Doctors on Strike

(My first Article published in The News on 31st January, 2013)

A cat and mouse game is raging on between Young Doctors and Government of Punjab. There is a set pattern being followed by both sides, based on earlier skirmishes in the last two years. The primer is usually an untoward incident involving young doctors. As a consequence,there is outrage from young doctors while the government announces some form of committee to sort out the problem. Nothing discernible happens for next few weeks/months. Doctors come out on the streets and OPD(Out Patient Departments) are closed. A few individuals are dismissed from service by the Government and a few people are arrested. As a last resort, doctors announce withdrawal of emergency services, crippling the already overloaded public health system. Within a few days, some makeshift solution is cobbled up and things go back to normal. This routine is being followed for last 2 years and if things remain as they are, can be repeated this time as well.

Young Doctors have been branded assassins and mercenaries, devoid of all humanity,  sacrificing all moral values to bargain for their demands. Hundreds of doctors have been terminated  over the last two years, and dozens have been jailed. A vicious propaganda campaign was designed last year, costing the public exchequer more than 400 Million Rupees  to malign doctors. There is little understanding of the issue plaguing doctors in this country and they are seen with derision and contempt because they have the temerity to demand their rights. The most prevalent misunderstanding about the doctors’ protests is the belief that they are demanding a pay raise. While this was true two years ago, the issue of pays was resolved. Let me clarify that it is not mentioned anywhere in the Hippocratic or any other medical oath that doctors ‘have’ to provide medical care regardless of the conditions. Regarding the morality of strikes, Awais Aftab, a fellow doctor, explained,

“A doctor enters into a contract with the society only by virtue of his contract with the Government, therefore, if the Government refuses to honor its obligation of providing adequate facilities and working conditions for the doctors, then the doctors’ obligation to work for the Government becomes questionable. This includes the issue of pay and service structure. If the amount of work and the circumstances in which they are expected to perform deviate significantly from the pay and facilities they are receiving, Government is violating its obligations. This can be augmented by a utilitarian justification. If the short-term harm brought about by the strike is balanced by a long-term benefit to the society in the form of an improvement in health-care, virtue of the fact that doctors can work more efficiently in better working conditions, then a strike is justified. But this utilitarian argument can only be an augmentation, not the crux, because we all know that human lives cannot be added and subtracted.”


The Prime demand of doctors is provision of a better service structure. The current structure is dependent totally on the whims of Baabus at Civil Secretariat who consider doctors as inferior and despicable species. There is no uniform system of promotion. I have documented cases of different doctors who graduated in the same year, from the same college, and having similar qualifications, where one of the two was promoted as a Professor and the other is still in grade 18. Hundreds of “relics of the past” are occupying positions in Major cities while young doctors are transferred to far flung areas. Professors of respective wards are kept busy in administrative affairs, affecting teaching schedules and regimes. Induction of doctors on Medical Officer posts is done via Federal Public Service Commission(FPSC). There were no inductions on regular seats for more than 15 years in the last two decades, contract employment was favored instead. Young Doctors in most major hospitals live in dilapidated hostels, single rooms shared by upto three people. More people do house jobs without any pay than those who get pay. These issue are important when you are doing more than 60 hours work per week without any reward.   

In November 2012, an agreement was reached between Young Doctors and Government of Punjab that the new service structure would be implemented. Two months after that understanding  there was no sign of implementation. The dispute over non-renewal of contracts and housing allowance was simmering in District Head Quarters(DHQ) Hosiptal Gujrawnala as a direct consequence of the non-implementation of doctors’ demands. A team of interlocutors from Lahore was there on 2^nd January 2013 when the whole scene got ugly, resulting in physical violence by doctors and by hospital administration. It was broadcast on live television across the nation with some spiced up subtitles. As a result, more than a dozen doctors were arrested and are still in Jail. OPDs(Out Patient Departments) are closed throughout the province in protest and a major ‘Dharna’ has been planned for 7^th February 2013.

Personally, I do not endorse the physical violence unleashed by young doctors in Gujranwala and want an impartial inquiry into the matter. Apart from that, I stand by the doctors’ community in the struggle for the proposed(and agreed-upon) service structure. Government of Punjab has tried all sorts of delaying tactics including court delays, invitation to 200 Army doctors, induction of substandard doctors during the strikes and police torture. As a doctor and as a human being, I hope the issue is resolved completely this time, or both sides are going to lose.
 

Public Health Care in Pakistan: A basket case

(Originally Published in two parts in The News as "Our Sickly Health Care" on February 7 and February 8 2013)






"The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being" according to the constitution of World Health Organization.
The constitution of Pakistan guarantees basic rights and liberties to all citizens of the state. These rights derive from fundamental principles of justice in accordance with which the State of Pakistan assumes the sole monopoly of power over its citizens. To provide health facilities to the citizenzs, there is a Universal Health Care system in Pakistan. This means that any citizen of Pakistan can get treatment at public sector health care facilities in the country. Pakistan has a wide network of healthcare infrastructure, including 919 hospitals, 5334 Basic Health Units (BHUs) and Sub-Health Centres, 560 Rural Health Centres (RHCs), 4712 Dispensaries, 905 Maternal and Child Health (MCH) Centres and 288 Tuberculosis Centres. This system is supposed to cater to a population of around 190 million people.

Thus, one doctor at a public hospital is supposed to cater to about 1724 people, while 1504 people have to vie for a single bed at a public hospital. In a physician per 1000 people statistic, Pakistan ranks 120^th among 200 countries, with only India, Iran and Egypt among developing nations below us.

Pakistan is among the only three countries left in the world with Polio Virus infection, the other two being Afghanistan and Nigeria. Recent reports indicate that Karachi, Peshawar and Hyderabad,Lahore and Rawalpindi have turned ‘polio-endemic’ due to continuous detection of the wild poliovirus virus type-1 in the sewage samples collected from there. There are more than a million people in Pakistan have Chronic Liver Disease while 10% of the population has had exposure to Hepatitis B and C viruses. As many as 1.2 million people die of waterborne diseases in Pakistan every year, of them 250,000 are children under the age of five years. In a recent meeting organized by a public health research and consultancy firm, 54% of the most serious crises and shocks Pakistan has suffered in the last three years have been health-related as compared to only 3% that have been law and order related.


We have had brushes with Widespread Dengue Virus Infection, the PIC(Punjab Institute of Cardiology)-Syndrome outbreak, Naegleria Infection in Karachi and the very recent Cough Syrup-controversy. To quote a report by Pakistan Institute of Development Economics,
“Pakistan’s health care system is inadequate, inefficient, and expensive; and comprises an under-funded and inefficient public sector along with a mixed, expensive and unregulated private sector. These poor conditions in the health sector may be attributed to a number of factors like poverty, malnutrition, unequal access to health facilities, inadequate allocation for health, and high population growth and infant mortality.”

There is acute shortage of data for health indicators in Pakistan. Health, is not a priroity of either the Government, or the people, until an emergency strikes. Every new government has brought in new health policies but implementation of these policies has not been undertaken over time. Take the case of Punjab. It is the most populated province of Punjab. There has been no Health Minister for the last 5 years and the Chief Minister has kept the portfolio with himself. The current government has opened medical colleges in almost all major cities of Punjab over the last 4 years. The lack of planning is apparent in this case as no new teaching hospital has been established and retaliatory shelving of plans by the previous government has affected the system. Without proper teaching hospitals, medical students graduating from newer colleges will have to move to other cities for getting better exposure to clinical training. The last teaching hospital established in Punjab was Jinnah Hospital, in Lahore, in the mid-90s.  Regarding retaliatory politics, the half-complete building of Wazirabad Institute of Cardiology is a living testament.


Started on the orders of the previous Chief Minister, this project aimed at catering to cardiac patients between Lahore and Rawalpindi and adjoining areas. At present, if a person needs cardiac care in Gujranwala/Gujrat/Jhelum area, he/she needs to visit either Lahore or Rawalpidni due to lack of any facilities nearby. Time, though is a crucial matters in cases of Heart disease and an early detection can significantly improve chances of Improvement. Patients are brought from all over northern part of Punjab to Lahore because of Lahore-centric health spending. There are 17 medical colleges in Lahore, compared to 17 in the rest of the province. For about 600 burn patients annually, there are a grand total of THREE specialized burn centers in Punjab. Similarly, only 155 mechanical ventilators are available in Lahore’s public hospitals for a patient load of more than 5 hundred thousand patients every month. 

Tubeculosis, Hepatitis, Cholera, Malnutrition,Polio and recently, Measles, are some of the major problems being faced by the Public health providers. With the advent of Breaking News culture, any issue deemed imprtant by the media becomes important, public health almost never makes the cut, unless there is significant panic, as in cases of Dengue, PIC-syndrome and Cough Syrup-controversy. High mortality rates don’t bring high ratings, thus no need to focus on the isssue, let the children die. Newborns only matter when bitten by mice etc, that sells. The dismal condition of public health infrastructure has given rise to a popular phenomenon in Pakistan; People taking up things in their own hands. We required a public ambulance service, Cue Edhi and Cheepa. We needed good schools and Universities; Enter Private Schools and Universities. Similarly, to fill the huge void of public health, private entities and charity based organization stepped in. Currently, almost 80% of health sector in Pakistan is based in Private sector.

For a self-respecting middle class Pakistani, visiting a public sector hospital is nothing less than a nightmare. Due to over-burden of patient load, resources dry up fast. Data collected by the author for one particular ward at a teaching hospital in Lahore revealed that in a duration of 24 hours, around 700 patients visited the medical emergency of the hospital. There were only 45 beds available in that particular ward. At the end of 24 hours, 60 patients had been admitted, resulting in patients having to share beds in majority of cases. There is acute shortage of beds in teaching hospitals and there are no plans on the horizon till now that anything is going to be done in this regard. According to figures from last budget, Punjab Government has allocated a spending of Rs 120 for every citizen of Punjab. That is not sufficient even if you want 2 surgical sutures.!!



There is an overall sense of pessimism in the Public Hospitals, which ultimately leads to the exodus of doctors to greener pastures. This is just the tip of the iceburg. All doctors are not god-fearing, messianic figures either. A lot of senior doctors practice twice a day; spending morning in government hospitals and evenings at private clinics. Then there is the issue of equipments and their effective running. Two months ago, the X-ray machine at the largest hospital of the Province was out of order, and remained like that for at least two weeks. No heads rolled. No reporting in the media. Situation is even worse in other provinces. There are hardly any specialized centers in Balochistan or even Khyber Pakhtunkhwa(excluding Peshawar) or Gilgit Baltistan. 

It is the first law of Health Economics that 
“ Increased Spending on health leads to increase in per capita GDP”. Currently less than 2% budget is allocated for Health Sector and even with this pittance, the behemoth of public health care system is functioning admist crises. The first and foremost solution to the numerous problems is presence of political will to spend more money on healthcare. Until that will is mustered, there is scant chance of improvement in the system.

Furthermore, there are significant Problems concerning public health both at the policy and implementation level, especially after the devolution of Health Ministry to Provinces. Spending has to be increased, population explosion has to be halted, Long term policies have to adopted to increase the outreach of public sector healthcare, private sector needs to be regulated, more Teaching hospitals and specialized centres need to be established in areas like FATA, Balochistan, Southern Punjab and Gilgit Baltistan.Our State has failed in providing the citizens good health care and it  is affecting the whole economy. Media and civil society have an increased role to play in this regard, because of negligent behaviour of the state. One of the tenets of the doctors’ movement has been increased spending on public hospitals and decrease in VIP protocol patients. Very recently, category for “poor” patients was shelved by the administration at Punjab Institute of Cardiology and no one has taken any notice of that.

It should not be forgotten that a state that absolves itself of its responsibilities, is paving way for its own downfall. Spending public money on flyovers, foreign visits and security guards is not going to solve the problems of health and education in this country.

Of Protocols and Parchi System

Published on 04 January, 2012 in The Friday Times

"Kindly admit our patient, Doctor Sahab. We have talked to the Medical Superintendant and your Head of Department. They have sent us here."


I was sitting in the ward, making discharge slips for patients when someone got my attention by uttering these words. I checked the papers and found that the man was right. He had been sent to our hospital by a top office-bearer of the ruling political party in the province. I was reluctant to oblige such commands as I don't personally think political workers are any more deserving of a doctor's attention than the downtrodden people who fill government hospitals. By sheer luck, there was no vacant bed available in the ward. I explained the situation politely to the man and the hospital employee sent by the "Protocol Office" (designated to oblige influential people, their relatives and lackeys). They tried to reason with me by pointing out that the M.S. had talked to our professor twice and he had written on a slip that these people should be accommodated. I asked my immediate superior about this, and he was also of the view that we have no spare beds and can't accommodate someone just because they have better connections. He talked to my interlocutor himself and in the end the party left without the bed. This was one of those rare times when we resisted the protocol patients, as we have come to call them. Most of the time, however, anyone designated as a protocol case gets preference over ordinary patients.
At the public hospital where I work, there are special VIP and VVIP wards specified for senior bureaucrats, political figures, judges and their families. In spite of that, countless patients are referred by political figures to the hospital with small slips on their letter pads. This is true for almost every public hospital in Pakistan. As we are based in Lahore, we get most of our "slips" from party affiliates or government officials employed by the ruling party of Punjab. In other provinces, only the names change and the "slip system" remains the same. Underlying this whole culture is the belief that unless you are influential enough, you won't get good treatment from public service providers, be they doctors or engineers or policemen. This understanding breeds a more-than-bearable nepotism for any society.

The worst abusers of public service systems are public servants themselves. Senior bureaucrats consider government property as their personal fiefdom. To ensure that every whim of the politicians and bureaucrats is fulfilled, most appointments on the post of Medical Superintendents are politically motivated. Subservience and acquiescence are the requisite qualities desired by the higher-ups for the highest posts in public hospital administration. 

Doctors themselves are no less culpable. It is usually said that doctors make the worse patients. I would like to add to this axiom that they not only are the worst patients, they usually are the worst attendants as well. I distinctly remember one time when a classmate of mine at medical school brought her grandmother over to our ward for admission. We provided her with the best care that we could. After two days, she passed away. Since then my classmate has not talked to me, as if it was my fault. She herself is a doctor. 



I have worked in the Intensive Care Unit (ICU) and a lot of times we've had undeserving patients brought in by other doctors. The ICU is supposed to be for patients whose lives can be saved by intensive care and who are on the brink of death. This is true unless you happen to know a doctor; then rules and regulations can be thrown out of the window. The tragedy of public hospitals in Pakistan is that unless you know someone working there, you are not awarded any extra care. As a doctor, I always try to provide equal care to my patients, irrespective of their status. I am not alone in behaving like this. We feel ashamed when resources are diverted for the sake of "sifarshis". We are sick of tending to the favored ones. We believe that our healthcare system is already neglected and needs no further roadblocks than the ones it already confronts. My request and plea to the people at the top: kindly stop pulling your rank to make us care for your cronies. Thank You.

Doctors Strike: The Aftermath

Doctors’ Strike: The Aftermath



It has been two months since one of the largest strike by doctors shook the province of Punjab. It all started with the closure of Outdoor Patient Departments (OPDs) in all major hospitals across the province as a gesture to protest against the attitude of the Government of Punjab in provision of a better service structure for Doctors. It was a move designed to be of minimal impact because only ‘stable’ patients visit OPDs and there was no threat to patients’ lives. Last year similar protests by doctors led to a commitment by the Chief Minister to provide a new service structure and committees were formed to pave the way for formulating an acceptable formula. The closure of OPDs happened after one year of useless meetings with the representatives of Punjab government.

Last year, government was unable to control doctors and the chaos led to loss of many precious lives and ended with a truce. This time around, Khwaja Salman Rafiq (brother of Saad Rafiq and Special Assistant to Chief Minister on matters of Health) was designated the responsibility to ‘deal’ with the situation. Punjab Government started giving half-page advertisements in all major newspapers stating it had already done too much for the doctors and that doctors were essentially getting too big for their own boots. An estimated Rs. 1.6 million per day was given to newspapers and Rs. 450 million of public money was spent on advertising by ‘Khadim e Aala’s government. In addition, Essential Services Act was enforced by the govt, making it mandatory for doctors to do their OPD duties or else receive legal proceedings.

On 1^st July, 2012(after 21 days of OPD closure), a police raid was conducted at Doctors’ Hostel, Services hospital Lahore, resulting in arrest of numerous doctors. The same night, hundreds of other doctors were arrested from their homes. There was another raid at Doctors’ Hostel, King Edward Medical College on the night of 2^nd July. A total of 360 doctors were kept in Jails including Kot Lakhpat, Attock and Mianwali for four days. As a result of all this, emergency services were withdrawn from all major hospitals and any negotiations were made subject to release of all the doctors.

I want to recount some of the ‘stunts’ pulled out by the government during all this, apart from ‘Advertisement’ money from the public exchequer.  

1. ‘Medical Martial Law’:

As a ‘contingency’ plan during the closure of OPDs, Punjab government requested help of Army Medical Corps (AMC) to decrease patient overload. This was an unprecedented act of desperateness and expediency shown by the big-wigs of Punjab Government. This ‘experiment’ did not work out though. It failed miserably. Senior Doctors said it on record that the Army doctors were not trained to deal with such situations. Additionally, those doctors were paid Rs 2000 per hour of duty and special police contingents were employed outside hospitals where the Army doctors worked. For comparison, government of Punjab was paying Rs 800 per day to junior doctors and Rs 1400 per day to seniors whose places the Army doctors took for few days.
There were reports of those Army doctors misbehaving with the senior doctors and the ‘flexible’ duty hours practiced by our 'Jarri Jawans'. At the start of the Strike, Zaid Hamid's Baloongra's alleged that YDA punjab is actually “NGO funded Young Animal Association” and they work for money, not for saving lives. The 'Brave' Army Doctors that came 'to the rescue' didn't work for free though. This is the characteristic selective Amnesia practiced by Qibla Zaid Hamid and his followers.  For the Record, only 200 Army Doctors were deployed.!!!

2. The PCO Doctors

During the strike by Junior Doctors, Government hired around 500 new doctors (in place of around 5000 doctors) on ad-hoc basis. Those individuals are known these days as ‘PCO doctors’. They mostly include foreign graduates (who can’t normally get jobs at Government Hospitals as per orders of Chief Minister) and people who could not get job in ordinary circumstances. Some people, who had not practiced medicine for more than 10 years, joined the service just to get a paid Job. Chief Minister Punjab is fond of parroting the mantra of ‘Merit’ but these blatantly out-of-merit inductions did not gain his attention. All these people were hired against the rules and on ‘paid seats’ while more than 50% doctors work in government sector without getting any pay.

3. The legal Front

Apart from hundreds of doctors arrested without any justification, four doctors from Mayo Hospital were charged with Murder of a child that died in the Pediatrics Ward on the night of 1^st July, 2012. The Strike was also challenged in court and it resulted in involvement of Lahore High Court in the matter. The court ordered to release all doctors who were arrested without any legal reason and granted bail to the four doctors alleged to be involved in the Murder. It was further ordered that matters pertaining to Service Structure should be solved amicably by the Punjab Government.

4. Lies and Damn Lies
Throughout the strikes, there was a continuous propaganda mongering done against the ‘Cream of Nation’. Government Officials lied on Television programs and press-conferences about doctors being greedy, selfish, hooligans etc. The entire Advertisements campaign consisted of Jacked up figures that were used to fool people.

The Aftermath

On 2^nd August, one month after the strike, a follow-up meeting was called up by Young Doctors Association in Services Hospital Lahore. Dr. Amir Bandesha, member of the committee delibrating the future service structure, explained at length about the proposed changes to the existing structure and the points on which a consensus had been reached between Punjab Govt and YDAP. ‘PCO Doctors’ are still working in the hospitals despite resumption of services by young doctors and it is the demand of YDAP to transfer them to DHQs and RHCs.  After the meeting of general council of Young Doctors Association on 29^th August, 2012, province-wide protests were held on 5^th of September to exert further pressure on the Govt to solve our problems. Committees have failed to provide us any relief and even the Lahore High Court has been unable to enforce the writ of law. Another Protest/Dharna is planned for 19^th September and a March to the CM Punjab House after that. Is another showdown between doctors and State on the way?

Diary of a young doctor (Part 4)

(published in The Friday Times on 13th July, 2012)

Pay Up
"Please give me some money, I'm hungry and don't have any money to buy food," said the beggar.

"I wish I could, my friend, but I earn less than you do," was my reply. And I was not bluffing. 

There is a simple basic rule that governs almost all professions in the world: you work and that earns you money. There are strings attached to this simple fact according to diferent fields but the basic notion remains the same. Soldiers claim to fight for the country, police officers risk their lives for maintaing law and order, public servants work (or at least they are supposed to work) to provide services to their countrymen. At the end of the day, however, they all get paid for it. From the highest offices of the country to the lowest, from generals to chowkidars, from CEOs to clerks, the maidservants that work in houses, sewage workers, technicians, sales boys, they all get paid for doing their job. But in present-day Pakistan we are making one big exception to this rule: doctors.

I have chronicled the lives of young doctors and have described the trials and tribulations associated with their job. It is hard to believe that despite all this hard work, most doctors working in public sector hospitals are not paid. Imagine a person with 17 years of education, working 28 days a month, doing 30 hr/48 hr duties, and earning a grand total of zero rupees per month. 

Imagine a life with no pay, no job security and no health insurance (given that we deal routinely with HIV positive and Hepatitis C infected patients). All that keeps us going are the 'thank yous' of patients and a hope that someday, things will be better. 

After the doctors' protests last year, pays were increased. This does not mean that everyone is getting that pay. In the department where I work, there are 28 people working as House Officers and around 30 as Medical Officers/Post Graduate Trainees (PGRs). Out of 28 House Officers, only 8 are on the paid seats while the remaining 20 are working on 'honorary' basis (there is not much honor involved; it is a euphemism). Similarly, out of 30 Medical Officers, only 15 are getting paid. The situation is similar or worse in other departments and hospitals across Punjab. People working on honorary seats perform equal duties, do everything as others do, the only difference is that they are not paid for doing that work. This is a unique and frankly disgusting way of treating a professional, and there is no precedent for it anywhere in the world. Apart from interns at offices, everyone gets paid for their jobs. At times, even the Senior Registrars, after 10 years of medical training, have to work on honorary basis. 

There is an inside story to this practice. Theoratically, the seats in wards of teaching hospitals are preferably given to the graduates of the institute that the hospital is attached to. This results in unequality at times because graduates of other institutes opt for institutes in bigger cities. In the case of Punjab, graduates from all over the province prefer to do their clinical training in either Lahore, Multan or Rawalpindi. There is also the issue of non-residents. If a resident of Lahore got admission in Rawalpindi Medical College or Nishtar Medical College, he/she would prefer to complete his/her post-graduate training in the native town. Due to this shuffling, there are more candidates for less seats and departments employ different people on honorary basis. The merit list for giving a job for post graduate training starts from graduates of the same institute. Second on the list are graduates of other government institutes and lastly, the graduates of private medical colleges, including the ones in China and Russia.

There are ways that people bypass the merit system, because in Pakistan there is a single key for every lock: Sifarish. If you have the requisite Sifarish, you can bypass the merit and get a paid seat in your desired department. 

To cope with the economic pressure due to lack of any pay, doctors from public hospitals look for jobs in the private sector which forms 80% of our health sector. As a result, most of the unpaid (and in some cases, even the paid ones) do jobs at private hospitals in the evenings and in public hospitals in the morning. After living for more than 25 years on the largesse of your parents, if you still do not earn anything on your own, it reflects poorly on you. Also, during post-graduation, a lot of doctors are tied in the knot of marriage and it is difficult to ask your parents for sustenance of another person while you earn nothing. I personally know some people who delayed their marriages because they did not have the means to support a new member of the family. In some other cases, the young doctors were the only source of income for their families and had to wait till completion of their post graduation to marry. 

This system of 'honorary' jobs should end as it is nothing but a kind of slavery.

Diary of a young doctor(part 1)

(published in The Friday Times on 1st June, 2012)
I felt as if I could not move my legs. It was as if my body was disobeying my mind.It was 4:45 a.m. and my alarm bell was piercing my eardrum. I did the only thing I could do at that time: I pushed the snooze button. I knew I had to get up in a few minutes and by then my legs probably would have enough energy to crawl out of bed and move. It was a Saturday morning and I had to be in the 'Accidents and Emergency Department' for my 12-hour duty from 6 a.m. to 6 p.m. I had returned the previous day after doing a 28-hour ward duty which included very little sleep and quite a bit of leg work. The reason my body was temporarily refusing to obey my mind was my tiredness and lack of energy. In the end, I made it to the emergency department and performed my duties as a House Physician for 12 hours straight. This is how the life of a young doctor unravels.
A lot of patients visit the emergency ward because they want "urgent" treatment of things that can be easily dealt with on a regular scheduleI am a medical graduate undergoing my first year of medical training known commonly as House Job. Being on the junior-most rung in the ladder of the public health care system, we are the first point of contact for the people coming to public-sector hospitals. We have to perform emergency duty once a week and twice every other week. In the emergency department, we treat the patients who require urgent consultation with a physician. The patients come in, we examine the patient and write medications for them accordingly, their attendants get the free medications from the medical store located inside the department and those drugs are then administered to the patients by the nursing staff. This chain is the usual protocol followed in most public sector hospitals. In some cases, some drugs are not available in the medical store inside the department so the attendants are asked to get them from any nearby store.In the hospital where I work, we have the Hospital Management Information System through which we enter medications for patients using laptops and they can get their medication from the medical store without any hassle. On a regular basis, we treat patients suffering from gastroenteritis (caused mostly by unhygienic food and water consumption), fever and body pain, and patients who are already on medication for chronic conditions like diabetes, kidney failure, liver disease or heart disease. Patients are charged only for the minimal admission fee; laboratory tests and radiological investigations, including X-rays, ultrasound and CT-scans, are done without any charges.
I return home with an aching back, an empty stomach and pain in the balls of my feetEmergency Duty is mostly spent by us while moving from bed to bed and not being able to sit for more than five minutes. There are very few seats available in the emergency department and most of the work is done without much respite. During the duty hours, more time is spent by us counseling the patients and their attendants than actually treating people. Everyone wants to get our attention first and it can become hectic very fast, with beds filling up to twice their capacity and still more patients streaming in. Things can get heated as well and incidents of fights between the doctors and patients have been noticed in the last few years. There are no security guards in the emergency rooms, leaving the duty of self-defense to the doctors themselves.Incidents of bullying by attendants led to the formation of the Young Doctors Association 5 years ago.The facilities that I have described above are at par with almost any private hospital in the city. But the only people who tend to visit public sector hospitals are of the lower-middle class or the lower classes. One reason for this is that there is a shortage of both space and personnel in public sector hospitals. We cannot refuse treatment to any patient and this puts a strain on our already scarce resources. A lot of patients visit the emergency ward because they want "urgent" treatment of things that can be easily dealt with on a regular schedule. I have personally seen patients of sinusitis, occasional headaches, acid peptic disease and increased blood pressure in the emergency ward while all of them are theoretically out-door department cases.In the emergency room, a house officer examines patients, takes blood samples, passes nasogastric tubes or folley's catheters, checks blood sugar levels and blood pressure and has to write prescriptions on discharge of the patients. These few tasks are repeated from the start of the duty till the duty finishes after 12 hours. There are times when the inflow of patients is very high and it becomes extremely difficult to shuttle between patients based on the severity of their symptoms; and there are times when most patients are stable and the doctor can catch his or her breath for a while.Apart from fulfilling our duty, we also receive many prayers and good wishes from patients who are successfully managed. The road is not full of roses, though, and patients complain if the treatment is not working. The toughest aspect of the job is to face the incidents of mortality in the emergency. In most of the cases I have seen, attendants raise a hue and cry at the death of their loved one, and that frightens the rest of the patients. In those moments of grief, all the doctor can do is to inform the attendants and get signatures from them on the death certificate.As for me: at the end of the 12-hour duty, I return home with an aching back, an empty stomach and pain in the balls of my feet. I try not to walk much after I reach home and after a few hours of rest and some dinner, go to sleep, ready for another day at work.