Saturday, March 04, 2006

Resident Doctors on Strike in Mumbai

The last few days the papers have been carrying all kinds of reports on the resident doctors in Mumbai who are on strike. Very few newspapers are on the side of these doctors. Most of them have criticised the doctors harshly.

Lets just look at a few points objectively.

As far as I know, Resident doctors are students who have cleared their MBBS exams and are preparing for their MD exams. In some cases you have students who have given their MD exams & are waiting for results.

Education & Pay :
Doctors are educated citizens in a civil society. They get a salary of Rs.8000/- per month.
Lift men in hospitals on goverment pay scales earn approximately 10,000/- per month. Call centre representatives earn an average of 15,000/- per month and in most cases they aren't even graduates. From the time of independence, the government has hiked its own pay umpteen number of times. That of resident doctors has only been hiked thrice in almost 60 years.
Do you think 8000/- per month is a reasonable salary to expect for someone who is well above average intelligence & has put in all the hard work to become a doctor ?
Most resident doctors in government hospitals are there on merit & because of a vocation & not because of donations. If they had become doctors through the donation route they would be serving their residency in fancier hospitals with better working conditions.
Until now their annual fees were 18,000/- per annum. They have recently been increased to 50,000/- per annum. Annual income 96000/- per annum. Resident doctors don't even fit into the lowest tax bracket. Which means they aren't even earning minimum wages.
Recommendation : Pay needs to be made commensurate with their education & the amount of work that they put in.

Work hours :
Lets compare the work hours of Resident Doctors to a couple of other occupations. Class IV government employees who are supposed to work for 8 hours but actually work much less as we all know. Call centre employees may work in weird shifts but at least their timings are fixed again between 8-9 hours. Resident doctors go 48 hours and more without a break. Forget sleep.
The factories act insists on at least 24 hours off in a week. I wonder if any of these resident doctors have ever had 24 hours off in the last 1 year. There is talk of forming a union for call centre employees. Resident doctors do not even have the time to attend union meetings and in most cases may not even know which union is purporting to speak on their behalf.
After the floods when most of us were trying to get our lives back to normal, Resident doctors were under even heavier stress. Many of them went 2 weeks with barely 3 hours sleep at a stretch because of the flood related diseases.
On paper their shifts are for 12 hours. But between handover periods it extends to about 16 hours. And once a week when shifts rotate it evens extends to 24 hours.
Recommendation : 8 hour shifts to be followed rigorously.

Bosses :
Has anyone done a random check on how many senior doctors are available in these government hospitals at any given time ?
Many of the senior doctors have flourishing private practices on the side. The entire hospitals are run by these resident doctors.
Recommendation : Senior doctors should not be allowed to shirk work or to operate private practices.

Duty Allocation :
Class IV staff are very often missing from their posts or their vacancies aren't filled up on time. Nurses are busy completing paper work for all the red tape that is mandatory in these hospitals. Resident doctors end up doing a lot of leg work which should ideally be allocated to others. They become the only face of the hospital for the patients family & hence the family takes their ire out on them.
Recommendation : Cut down on paper work or hire enough staff to take care of routine jobs and leave the doctors free to focus on their area of expertise -Healing ! Additional benefit, create more jobs.

Irate Customers :
The worst expereince in life is when someone you love very much is in pain & there is nothing you can do to make them feel better. This pain, often turns into rage against oneself & in some cases manifests as anger against whoever is easiest to blame. In this case the Resident Doctor who is the face of the hospital.
Patients who visit Government hospitals for treatment, often wait till the last possible moment before consenting to visit a doctor. Often, there is little a doctor can do once the patient has arrived because the disease may be in very advanced stages.
Social workers & local politicians trying to make their mark often indulge in loud rhetoric to make their mark in unfortunate cases where the patient dies. They further incite the family to take "revenge"/"badla"
The resident doctor does his/her best to ease the patients suffering and heal him/her. But sometimes that isn't enough. Life & Death is in God's hands. If your time has come, it has come. Do you think it is easy for a doctor to sleep peacefully when a patient of theirs dies ? I know doctors who have spent sleepless nights saying "Why couldn't they have brought the patient in earlier ? I could have saved him" Many doctors suffer from depression along with fatigue. And to have to put up with violence too ? Aren't we asking for too much. They too are human beings after all.
Recommendation : Grief Counsellors & security. I think the time has come for Indian hospitals to hire grief cousellors. Given the hectic dog-eat-dog existence especially in Mumbai, a lot of people are hanging to sanity on a slim thread. A loved one's death is just the trigger to push them overboard. Grief counsellors can help break the news in a humane way & help the family copy with their loss. Very often a large group assembles to either see the patient or offer condolences after the patient has died. This sometimes leads to a mob mentality which could trigger violence. Better equipped & sensitised security could handle this.

Living conditions :
Have you ever visited a hostel room of these resident doctors ? Lalloo & Rabri's buffaloes lived in better conditions. Small cramped rooms. Tiny windows (ship port holes are larger). 2 beds between 4 or even more. 1 centuries old ceiling fan painfully trying to whir itself. Pathetic, tasteless mess food so much so they prefer to eat at the hospital canteen even if they have to pay extra (and we all know how bad hospital canteen food is) Some even shell out extra for a dabba, so they can eat at least one decent meal a day. Irregular timings, irregular meals. Most of them survive on coffee & tea.
Recommendation : 2 students to a room. Better ventilation. Better management of hostel mess with nutritious hot food.

Working conditions :
Irregular hours, double duty shifts, no staff to handle the medical tests. Resident doctors have to handle the medical tests, dealing with the patient, dealing with the family. They have to manage it all almost single-handedly. I have seen patients who refuse to let their blood sample be taken, patients who flat out refuse to take their medication, patients who demand that their entire family be allowed to come into the ICU, patients who want the best treatment at the least cost. the doctor has to handle all of this. Very often the equipment at government hospitals fail or are just not available. Blood banks do not have enough blood.
Recommendation : Medical equipment manufacturers could be allowed tax breaks for supplying free equipment to government run hospitals. Better awareness programmes on blood donation, eye donation drives. An organisation in Kolkatta collects pacemakers from the dead before they are burnt or buried & provides them to families which can't afford them. We need better awareness on the steps that the common middle class citizen can take.

Who becomes a doctor today ?
One who can afford the donations & palm greasing.
One who has less that 40% marks but has a quota or has managed to procure a minority certificate.
Are these the doctors you want, treating you ?

The only honest merit based doctors that are coming out of our system today are doing their residency at government run hospitals and we are treating them very shabbily. These doctors have to depend on their parents to support them & supplement their meagre income until they are 27-29 (MD) 35(if you want a better qualification) They literally put their lives on hold for their vocation. They might earn good money after they are 40, but they have lost their youth in a blur.
If I have to be operated upon, I want the surgery done by a competent, intelligent doctor. But if the government is going to sack all the current resident doctors & not recognise them, will I be able to find a qualified one ?

Are the resident doctors justified in striking ?
Under the essential services act maybe not. But are the conditions they are living in justified ? Absolutely not. If they don't take a stand right now, future generations will suffer. Not just the future doctors but also future patients. We may not get any honest hard-working doctors in future if we do not correct the present.
By the way, there is no such thing as a "legal" strike ? By their very definition, all strikes are illegal.
None of their petitions to the government have worked. Violence against doctors has been in the news continuously since the last year or so, but nothing has been done. Encroachers have built shanties inside hospitals. Nothing has been done. The Mithi river flooded the entire city last year. Nothing has been done. Amount of Electricity needed this summer is at a huge shortfall. Nothing has been done.

There are umpteen problems facing the common man, that have been evident for more than a year. But the government has done nothing to ease their burden. How then can you blame the doctors for going on strike. How long can they continue in silence and hope that things will get better. The government said that we have promised to look into the issues, so now get back to work. But how many times have we heard that statement before ? Has anything ever been done.

They say we get the government we deserve. The common man is fed up of its government. They want a better government, they deserve a better government, they deserve a better life. And now he is willing to stand up and ask for it & the government that hates any dissent is trying to squash the common man even further. How long will we take this attitude? The common man pays one third of his salary as tax & gets a loutish paan chewing kind of service in return. We should stand up in solidarity with the resident doctors but in this Mumbai metropolis which common man has the time ?


Kim said...

Today's article in the paper says that the BMC is going to be evicting the Resident Doctors from their hostels ! ! !

The BMC doesn't bother to evict illegal slums, illegal constructions along the Mithi River. Illegal auto repair shops all over the city. Illegal markets, illegal street stalls, illegal pavement dwellers, illegal encroachers in mangroves & on public beaches. . .

But u can b assured that they will evict these resident doctors. Why ? Because these doctors have a sense of dignity & self-respect ? Because they are legal occupiers of their space, they have paid their hostel fees ?

Its a sad country that we live in, where illegal marketeers & land grabbers flourish & honest hard working resident doctors who persevere to heal & help the general public are kicked out of their hostels.
Where is the voice of reason ? The voice of sanity ?

Anonymous said...

Could it be that the netas despise the educated & professionally competent, because they are neither ?

Naddir Patel

Kim said...

The striking Medical Doctors have received some support from an unexpected quarter.
We hear that in the view of extending support for "Protecting Doctors against Violence" the Indian Association of Cosmetic Surgery & International Federation of Restorative & Cosmetic Surgery (IACSIFRCS) joins in the strike.
They have declared "No Cosmetic Surgery for One Week" beginning today, to support the GENUINE cause of residnet doctors of Maharashtra.

As reported in the Mid Day, March 8th 2006

Anonymous said...


Is the only word that comes to my mind…

I think you should try and get this circulated as wide as possible… It moved me . I doubt even the resident doctors themselves could put the issue better. May be send a copy to them as well… …

Brajesh Bajpai

Kim said...

The strike was finally called off yesterday night. Not much news on what conditions were accepted & which weren't.

The only bit I heard was that the doctors had asked for a slaary raise to 13,500 & have been given 12,500 per month. Looks pretty insignificant given the recent euphoria over MBA salaries (32 Lakhs pa for a lucky guy from IIMA with RPG) but for the doctors themselves its over 50% increase in their salries & they seem happy with it.

So guess this chapter is closed for now.

Kim said...

Although DNA didn't publish my post in their paper in letters to the editor, this post has been linked to their blogspecials. Just found out myself.
Go down to below half page level. Scroll for the topic :
Doctors on strike
It has 5 subheadings
• MARD strike
• Services suck
• Doctor's voice
• Pay time
• Martyr's story

Of these "Pay time" links to

Yippee !!! I'm getting famous online

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