It is 6 am and Arvind*, a second-year paediatric resident doctor at Mumbai’s KEM hospital has just woken up. The workday will soon begin. The only problem is he has no clue how long it will be — it could go up to as much as 36 hours.
For starters, from 8 am to around 12.30 pm, he will examine patients at the hospital’s Out Patient Department (OPD), which gets more than 800 of them on a daily basis.
Next, those patients who need to be admitted will have to be attended to. 2 pm onwards, he will have to man the emergency ward, which in any case is always teeming with patients.
On the days that Arvind is ‘on call’, his shift will end only after 12 noon the next day.
“There are times we sleep on the stretchers in the operation theatres. We carry our brushes with us. Returning to our rooms is a luxury on most days,” he says.
But that is better than sleeping during surgeries because that happens, too. “That is the only time we are not disturbed for extended period of an hour or two,” said another resident doctor on condition of anonymity.
Ironically, the few days that post-graduate medical students — or residents — got a break from work was when they went on strike late last month to protest working conditions, particularly physical attacks against them, usually by relatives of patients.
Brickbats, not bouquets
Late in March, the public healthcare system in Maharashtra and, briefly, in Delhi, came to a crashing halt when resident doctors took leave en masse to protest a string of attacks against their peers in other parts of the state.
The provocation was the brutal beating of Dr Rohan Mhamunkar, 31, in Dhule’s Government Medical College after an altercation with relatives of a patient; the resident, an orthopaedic doctor, he was beaten to within an inch of his life, and is likely to lose vision in one eye.
The incident led Maharashtra’s 4,500 resident doctors to go on mass leave till they felt secure enough to work, even as reports of more attacks against doctors poured in.
Soon, the Indian Medical Association (IMA), with 40,000 doctors as members — many of them former resident doctors — joined the agitation, which ended only after assurances from both Maharashtra’s Chief Minister Devendra Fadnavis as well as the Bombay High Court, and promises of a 1,100-strong security force for public hospitals.
But despite the imminent danger to their lives in the line of duty, the resident doctors became instant villains for making poor patients suffer. But that is only part of the story. After all, violence at the hands of frenzied relatives of patients is only of the many problems residents must face.
One for all, none for one
A resident’s travails start with the abysmal doctor-patient ration, sometimes as high as 1:200 during peak hours in some wards. “Most paediatric patients are accompanied by four to five relatives,” Arvind points out. It’s a ratio that has the doctors not just outnumbered but scared for their safety should things not go the way the families want.
The patients are often the poorest of the poor, who have no option but the country’s almost free, if doddering, public healthcare system. The resident doctors are here after having cleared a rigorous entrance test, beating thousands of competitors.
Patients coming to the tertiary hospitals like the KEM or Sion hospital are often from far flung areas, usually exhausted by the effort of accessing some sort of healthcare. The overworked doctors, too, have little patience left to focus on communication. It is an incendiary combination.
“Everyone thinks doctors are their slaves. Educated citizens and journalists are questioning us. What people are not trying to understand is that it is the government that has failed to deliver,” said Richa*, a second year resident doctor at KEM.
During her endless shifts, Richa does more than just attend to patients. She fills forms for the patients, many of whom are unlettered, fetches test results, and even shifts patients around for an X-Ray or a CT scan — all jobs that ward boys are supposed to do.
“On a good day a ward brimming with over 100 patients will have one senior nurse, one junior nurse and one ward boy, provided no one is on leave,” Richa* shares.
The acute shortage of ancillary staff is wearing down doctors.
‘On call’ days are the worst. It means that the resident doctor has to be available through the night. On such days the work stretches up to 36 hours and every resident doctors is ‘on call’ at least once a week in most hospitals.
At peripheral hospitals grappling with shortage of doctors though the number could be as high as 3 times in a single week.
And the room that they retire to, if they ever have the opportunity, is anything but welcoming. Four to five residents in the first year are often cramped in a 100 sq-feet room.
“There are times when the first year students don’t get a room till seniors vacate it in which case they have to share a side room near a hospital ward. Eight to nine residents occupy it at a stretch at times,” another resident doctor from KEM said.
In critical condition
Depression, too, is widespread. “We leave our personal lives behind us at 18. My mother wants me to get married but where is the time? Unless you find someone who is also a doctor, it is almost impossible to manage,” says Richa. Yes, they are willing to serve the patients but don’t they deserve a shot at a normal life, most ask.
Arvind says almost everyone in his family is a doctor — 30 in all — working across the world. “But they don’t have lives like these,” he points out. Not surprisingly, he is waiting to get out of the public healthcare system once he clears his residency.
And therein lies a huge problem. The system is so gruelling that the best leave the first chance they get.
Dr Aadil Chagla, neurosurgeon, KEM hospital, while clarifying that he does not believe in strikes, sympathises with the residents.
“The hospitals are far from clean and that also means that the people at the end of the food chain suffer the most. One must realise that the condition of the resident medical doctors is abysmal.”
Dr Girish Sawant, a gynaecologist who now works in the private sector, has horror-inducing memories. “When I interned at KEM one decade back there would be 60 patients in a ward and three to four resident doctors would be waging a war.”
“If we continue to be so apathetic then it will only lead to the downfall of our health care system,” asks Dr Pranali Ahale, gynaecologist at the Jogeshwari Trauma Care Hospital.
And yet, amidst the bleakness, the lack of a personal life, poor compensation and being treated badly, there are the occasional moments of light. As Richa explains: “When someone gets better and even acknowledges our effort, it makes up for all the hard work.”
(*Names have been changed to protect identity)
NEED TO KNOW
- How long is the course: 36 months
- How much do they make: Around 40,000
- MBBS course: 5.5 years
- Preparation for PG entrance: 1-3 years
- Post Graduation (MD/MS): 3 years
- 1-year compulsory service in government hospital
- A year of preparation for super-speciality
- MCH/DM: 3 years