Notes from internship

The relatives agreed to his price. I had no idea from where the money was going to come. I started feeling ashamed, angry and more restless than ever before. How many people have we pushed into poverty for satisfying our greed? Am I a doctor, a commission agent or a sophisticated extortionist? 

 Internship was the year when we started ‘dealing’ with patients - and literally so. As an intern, part of my job was handing over prescriptions to relatives. Once when I was working in the Obstetrics & Gynecology (OBGY) ward, I handed over a prescription to an old lady who had come there to get her daughter delivered.  She touched my feet with her hands and pleaded me to not prescribe any more. The next day, I tried to wonder what her state of mind was when she did that. ‘People’ had always been telling me I was in a noble profession. I was in a profession which most people think is synonymous with intelligence. She obviously did not touch my feet out of respect or gratitude. She had very little money, no relatives to help her out. She had come to a government hospital exactly because of these reasons. The prescriptions were expensive. She was absolutely helpless. How could I be intelligent if an old lady had to touch my feet to get the point across? How could I be noble if she had to give away her self-respect to get her daughter treated?

Earlier this year, I went to the pediatric ward for some work. There was a man whose son was admitted to the ward the day before. He was an Adivasi and had come from a hilly area about 100 km away from the hospital. He had travelled by train and carried his ~8 year old child on his arm all the way to the hospital. He asked me if I could arrange for a plate for him. On probing, he said he had not eaten since the morning of the previous day because he did not have a plate while all other patients did. (The ward always has extra plates and all he had to do was ask). He had used the money he had to buy the medicines prescribed for his son. (And hence he had not been able to buy something to eat either). He preferred staying hungry for two days to requesting a plate. After 2-3 days, his child was to be transferred to a different hospital and my job was to accompany him. I completed the formalities at the other hospital and went to meet him for the last time. He started crying profusely and said ’Please let us go from here. You will kill us both anyway. We prefer dying in our village’. He had come to a hospital hoping that his son gets better, but now was sure that both will be killed.

When I was posted in a PHC, there was a patient for delivery who had to be referred for Caesarean section. It was late at night. The PHC ambulance was not available. They were vegetable vendors by occupation and did not have money to transport the patient to the next referral centre. Private transport, especially at night, was expensive. The relatives were obviously angry. They arranged for a tempo from their village and I accompanied them with a nurse. The referral centre was approximately 20 km away. The doctor there said that he was only an MBBS bonded candidate and there was no consultant available. The next higher referral centre was 50 km away and the patient’s condition had worsened. Going to the next government centre was very risky because of the distance. The relatives decided to get the baby delivered at a private hospital. The first 3 private doctors did not bother to come and see the patient at that hour. The fourth one was a non-MBBS general physician with a 20 bedded hospital. He quoted Rs. 27,000 for the surgery. The relatives discussed amongst themselves, made a few phone calls and told him that someone from their village had been delivered there for Rs. 18,000. He said-‘I am willing to take risk at this hour. The extra fee is for that’. The relatives agreed to his price.  I had no idea from where the money was going to come. I started feeling ashamed, angry and more restless than ever before. How many people have we pushed into poverty for satisfying our greed? Am I a doctor, a commission agent or a sophisticated extortionist? 

Whose responsibility is it to fix this? Doctors believe that their responsibility is limited to diagnosing and treating. But what do we treat? We treat the case paper. We treat the investigation report. Everything else is not my headache. I am a doctor. Everything else is inferior. Isn’t higher education supposed to add one more skill to what I already have? Is it supposed to be the only skill?  I am ALSO a doctor. If education does not empower me, there is a serious problem with my educational system

I realized I cannot help anybody by simply prescribing medicines. I had to go beyond that. At this point I did not know what to do next. I wanted to do something, but I had no clarity as to exactly what. I had several questions.  How can I bring about a change? Is there a method, a science to it? What skills do I need? Will I be alone? How will I raise funds for my work? What about my survival? What about my responsibilities towards my family?

I had heard Nayana speak about HBNC at JJ Hospital once before and hence I had heard about SEARCH and its work. I decided to visit Gadchiroli and meet Nayna to discuss my dilemma with him. Through him I was introduced to NIRMAN, and an enriching journey of serving 44 Adivasi villages in Gadchiroli, through the Mobile Medical Unit, began.

Sujay Kakarmath