tuesday's clinic at bamhni was less busy than usual: patients came in a steady stream and not all at once, which can sometimes be overwhelming. several patients with diarrhoea, two of them dehydrated. one woman very sick with pneumonia. four pregnant women, one child with a large abscess on her neck, another child with malaria, an infant with asthma. two old TB patients and one new one. a woman with rheumatoid arthritis, two patients with psychiatric illness, one with a seizure disorder on medication, four hypertensives. a man with an insect bite that has caused local necrosis, and old man with a malignancy. several with anaemia, two with otitis (a ear infection), a couple of dozen other patients with less serious problems.
and the first patient, a child, brought with abnormal behaviour for a month, when faith healing did not work. i brought him back with me to ganiyari and he is being investigated for the cause, having been started on medication to control the seizures.
patients come to the bamhni clinic from about 50 villages around, many crossing over from neighbouring madhya pradesh, walking a day or more to reach a nearby village where they stay with a relative to attend this clinic which runs on tuesdays. enterprising jeep drivers sometimes run chartered trips from a large village surhi about 10 km away, where patients can reach by bus. most come with serious problems, and the dearth of adequate medical care at an affordable price in this rural area on the border of chhattisgarh and madhya pradesh, is obvious.
this was one tuesday clinic inside a remote forest area, most tuesdays the clinic is busier and sicker than this one.
yet our Government seems to feel that people in rural areas have small problems that can be dealt with by badly trained health workers, or even a village level woman with minimal training, with no supervision or continuing support. access to secondary and tertiary level care - even primary care - is a dream for most of the population that resides outside large towns or cities.
The government did try to get newly-graduated doctors to do training in rural areas for a year. The doctors didn't like it, one bit. After years of training and investment, most doctors don't want to spend time in rural areas running health centres. At least that is a feeling I got when I spoke to my friends in medical colleges in Mumbai. Of course, most of them are now in America. Is that a myth that I carry in my mind? Will it be easy for the government to get doctors to serve in rural areas?
ReplyDeletethat is another of the government's policies that is inexplicable. if i were a fresh medical graduate and had to handle the tuesday clinic, i would lose it! the illnesses are serious, and need experience and laboratory support quite often. however, our government seems to think that the most remote clinic (for example a primary health centre) can do with the most junior doctor. indeed, as you grow older in the system, your seniority is measured by how close you are to the district headquarters, or posted in the district hospital itself. there of course, there are specialists and investigation support and the reassurance of a second opinion if one needs it. a new recruit would do much better if he / she had a couple of years of being mentored in a district hospital by seniors. perhaps if the PHCs were staffed by doctors in their second or third year of service, it may be better. they would not be so lost, and the patients would get a better deal.
ReplyDeletealso the assurance that your stint in the god-forsaken place is time-bound. which it often isn't, so people just don't take up their postings if they happen to get such a place to work in.
as for the training and "investment?" unfortunately that is the business aspect of medicine and medical practice that has commercialised the profession. it certainly calls for introspection: can the pursuit of returns on the investment, whether in this country or abroad, wait for a couple of years?
i would very much like to interact with the young doctors of today, to understand their thoughts on this.