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Carry on Trainee Doctor

When resident doctors went on strike in Maharashtra, interns went on duty. Sumedh Hoskote (Intern, Seth G.S. Medical College & K.E.M. Hospital), Parel) recounts the experience

The elation of passing (rather, surviving) the final MBBS examinations soon makes way for the bewilderment at the prospect of facing the year ahead – that of internship. It’s the period where, one is forewarned by seniors, one has to perform the unenviable job of a highly qualified technician (under the guise of practical training in the field of medicine) – all for the princely sum of Rs. 1700 per month – the first pay a medical graduate receives.

This year, the bewilderment increased manifold because of the resident doctors’ strike virtually coinciding with the commencement of the internship period for the fresh batch. Our “orientation programme”, which is a fancy term for officially boring the students with umpteen details about irrelevant topics, was truncated by a couple of days and we were asked to report for duty to fill in for the residents.

Partly excited, partly bemused and partly apprehensive about this twist in the tale, we reluctantly headed for our postings. All final MBBS students know that the knowledge they cram for their exams is disconcertingly volatile and can let you down at the most critical juncture. ‘Doing is knowing’ and that is why taking the place of resident doctors is just about impossible for interns who have had no practical, hands-on training prior to this.

On the first day of the strike, in the emergency departments, patients were being redirected to private hospitals after reciting the parroted line “We are trainee doctors, a strike is on; please take your patient to a private hospital.” Out-Patient Departments (OPDs) were being managed by interns who, too, repeated the same line, saw patients, did what they could but admitted none of them to hospital. As the days went by, more activities happened as the senior staff (the lecturers, associate professors and professors) adapted to the situation, started managing the workload amongst them and were currently using the interns as half-residents in certain departments.

The interns had a lot to gain from the strike, in terms of practical knowledge, doing more procedures and, at times, getting caught in situations which will stay in their memory for life. One such incident occurred with me. I was asked to run to one of the wards, from the emergency department – where I was posted, to attend to a call made by a nurse. On reaching there I found out that a patient had suddenly become worse and was lying still on his bed, pulseless, when I examined him. Three nurses stared expectantly at me (let’s not forget: I was the ‘doctor’ here). Calling on all the knowledge I had accumulated over my MBBS course, I began CPR (Cardio-Pulmonary Resuscitation) – for the first time in my life. After a few minutes, it was proving to be an exercise in futility as neither the pulse nor the heart sounds could be appreciated. The nurse informed me that I would have to break the news to the relatives and explain to them the cause of death.

It’s worth mentioning here that the strike was initiated by a relative assaulting a doctor when the latter broke the news of a patient’s death – and that was, obviously, playing on my mind. Having never interacted with this particular patient before, I had to consult his file to conjecture the cause of death. Measuring my words and controlling my tone, I trod the dicey path gingerly. The deed was done, the relatives had reconciled; but my mind wouldn’t rest. I had just witnessed a death that could easily have been prevented by the presence of the house-officer in the ward. At this point, I felt that striking work is an unjustifiable means of trying to make one’s point. It’s a fight between two parties that have virtually nothing to lose, but the innocents who are caught in the crossfire stand to lose all. Striking work is even less justifiable for those entrusted with caring for the health of the populace, which, in its time of need, is made to suffer further because of a quarrel they never were a party to.

The situation was complicated by the fact that the resident doctors did have very genuine demands. Having personally perused the MARD (Maharashtra Association of Resident Doctors) document stating their demands, I am compelled to behold their plight with sympathetic eyes. These persons work for a minimum of eight hours a day, with at least one day of the week being on-call for 24 hours, have the occupational hazard of contracting diseases such as tuberculosis, hepatitis B and C, and AIDS, have psychological stresses probably unparalleled in any profession, have the same academic pressures of any post-graduate and have the gargantuan responsibility of dealing with patients’ life and death, surely deserve more than what they have been served. Typically, Resident Medical Officer (RMO) hostels have more than 5-6 people per room meant for two persons and the state of toilets and bedding is appalling – making for a horrendous experience that has to be endured over three years.

Another valid demand is to improve the doctor-patient ratio by increasing the number of postgraduate seats. Typically, a resident doctor posted, for example, in General Surgery has a ward containing no less than fifty admissions to monitor, examine and attend to. This ratio surely needs to be amended in the interest of decreasing the stress on the doctor and, more importantly, in the interest of patient care.

At first glance, the pay issue may appear as a permanent grouse (especially from employees of Governmental and Civic bodies). A closer look reveals a different picture. MBBS graduates who take up employment with the BMC or Government as AMOs (Administrative Medical Officers) or Casualty Officers (COs) are considered “Class II Medical Officers” and are paid between Rs. 16-20,000. The RMOs, in sharp contrast, are similarly qualified and work several hours more than AMOs, are considered “Students” and paid a stipend of a little over Rs. 8,000. Also, Maharashtra state has one of the lowest stipends for RMOs in our country. The palpable discontent regarding the pay-scale has emanated from these glaring disparities. It is worth noting here that unskilled “Class IV” workers of the BMC (ward boys and sweepers) earn almost Rs. 2000/month more than the MBBS-passed RMOs.

In the face of all these adversities, the recent incident of violence against a doctor acted as the tipping point. By my reckoning, it provided vent for the pre-existing discontent, as a result of which this strike was launched. It was not a knee-jerk reaction, but a reaction born from the circumstances breaching the limits of tolerance.

With the strike called off now, the government has agreed to increase the doctor’s stipends in the range of Rs. 12,500 to Rs. 13,000. We hope the needful is done in time so as to avoid such a situation again. Or more innocent lives will be lost…

To learn more about what happened, and why, log onto: http://mard-strike.blogspot.com or www.mard.org.in

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