Modern Day Slavery!

Compulsory rural service for all medical students is soon going to be made into law with effect from the next academic year. I really empathize with all those unfortunate M.B.B.S students who are going to be subjected to this meaningless activity, in the name of "service".

Why meaningless?.. because its plain stupidity to expect a hapless, untrained medico, fresh out of M.B.B.S to be the backbone of healthcare for all the rural folk in this country. In short, we are taking our most inexperienced medical personnel to serve 75% of the Indian population!. That amounts to majority of our population being under-serviced as far as health care goes!. There is a clear discrimination of policy when it comes to tackling urban and rural healthcare. Even the proposed 4 year Master of Rural Health (MRH) is a clear violation of the rights of rural citizens to equitable health care like there urban counterparts.

Most of all, it is the poor medico who is going to be worst affected by these thoughtless rules. Not only is he called to serve in an environment of poor infrastructure, he has to sacrifice ties with his family, work for paltry sums of salary to get his degree.

Health Care Reform

Healthcare in India is an industry in want of good management. The onus of providing this precious service has been divided between the private and public institutions. The public institutions are overburdened, under-financed, and notoriously mismanaged. The private institutions cannot claim to be any better. Although they provide a better work culture, they are famous for over pricing and over-investigating.

The poorest of the poor are always the worse affected by these policies. Disregarded by the government hospitals and drained of all savings by the private hospitals they are at the receiving end at all times.

The government in some states, has taken steps to fund the expenses of healthcare for BPL families by providing health packages. Although well intentioned, this is like most government policies is bereft of forethought for possible repercussions. An old adage summarizes this policy- "give a man a fish, and you feed him for a day; teach a man to fish, and you have feed him for a lifetime". Anything handed out on a platter, for grabs, is always ignored for value. Anything worked for or fought for is valued beyond its true price.

These schemes are also exploited by many- some who use it to obtain free healthcare not appropriate for their income, some who pocket money meant for medicines/services rendered and others who take kickbacks for referring the poor souls to an institution that would ultimately benefit from the ingress of money to its coffers.

No scheme involving large amounts of money can be adequately insulated in India from corruption. Unless we incorporate good work ethos and eliminate poverty- which cannot ever happen overnight- we are slaves to corruption!

How then, can we hope to implement better health care to our masses?

Instead of putting lump sums of money into schemes that concentrate on referral and private/public tertiary care setups, we must build around a three-tier system of healthcare with most of the finances and maximum emphasis on the base of the pyramid- the rural health care centres and district healthcare centers. A large chunk of problems can be tackled by these setups itself- if adequately staffed and equipped. Private setups in the rural areas must be encouraged- with incentives such as tax-free holidays (on the lines of IT companies); these centers must be monitored for quality of care by independent responsible observers. Medical colleges must be ordered to adopt a district level hospital and dispense the required heath care to all subjects in that district. Tele-conferencing between district level physicians and those at the tertiary care center must be offered for counselling regarding difficult to treat cases. Unless this kind of infrastructure is in place, it would be meaningless to deploy fresh medical graduates in the grass root centers by compulsion.

Private and public hospitals in two-tier and three-tier cities must be the next target of the government health policies. Only by reducing the burden (by diverting simple-to-treat case to the district level) on these institutions first, can we begin their reconstruction. Strict monitoring of health services dispensed must be undertaken to ensure quality care.

The final priority of the government must be the public institutions in the metros. These must focus primarily on specialized services and advanced training. Soaps and services must parallel the private healthcare setups to be able to survive the economics of the times.

A Mother's Resolve

She was a thin, frail-looking lady with a even more frail-looking son. The boy was struck with an incurable disease. She never gave up on her (only) son, but, ran from pillar to post, spending the last of her salvaged money on his treatment. Her doctors advised her otherwise, but she would not heed to them. She was always there by his side, cleaning up his detritus, shunting food down his feeding pipe, holding him tight while he slept. He was once a talented, alert and active 10 year old, like others his age. But the disease had gotten to him, depriving him of his senses and making a vegetable out of him. Still, she would not let her motherly resolve be diminished by the obvious incurability of the disease. The story doesnt have a dramatic ending one would wish it did, but the mother's love for her dying son was truely remarkable.

My first steps into Oncology

This is the first of a new series of posts that i would like to share- experiences while on the job- in my case, a fledging cancer speacialist. Its a job, not many will be willing to take up- for many reasons- poor patient response, dissatisfaction with treatment, frustration of not being able to do more when you want to, and so on and so forth. But somehow, none of these were reason enough for me to heed to the constant peer pressure to reconsider my decision. To a lay man, an oncologist is not so appealing as say, a cardiologist or a neurologist- now they were people who are literally considered gods!.. so whose an oncologist, i was often asked? "Cancer!.. why do you want to study Cancer?".. people asked me baffled at my choice of a career. But, somehow, somewhere a chord had struck, and i knew that i was destined to make this my calling.
My first few days at the department were nothing short of frustrating. I was so confused"why this? why not that?How do you guys decide the protocols? How will i ever remember the drugs?" Everything was new, unexplored territory. It helped to have a supportive work environment that gave me the time to fall in place.
Well, two months of working in the wards has been satiating. Im beginning to understand how the system works and how to make the decisions we take. Im not claiming to have mastered it, but definitely the whole picture seems less hazy now and more transparent!
Anyway, im at the start of a journey that seems to have more experiences to learn from than learn about..