Dr Binayak Sen: A perspective

Dr Binayak Sen on an Indian Doctor’s view towards the deplorable rural health services in India and his role towards ending the inability of the Govt to impart proper social justice:

” First we have to look at the overall scenario, and then everyone would like to see how they fit into it. I think that’s a better way to go about it. As thinking people, we have to follow some kind of logic in our analysis. We can’t just go on individual motivation as a personal choice. Inequity is the framework within which we have to look at people’s talents, people’s priorities and what you can contribute. I would say that it’s more important to think in terms of that. In this contention, of how you factor in the analysis of the health situation into your choices, you have to take sides. The system is not kept in place of its own volition; it is kept in place because people see an advantage in keeping it that way. So, you have to decide whether your contribution is going to correct this system or make it worse. You can’t stay neutral; you should not be in a situation where you think you are just going along. You have to be conscious as a thinking citizen, conscious of the choice you make and own up to it. That is the duty of the intelligent person towards his own conscience. You decide how you want to address this scenario. You have to think of your future and plan, but in planning, this scenario needs to be taken into account. Don’t make your choice in ignorance or in feigned ignorance. Don’t fool yourself that the choice you have made is a matter of convenience; it’s a moral choice you have exercised. Our constitution gives you the right to exercise it and you must take the responsibility for it. ”

Courtesy: http://www.indiamedicaltimes.com/2013/12/07/the-choice-before-us-an-encounter-with-dr-binayak-sen/

A different take on Rural postings of Doctors in India

Although it is very late to be sharing events of the previous year today, I consider that the correct timing of posts is also important for the proper reception and comprehension of their relevance. Especially in the coming days of huge change in the Indian Medical School Curriculum which is now to involve a one year Rural Posting, I thought sharing my work experiences in a quasi-rural quasi-urban environment would generate some ideas as to the nature of the challenges that students might face in the outside world we call “Bharat” (an euphemism for the less developed rural/ semi-urban areas of India).

As a part of an initiative called the National Services Scheme (NSS), I had a chance to be a part of a series of Health camps organised in various suburban and slum areas of Delhi, thanks to my friend Saurabh. Students of Delhi University have been organising these camps for some time, involving students of our Medical School along with Doctors working in Private facilities who have come forward to help.

Each camp day needed us to travel to the interiors of Delhi, which very few people can imagine to exist, spanning shanties behind university area to distant Jahangirpuri slums. Walking down the streets, one could not possibly miss the almost 300-400 metres high mounds of “Kooda” (rubbish) lying on either side. Utterly surprising was that at places, a whole slum would be situated right behind the huge mounds, hidden, as if protecting it from the eyes of the civil society.

A team of students would be seated at the Registration desk and another team of volunteers would go about the community creating awareness for the camp and mobilising people, while I and my Medical school friends would be posted at the drug dispensing counter. Our work involved making copies of a line-list of drugs available for the day to be given to the Doctors. Every person who has been seen by the Doctor would come to us with the Doctor’s prescription and we would search in the not-so-scanty supply of drugs to cater to it. Finally it would be our duty to counsel the patient on usage of the drug, when to consume it, how much and till when.

The prototype patients that I would counsel:
1. A very elderly man/ woman, having scanty vision, dry skin, pyoderma, complains of piles, these being a few of the long list of complaints
2. A pregnant woman in her early trimesters
3. A 5 or 6 year old girl/ boy with fever, ear discharge or scabies
4. A mother carrying her one year old infant who has complaints of nasal discharge, fast breathing and cough

In the above cases, the Doctors would be ordering oral antibiotics, eye drops, ear drops as and when required and vitamins in almost all cases. Funny thing was that a Vitamin would be given even if the person would not have any medical needs.
This is because:
1. For the satisfaction of the patient. This in a way increases the trust of the person in the Doctor and enables repeat attendance of the same person in the next camp or to any medical facility per se in case of valid complaints.
2. Most of these “patients” belong to the lower classes which suffer from common yet often overlooked problems of iron deficiency, vitamin deficiency, worm infestations, etc.

Certain aspects of this mode of treatment which I found could be harmful was the evaluation and treatment of children aged less than 1 year within this facility. It is not uncommon of such young children to catch pharyngitis or sinusitis which after a few days convert into lower respiratory infections namely pneumonia, abscess, etc. The time when the Camp Doctors are seeing the child, the infection might be at its earlier stage, but if the mother is not counselled regarding the natural progression of the disease in the child, she would be late in bringing the child back to a medical centre for proper timely intervention. And not just in Camps, but it holds true for Primary Care system present currently at the grass-root level.

Every now and then, a woman would get restless standing in the long queue, waiting for her turn for the Doctor to comer, and would start expressing her dissent wailing and waving arms, as if they would come by and ransack our supplies any moment. But nothing like this ever transpired. We could control the crowd by taking an authoritative attitude and despite knowing that refusal of treatment or drugs to patients would be unethical, we had to resort to such “Dhamki”s (threats) more than once; although always remembering the fact that we weren’t going to resort to such lows ever.

In consideration of patient satisfaction, we could never ascertain the status of the compliance or the ability to follow instructions in the community. The basic problems that I could identify were:
1. People were not aware of the disease conditions that might affect them in daily life. [traditional knowledge of the elderly was falling short of the modern knowledge obviously
2. They had little idea about adding leafy vegetables to diet and cooking in iron utensils for adolescent girls and pregnant women. [Basically the felt needs of the community were very less, mostly due to lack of knowledge and absence of any timely educational activities trying to reinforce their knowledge regarding health]
3. They had almost no orientation as to when they needed to go to a Primary/ Tertiary care centre and when to just stay restricted to the local Primary Health Centre or a Private practitioner. I remember advising all those who weren’t satisfied with the treatment received from Local practitioners to give a visit to the bigger hospitals around the place, Hindurao Hospital for example. Any modern health system would mostly require a Tertiary care Centre to look at referral cases from lower centres. But, in our communities, the situation is grossly the opposite, majorly due to non-availability of local medical practitioners, lack of ability of the practitioner to reach out and connect effectively with the community, etc.

More than once, my friend would have a discussion with the Doctors regarding advice of unnecessary drugs (e.g., antibiotic drops for dry eyes) and the fallout would be an unwanted altercation of one person trying to understand the intricacies of drug prescription and the other party trying to explain his stance of doing the same. What obviously transpired from such discussions was that we as students had a lot more to learn not just about the Pharmacology part but also about why, how and when to dispense drugs. After completing my final year Med-School, I have finally realised why Medicine has been time and again referred to as a Pseudo-Science and an extension of Arts in Science.

Coming to the issue of the Rural posting; the logistics are still under review and the doubts regarding allocation of centres, budgeting and the pay scale remain unanswered. Leaving all of that to the policy-makers, as a Doctor who has just completed a 4 and 1/2 year long rigorous clinical training and awaiting a 1 year Internship in the multiple branches of Medicine, and as one who strongly believes in serving people at whatever cost, I would expect the policy-makers to also consider the difficulties that a new-comer might face when he is appointed as a Medical Officer in a community. The expectations of the community are going to be huge and in order for the system to work, logically there should be a mentoring program running alongside this, to ensure the proper acceptance of the new young Doctor by the community. For this mentorship program, the Govt. may hire professionals from branches outside Medicine who have a better idea regarding handling the socio-cultural aspects of people.

At present, to the would-be Indian Doctors, the crisis at hand is the selection in the Post-graduate entrance examinations based on whether or not he has served in the rural community for one year. But a lot of people fail to understand that even after Super-specialisation, once a Doctor goes out into the community, he is insufficiently equipped to deal with the non-medical needs of the community. Their needs are not only Medical in nature; a lot of times they need plain and simple counselling; like in cases of non-communicable diseases, proper explanation of diet, physical activities and lifestyle changes, which altogether is not possible by the treating physician alone and should involve a social worker and a dietician, who would help bridge the gap between the busy Physician and the patient, who does not need to visit the doctor for every minute question regarding his lifestyle. And this is just an exemplary situation that I’m talking about.

Currently, the Govt’s plan is to decrease absenteeism of Doctors at PHCs by making this rural posting compulsory. But I fail to understand one simple thing. Isn’t anybody concerned about the social relevance of such a step? DO they expect hard-core urban-mentality Doctors to suddenly go into the community and then understand how to deal with socio-cultural aspects of the community on our own? Another aspect which is of mention is the sensitisation of Doctors towards gender and religion which as of now is absent in the Medical school curriculum. It is a matter of debate as to how to impart such practical training in the curriculum, whether practice-based, i.e. along with the demonstration of clinical signs on the patient by the demonstrator, or as a separate subject dealing with patient psychology. I am sorry to accept that such sensitisation training is lacking in all of Indian Medical schools.
We are left with basically our own instincts and intelligence to learn to handle the outside world at large.

Only time can tell what shall be best for the betterment of the situation.

Until next time,
Peace.

Quackery: a social evil and a doctor’s nemesis

Yes. I am a Medical School student in Delhi. Yes. I knew very well before taking up Medicine, that I would have to face such situations in this career which are one of the very prominent evils of our society. Yes. I knew that there would be situations, when I would want to curse the stupidity of people so much that I would forget what my aim is, whether to treat diseases or turn into a  empathy-loving social thinker.

I have Paediatrics clinical rotation going on at the moment. I have seen many different diseases till now, undiagnosed cases and complicated cases, cases which have very poor prognosis( by this I mean that there is no discovered cure for the condition and child is going to die in a few years). Tubercular meningitis is a very commonly occurring condition in the Indian scenario. Many children of below school going age get affected every year by this chronic form of meningitis. Following sequelae of the disease are not very good to hear — hearing loss, loss of vision, permanent paralysis of limbs, seizure disorder, etc. Many of them go into coma and finally succumb to the condition.

The child I saw today, Durga, a child two years of age resident of Farrukhabad, Uttar Pradesh, had been having episodes of fever of unknown origin since October. The parents were complaining of delayed attainment of developmental goals (walking, speaking, eating on her own, etc) till the age of one and half years age, when suddenly she started having these fever episodes. Her development delay might have been due to malnutrition because she hailed from a not well to do family.
But the most remarkable part of her history that I elicited from the mother was, even after recurrences of fever, they had not taken the child to any proper medical practitioner or to any Government facility whatsoever to get her checked or at best referred to any higher center. What they had done was to take the child to “a person in the village” who had been giving the child “puriya” filled medicines. Those who are accustomed to the local use of words, (and this is for those who aren’t) would be able to understand that “puriya” giving persons are none other than “quacks” and these are no conventional medicines that we generally refer to apart from being some ineffective sugary or some other chemical mixtures.  The bravest thing that this illiterate guy could do was to continue giving these supposedly effective “medicines ” of his to the poor child for two months and when there was no improvement and the parents were getting agitated, he had finally referred her to Lok Nayak Hospital, Delhi.
In the meantime, over these 3 months, Durga had gone into altered sensorium, meaning, loss of consciousness, lethargy, decreased eating and drinking, increased nausea and all other clinical features which even a mere MBBS practitioner would have been able to pick up as signs of a neurological phenomenon, which immediately would have required proper medical attention.

As of now, Durga is in a comatosed state, not responding to calls, not looking up; she is being fed through her nose. Her anxious parents roam about her bed, not knowing or understanding the magnitude of her illness, not realising that she might not be able to sit up in future, or see or behave normally either; she might have retardation of her mental abilities.

And all this because of some stupid quack who has been living off some poor person’s ignorance. Uttar Pradesh, India is plagued by these quacks more than any other state in this country. and that does not mean that I am undermining the number of quacks in the other parts of the sub-continent. They are everywhere, unqualified, ignorant persons who can convert the poor man’s distress into a way of business and money-making.
Even after the Indian government trying to put in place a proper rural health system throught National rural Health Mission, or trying to send MBBS doctors to rural postings, these events keep on happening. And this is not just because of the evil-minded quacks; it is partly due to the lack of awareness and callous attitude of the parents as well, that even after 60 years of Independence and increase of opportunities to education and contact with mass media, people keep on repeating these mistakes.

And look who has to suffer. The weak, the fragile children, the treasures of the country, those little souls who are destined to take the country forward and rise above others.

Haplessly hoping for peace, until next time.

Compare and Contrast 2 Health Care Systems

Compare and Contrast 2 Health Care Systems.

Inspirations…an Elegy

Here’s me sharing some memories of the year, some trifling thoughts fleeting past daily life amidst college work. I have not compromised with the length of the post as I felt that what had to be said had to be penned down (typed, rather) in whatever length it comes to be in.

Nevertheless, worth a read I feel!

Feel free to comment.

• The Motorcycle Diaries — The Struggle

All right. I would not deny that the first few minutes of the movie I kept on thinking why I was watching it ‘coz I couldn’t make anything out of the story. Usually, its my habit to wiki the movie. So I find out that its based on the autobiography of the famous Marxist leader Ernesto Guevara, commonly called “Che” by the public and describes the journey that Ernesto and his friend Alberto took across the streets of South America, on a broken motorbike, from Argentina to Chile. Surprisingly, I learnt that Guevara was a Doctor in his final year of Medical School and this trip was to be a road trip, which finally led to his dropping Final Year medical school. This was latin America of 1950s and capitalistic policies of North America were starting to affect countries across the globe. Post World war II world was that of hostility and non-cooperation. What Che saw on his journey were the inferior conditions that the common man was living in; the poverty, the exploitation by the landlords, the atrocities thrown by the companies involved in mining and construction industries. but throughout the journey, Guevara could not leave his Doctor sentiments behind. What I realised on the morning that I was watching the movie was that, a doctor is not just a person to treat diseases with drugs or surgeries. He is to be a reformer too. A socialist, a parent, a teacher, an entrepreneur; altogether an inspiration for the common mass. Guevara could not tolerate the discriminations done to the Lepers at a leprosy treatment center in Chile. He mixed with the then considered “untouchables” freely, much to the scorn of the Christian nurses and lent fresh air amidst the gloomy calm of the leper island. The result was that, at the end of their journey, Guevara could not return with Alberto to his hometown. Instead he took to the roads to work for the oppressed, later formed a revolution that changed the face of politics of the south.
At this juncture, I would like to reflect the health condition from the perspective of my home country, India. Investment interests here rest more towards the private health sector. The country is going through almost similar socio-economic conditions as that of Latin America described in the movie, whereby, the rich are growing richer and the poor poorer. There is a growing dissent towards the ruling classes, which are not necessarily the rich. There is an increased sense of responsibilities and due services and opportunities among the masses and the youth is ready to fight for what is not there. But the societal build of this country is such that, since childhood only, the mere practice of questioning an institution is considered sacrilegious. That is sort of the reason why it is very difficult to control law and order situations in the country and give shape to new by-laws. Health is a universal responsibility of the state, that has been felt over the years. One doctor, like Guevara, to leave home for taking care of the common man cannot be the option for all. But, the trainee Doctor of today should realise that the country is not an economic heaven like the US so that all of them can sit in their snug offices, writing ornamental prescriptions; neither is the option of not having the infrastructure to offer the people modern methods of treatment. So the system needs a change, which might be in the form of the new National Health Mission.

• Life of Pi — The Book rediscovered

Talking of inspirations, nothing can be more demanding and mood lifting like the story of the struggles of a boy stuck on a life-boat for 211 days after a shipwreck on the Pacific. Martel narrates the true story in the last two pages of the book and clarifies that the happenings described throughout the rest of the book are fractions of the boy’s imagination, all of it revamped and refurbished in order for the boy to attain mental peace who sees his mother’s throat cut open on board and experiences cannibalism. The story is as peaceful as the calm of the Himalayas and equally as disturbing and haunting as the shrill laughter of a Hyena. It gets back at you, thrashing realities of human life and makes you learn that life is not as frail as it appears. It goes on and on, evading the dreary desert sands one has to tread before he can visualise the image of an oasis which again proves itself to be another mirage only.

• The knowledgeable Train Co-passenger — The Exception

Each time you travel in a 3AC coach be it of the Rajdhani Express or the Duranto Express, there is always the underlying itch; an itch that stays with you throughout the journey, till you pack your suitcase and laptop bag and stomp heavily out of the station to face the usual vagaries at the Auto/ Cab stand; this itch I’m referring to as many of you would second me on is the issue of co-passengers. There are all kinds of them; talkatives, screechers, cry-babies (literal), fish-market families, moms scolding kids, and those single passengers who, not unlike me, vexed at the thought of the next 17 hours of pestilential torture by the nuisance, sit quietly on their allotted seats, throwing observant looks at the other 6 or 7 people beside him.

This time, my return from Delhi was a lot different. Mr Arya Bandyopadhyay from Kolkata, a freelance photographer for several news-dailies, an Advisor to Executives (Mittals, etc :D) and a former employee of the Anandabazaar Patrika, seemed like a decent person and it was not until I talked to him the following morning that I got to know of his credentials and the level of expertise he has in what he does. The best point in common was him narrating the story of a heel bone tumour that his wife had almost 10-15 years back. I, being a Med student, got ardently involved in listening to the true incident, which according to me, not only was a narration of the celebration of life, but also of the success of modern Medicine. He went on from the events from taking his wife from Kolkata to AIIMS (Delhi), all doctors differing in their opinion regarding the character of the tumour and hence, the management options. His was a story of perseverance and vigour, which finally led him to lay trust on the opinion given by Dr. K. K. Unni from Mayo clinic and accordingly his wife received management from Tata Memorial and Research Center, Mumbai. But, the most haunting part of their experience is the part where the tumour recurs in the spine and stops responding to the conventional treatment methods. The next thing that he told me might appear hoax or hocus pocus to some, but his wife did indeed recover from the treatment offered by Vaidya Balendu Prakash, a specialist in Ayurvedic medicine from Dehra Dun. At this point, I might mention that Indian System of Medicine is already being considered to be included alongside the Allopathic form of treatment. It might not be a well discovered form of Medicine, but if proper R & D investments are done in these branches, then many secrets to treatments of many diseases might be in store. But, then it is India again, a country which realises her potential late, after maybe “somebody” from “somewhere else” comes and points out what’s wrong or what’s possible to do.

• Vizag and Pablo’s Photography — The Trip

Tribal Dance at Araku Govt Resort

A long awaited trip; with Dad’s friends and their families. Well actually it was hanging in the “awaited” status for my parents mostly. For me it was more of a premonition of getting sucked into 4 days of extreme form of boredom at an even more presumptively boring prospect of going to visit Visakhapatnam, which according to my Delhi friends is “a place unheard of before by tourists”; such is its popularity!

Once we boarded the train in a reserved Sleeper Class compartment and people from the General compartment started roaming around our seats with keen shining eyes of a hawk, expecting to declare ownership (temporarily so) over any seat visibly empty on their way, my father got irritated and I again had the same kind of  feeling you get when you suspect that the trip was going to be a drone. But thankfully, I got comfortable with the son of one of Dad’s friends, two years junior, Pablo. The rest of the journey was spent eating and sleeping mostly.

I would have to accept that Visakhapatnam surprised me like hell once I set foot outside the train Station. Roads like highways and clean road-curbs (which is quite unthinkable to Kolkatans), small and cute residential blocks, a brilliantly maintained sea shore and the Bay of Bengal facing Guest house that we were staying in; an overall experience worth remembering, also considering the fact that our Guest House stood just 20 metres from the Gateway Hotel, Taj Group.

To me, Pablo‘s masterpiece photography was even more fascinating than the stalagmites of Borra caves. It would not sound over-exaggeration to say that the guy has a real shot in the media industry if he wants to take this up as a career. But, passion is not always to be a gateway for trade, it might just remain a hobby, quiet yet classy!

And myself! I took in all the fresh air I could, into my lungs, to get prepared for the difficult times lying ahead in front of me — Final year Med School, Internship, Residencies; in short, responsibilities increasing by leaps and bounds every year. And I must mention the visit to the Extreme Sports Bar and the indulgence in smoke and alcohol, which smelt of freedom and growing up; an evening full of thumping music, scarcity of girls and overwhelming urges to pee every half an hour! 😀

• Apple iPad 2 — The Indulgence

Got this at Supreme Electronics in June. Considering the fact that we as young techno enthusiasts during 2002-2003 had been brought up to believe in the supremacy of Microsoft Windows, I had come a long way indeed. More so because of the repeated persuasions by Ravi Mittal and the reading of Steve Jobs by Walter Isaacson which actually increased my fascination and wonder for Apple products. Besides, it would have been the umpteenth time my HP DV4 laptop screen went flashing red and finally the BIOS got dumped. So I needed a more compact device.

Extremely sorry if anyone feels I’m bragging about my obsessions. But can’t help it, see? 🙂

• The Casual Vacancy — The Tragic Transference

Tragic, not because I felt J. K. Rowling has lost her mojo (unlike many), but because this book indicated and glorified even more, the fact that she’s not going to write anything else in the Harry Potter franchise ever again. I didn’t mind the dark and gloomy atmosphere hanging over the town of Pagford as the storyline brought in characters from everyday life. Rowling played her magic of weaving life into ink by sketching deep personal feelings into the pages of her book. It is truly an adult book, not because she uses swear words like cheese toppings on Dominos Pizza, but, because it deals with issues specific to adult life; indifference, divorce, adolescent sex and drug addiction. Rowling proves that she is best in writing on adolescents and the problems plaguing them, their confusions and their struggle for identity and their urge to prove themselves, only to find that the harsh world is too small to contain their dreams.

• Avanti — The Beginning

First of all, it needs to be clarified that Avanti Fellows is a non-Government organisation formed by former IITians from US. Mentor. Motivate. Inspire. — Its motto. How I got involved with this? Adrish Bhadra, my senior in college approached some of us with this friend of his in IIT-Delhi who has remained the Former Director of IIT-Delhi Avanti Core Team, with a proposal of forming a group of enthusiasts and see if we could implement the system of Avanti at our college campus. And the Band played on. We didn’t stop. Starting from requesting the Dean, MAMC to declare MAMC an official associate with Avanti Fellows, forming question papers, conducting tests across RPVV, KV and DAV schools in Delhi, correcting answer sheets and going to student houses for Home Interviews; Avanti Fellows has brought me an experience that needs to be shared, needs to written, to be told. I was appointed as Mentor manager of 5 Fellows and their Mentors (Juniors from college) and entrusted with the duty of following up their results, doubts and forward it to the Core Team Advisors (Seniors in college). Apart from being updated about the progress about the Fellows via calls or message, we have had to conduct a few doubt clearing sessions for the Fellows and judging the mentors on the basis of their motivation to function. It has been 6 months now as Mentor Manager and there have been a lot of difficulties for the system to work till now, ‘coz they are real people we are dealing with here and there are problems of such amounts which us students would not know how to deal with if we haven’t functioned like this previously. In a way, Avanti has been a source of a great amount of confidence and self-reliance and a chance to give something back to society in our very small yet genuine way. Plus, for us to become Doctors, human interaction is a necessary and sufficient condition, and Avanti has been a major platform for me to interact with people.

• Coke Studio Season 2 — The Music

This is India growing; India developing; not just the economy but, prowess in the world of Music and Literature too. Music as we have hardly known of; folk, rock, pop, jazz, country genres get mixed at the hands of our finest composers to create magical tunes. My favourite episodes were the ones by Amit Trivedi and his discovery Mili Nair, stringing together songs like “Yatra” and “Badari Badariyan“. Clinton Cerejo and Papon were the others mentionable. Indian music has grown beyond the shackles of Classical forms of music and youngsters are taking to Western form of music more in contradiction to the tradition. Standing at that point, Coke Studio brings a turning point for Indian music. It shows that its not about Indian classical or Western rock, Pop, Jazz; but the absolute fusion rendition of the Orient and the Occident is creating such amazing tunes. Though the show might not be a platform for the upcoming bands or music groups and is majorly run by Bollywood producers, this is just the tip of the iceberg showing what real discoveries and thoughts  are going into the music scenario every day as we sit and lament the destruction of the spirit of Puritanism; well, maybe this is for the betterment.

• It Might Get Loud — The history

 

I’d have to thank Anish Chowdhury for recommending this Documentary Movie to me during the Hols. Cursing at the extremely low download speed over the wifi, the movie took 10 hours to download but I would have to say that the wait was worth it.
One thing I’ve realised is however much I might be into Indian Classical music, songs of Rabindranath or Nazrul, Hindi music, Western music has attracted me for a long time (though haven’t tried it on stage till now :P) now and for the past year, after listening to the playlists of Led Zeppelin, Coldplay, Guns N Roses, Rolling Stones, Pink Floyd or Aerosmith at low volumes while at my study, I have had this feeling that the more you listen to them, the more you get addicted to them. For example, Gimme Shelter-Rolling Stones, Babe I’m gonna leave you, All my Love — Led Zeppelin, November Rain — GNR; these are the songs that I can’t get out of my head at any instant!
And the documentary was a bonus over this! Jimmy Page, Edge and Jack White, sitting in a room discussing how they developed their music forms, hitting a chord or two, and a full song at the end! Its like seeing Einstein and Roger Penrose discuss their styles of Physics thinking together, although being decades apart. Page’s time is almost two decades away from the two others, yet they mingle comfortably over the table regarding emotional memories related to their early life careers. It is quite mystifying how dedicated people can be to get what they desire, for e.g. Edge carving his own Guitar or sitting for three hours just to adjust the output of a 20 second lead in a song by U2! These are the most creative minds of the last century. However much the next generation moves over towards Hip Hop or R&B, the classic rock bands would be far from going down in history. Their songs speak of love, life and living, their guitars sing, their drums beat with the rhythm of the heart. They are truly inspirational!

Until next time.

Peace!

Visions for a strong rural health

Read @Pranabda’s article on rural posting tonight.

And suddenly at this hour of the night I realised the importance of that article of his. This and the ongoing Community Medicine Family advisory posting in my college; the country’s need for a very effective, reliable and accountable primary heal care system is absolutely evident from the current circumstances. I would not go into the statistics. But the more important matter is the realisation of the fact that for building up a proper community based healthcare delivery system, there is dire need of a brigade of adequately trained medical and auxilliary workers at the field level. And if MBBS passout recent interns are being prefered for these posts then this might lead to a big strategic mistake of the GOI,MCI, MOHFW and all the others associated. It is not unheard of how junior doctors are beaten up every day by agitatating patient relatives protesting against someor the other alleged case of negligence. The hospital and state authorities quickly control the situation either by threatening the junior doctors to drop their protests or by explaining some medical jargon to the public in a way which hardly brings out the magnitude of the scenario. It has been realised time and again that just as the doctor strives to perfect himself in the knowledge and art of healthcare, so also the patient has to be made aware of their demands, the facilties available, and their rights to healthcare as rightful citizens of the nation. Keeping all this in mind, sending inexperienced or less experienced interns to the field to work on extremely less educated and almost nil informed rural public may indeed seem to be the second best option possible at the moment. Also it has been considered that patients are not animals on whom experiments are to be carried out blindly, they are actually live subjects with intelligence and feelings, on which the doctors are going to operate.
What seems logical is first to look into the matter of adequate training of the rural health brigade, before adamantly jumping into decisions on rural health missions. Elderly doctors could be invited both from the country as well as abroad to extend their knowledge and experience to train the young minds better. It would also seem befitting to include the compulsory rural posting at the end of the postgrduate residency, when on one side the doctors are already trained in their respective branches of medicine, and on the other, there would actually be no issues also regarding sending inexperienced doctors to field or any ethical or moral issues from the point of view of the fundamental rights of the rural people. Furthermore, these doctors could funtion in their respective fields of work fulfilling the needs of the community better and in a more well planned and regimented manner than what an intern would have done. At this juncture, it would also seem encouraging to increase the postgraduate residency seats all across the country to increase trained manpower in respective faculties and also to build up the human resource for implementaton of the rural health service.
Hoping to see changes within this decade, regarding GOI policies and attitude of the healthcare system towards tackling their own ills and amendments which are congenial for both the public at large and the doctor population, with improved working conditions and upgraded infrastructure, rather than relying on idealistic expectations of huge contributions from the less trained interns.

Till then,
Peace.