Atul Gawande on status of health systems in erstwhile India

—— You have very good people with a lot of experience and good training in India. But if you put some of your best and smartest people in dysfunctional systems, it’s demoralising for them and it is unsafe for the others. The easy thing to say is that this is a bad doctor and he will be punished and that will solve the problem. But we all know that it is not the case. ——-

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.