Rural Posting: Red tape fanatic? Or social service?...

Of late, medical profession has become near-synonymous to ‘strikes’, be it doctors at peripheral hospitals or resident doctors at government hospitals. While the former strike for higher wages and better medical equipments, the latter do so, sometimes for or against imposing the benefit of reservation, sometimes against procrastination of promotions, and now-a-days purely against the government rule to impose compulsory rural postings on every course that the doctors undertook. The rule said 1 year after MBBS, 2 years after post graduation and 3 years after a super specialization. So a doctor who started his studies at 19-20 would complete his super specialization and postings at the end of 17 years i.e. by the time he would be in his late thirties.
While thinking of all this, on my way back to college, after hearty Diwali celebrations at home, I went through the same gamut of sentiments. How insensitive can doctors get? After all they earn so much. How greedy of them to refuse rural practice just for the sake of the extra earning that they would get in the cities, said one. They are all brutal, selfish and inhuman, said another. Soon half the people in my AC coop of Maurya Express got involved in the discussion. But when I recalled seeing patients coming to SKMCH all the way from Sitamadhi and Motihari, my bias strengthened. Yes bias, because both patients and doctors are actually suffering from the same problem - policies made by people who understand neither the profession nor the needs of patients.
There are patients who come in regularly from far away to get treatment. Each time, some ward boy or nurse tells them “it will not be possible”, even before they can talk to the doctors. There are patients who want to get tests done and can not afford private labs. They are being told that the hospital does not have equipment. If daily hospital days wear out patients like this, what is the point of going on a strike and further troubling the patients? “In Bihar, we doctors work in such adverse conditions that there is barely any dividing line between rural and urban posting”, said a co-passenger. Luckily I was not the only medico in the group, I thought. He continued, "There have been times when we have been ready to perform an emergency operation, knowing that any delay would be dangerous. But the government has tied us up in various procedures, legalities that have to be completed by other employees, who do not feel the same helplessness that we feel when we see a patient suffering because of bureaucratic delay." It was an admission in shame. He continued to tell us stories of how doctors had been denied newer and better equipment because the people they applied to, saw them as only costs and not a necessity. And this is the case in cities. So what about the rural hospitals? No wonder a rural posting in every government job is considered as a punishment posting.
A resident doctor already has a difficult life. The government doesn't give him proper accommodation where he can live comfortably with his family. So, mostly he/she lives alone in the hostel, sometimes working 3-4 days in a row with no rest, And all the time attending to patients who have already waited so long that they have no sympathy left for the doctors; which is a very natural reaction. Still my co-passengers didn’t seem to conciliate, “If you went to work in these rural hospitals, you would be able to serve these people better and not have to face their anguished wrath.” “But, suppose I have done my M.Ch. in cardio-thoracic surgery and I go for a 5 year rural internship to a hospital which doesn't have enough equipments, beds, attendants, will I be able to help the patients out there? I would end up being eaten up by guilt and helplessness everyday thinking ‘Here I am, at a place where people need me but I don't have anything to help them with. I can't perform a surgery and so for three years.’ So I just do normal check-ups and play a consultant's role and then when I finish my posting I would have forgotten everything about cardio-thoracic surgery. So what use is my M.Ch. now?” came up my savior. “And then, staying in adverse conditions Bihar villages, preparing for post-graduation entrance examinations would become next to impossible”, I added.
That gave the coop a new perspective on the whole issue. Until rural hospitals are well equipped, there is no point in blaming doctors not wanting to go there. What use is a doctor without his paraphernalia? He is as good as the compounder of yore who set up a mini practice after retirement by prescribing medicines he had doled out all his life over the counter. The compounder knows what could cure the patient; but would never be able to do it himself. Why not build super specialty hospitals in rural areas? Why not concentrate on making rural hospitals so efficient that a rural posting would not be considered a punishment? Why not spare the poor family from Motihari all the trouble of traveling up to Muzaffarpur? Why not let them have a proper hospital near their hometown so that they do not have to be disappointed with the behaviour of the medical staff?
Every day scores of patients come all the way from towns across Bihar to the government hospitals. And hundreds of them are sent away because even city hospitals do not have the services they want. I wonder when those facilities would reach rural hospitals. I wonder when the policy makers would realize that a policy is not a one line statement but a planned strategy to change lives of people. But then probably that is the very reason that they are called policy guidelines...Things which would always have a loophole because they are not plans of action. It is difficult to be a doctor in India, it is even more difficult to be a poor patient; but it is very easy to be the policy maker, governing the lives of thousands of both of them, everyday.