Thursday, January 7, 2016

Practising medicine in rural India.

For the love of the country and altruistic reasons one, after qualifying as a doctor , decides to work in rural India .All is well at this stage  but when the red-tapism starts throttling you in the neck you wonder if it is really worth it.
Government of India needs to have a second look at the rural health in the country.
I presume 60% of India lives in villages.When I first finished my post-graduation and joined work in Jharkhand our competition used to come from the 'jhola chaps'.As frustating as it was,the facilities we had in hand were not much better than theirs .However ,I had never practised medicine outside India.
I trained in medicine under great physicians,perhaps the best in the field in India where a lot of stress was given to clinical acumen but they did have proper facilities to back their work up.
I had an oppurtunity to practise medicine abroad for a year.
One important lesson I came back with, to India is that facilities matter,quality matters,order matters,vigilance matters,incidence reporting affects quality..Such things save life.
Brings to mind a senior consultant from a place where I worked in earlier who has opened a clinic amongst the tribals in one of the  hills.He runs a clinic in a mud-house but he has a blood gas machine,a defibrillator,ecg machine,a small lab,ultrasound machine.He is a physician and his wife is an obstetrician.They are easily some of the best in the field.The cost to thepatients are nominal and I guess are subsidized heavily.
Abroad,one patient dying with a cause which can be reversed is a huge thing ,can cause a  clinician to lose their license.In India the muck up starts right from their doorsteps and only thing the system scrutinises is the hospital which the system has in no way facilitated, to give better services.One hardly hears of a government hospital being scrutinised.
Government needs to take leadership in utilising resources and taking all the medical fraternity both  government and private together forward in providing adequate and good facilities to the public.
For instance we have been working on building a critical care service in the area.There is a need for it and we have qualified doctors.Simple things like an echo or a scan which would take the services provided to another level is tied up in the red-tapism of the PNDT act.You need a radiologist to register a machine.Show me enough radiologists who will be willing to work in these remote areas for the sake of registering a machine.However,people whose skills are a suspect, have certificates and so can do limited ultrasounds which can rake in the mullahs for them but barely improves the quality of care provided.
What a land of contrast India is.On one hand the government talks about equipping non-medical personals with medical skills to reach every doorstep and on the other hand they tie the hands of the qualified personals who have intentionally placed themselves at the doorsteps with these beaurocratic tapes.
When one as an NGO thinks of networking with the government for the various schemes one can get a heart attack just  looking at the requirements to qualify for the tie-up.It has been structured in such a way that smaller hospitals cannot participate.They ask for every specialists under the sun and the amount of renumeration they prescribe for the services will not even pay for the services.Period, we are not here in these far-off places to rake in profit,but we still need to support families and staffs who make these services possible.We are here to provide services to the needy,to participate in the nation building of this great nation we are so proud of ,try and stand in gap for the marginalised but the temptation is strong to close shop in these areas and just concentrate on fewer institutions which have the capacity to fulfill the unreasonable government requirements and practise medicine in peace,however the poor will die,the government will continue to make legislations and rules based on the health practises in the bigger cities...like my junior was telling me the other day ,snakebite patients will continue to die...,malaria patients will continue to succumb to the disease due to lack of intent on the part of people who hold the resources.
India has a huge population and one life here or there will not make much difference especially when it is of a rural poor.


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