencies of the government setup, patient diagnosis and treatment are as impeccable as anywhere in the world. As with schools and courts and other institutes, there sure are several ills in our hospitals. Most young doctors and interns keep ranting about them, but once their courses are finished, hardly anyone displays any willingness to get back into the system and try to improve it. A very relevant quote comes to one’s mind: All of us are experts at practicing virtue at a distance.
It’s a plain fact that without sweeping, nationwide political reforms, it will be impossible to get rid of most of the problems with the health system, or for that matter with all government systems including education, judiciary, agriculture et al. However, young doctors, especially the querulous ones, still do have a lot of options to make significant contributions if they wish so. We have very few ethical and efficient doctors in the decision-making processes of health systems. Young doctors can assume the posts of medical officers at primary health centres and district hospitals. They can work hard and climb the organizational ladder to become a Taluka MO or even a District Health Officer/ Medical Superintendent. These posts will give them a lot of leverage in making positive impacts. Doctors can even study public health and get into government/international agencies responsible for the drafting and issuing of practice guidelines. They can earn a PG degree and assume a teaching post at a government hospital instead of setting up a private clinic: that way they can contribute more constructively in getting rid of the ills they witnessed during their internships and residencies.
There is so much to be done and so many avenues of going ahead and making an impact. But for that a better, more positive mentality is a sine qua non: first in the general public so that they acknowledge the intricacies of health systems and rather than just breathing down the necks of ‘sitting duck’ doctors, they demand proactive attention to health issues from their chosen political representatives; and secondly among medical personnel so that instead of getting bogged down by the stinking, diabetic foot of their own parent health system, they go ahead and nurse it, clean it, cure it as best as they can.
Dr Kiran Kumbhar
Sassoon Hospital, Pune