The rural-urban health gap in India is an inconvenient truth – one which we may not acknowledge exists, but it does. The fact remains that even students who come from interior villages, once they get their degrees done, hardly tend to return to their roots. The Newspaper Headlines today reminded me of my memories of working in a community health center in rural West Bengal.
A lot of my contemporaries are saying that they have managed to escape this “unfortunate” rule just by the skin of their teeth but I think this is a positive step, provided that the GoI and MCI keep an eye on development of infrastructure as well. But more of what I think about this ruling in a later post. In this post I will ruminate fond memories of spending a short and enjoyable stint in a rural hospital where, for the first time, we tasted what it feels like to work on our own (since during most of our internship, except ER postings, we were basically doing scutwork for the residents).
The place where we get posted is a pilgrim town and has a number of temples in close proximity. But thankfully, we were not there during the “pilgrim season” when there are literally hundreds of thousands people pouring in from all over India everyday (which means all the more emergency cases to deal with).
However, we saw a number of cases, we had the experience of working on our own (which might be a tad dangerous for the patients) and for us city kids, it was great to be out there in the countryside for a change.
The community health center we worked in was attended by a large number of patients in the OPDs every morning and though there were limited inpatient services (almost exclusively confined to Obstetric cases), the work load was pretty heavy. Amongst the patients I dealt with, there seemed to be a profusion of diarrhea, scabies, upper respiratory tract infections and UTIs. They were pretty simple to treat and results were pretty good on follow up. We had an attending who took care of the obstetric cases and we were glad to have that off our hands… or at least I was! True, I did miss my laptop and mobile connectivity and the buzz of being in the city (the folks there seemed to go off to sleep by 8PM and be up by 5AM! Unthinkable hours for me!)… but that said we did have a lot of fun!
There was a small kitchen garden of sorts behind the rooms we were allotted to stay and though none of us wanted to do any cooking, it was pretty cool to know that we had the option of doing so if we wanted to!
We had a lot of fun exploring the locality! I do have a family farmhouse in a village-ish place (I hope to go there this Mango season – we get an awesome crop every year – will post pics then), but this was an entirely new thing for me. AND my city-loving friends. It was still wintery and it was a brilliant experience to walk around with the sun on our backs!
We hired two rickety bicycles and went off exploring the countryside once we had closed OPD. Though we had achy calves the next morning and sore backs from all the bumpy rides, it was a joy to go out cycling once again. It not only made me realize how unfit I had become, but also showed me the unspoilt beauty of the Indian countryside!
The people were simple, trusting, hard working and honest. And when they heard that we were the new doctors in the hospital, they accorded us respect that we were hitherto unaware of! They literally invited us into their homes and hearth and made me feel, for the first time, what it meant to be a doctor. In this age of consumer-provider relationship, we are on the brink of forgetting the romance and social privilege that was once given to a doctor.
In order to reach the place we had to make a train ride for several hours and since we chose our travel times to avoid the office rush hours and traveled in a pack, it was great fun for us all. In Indian local trains, people hawk a lot of junk food and we ate a ton of them (without falling ill – kudos to our secretory IgA!). I ate a dozen or so HUMONGOUS bananas on a bet!
And of course, one of the things we insisted on was to eat the spicy, totally unsanitary yet mouth watering guava-mix (the very thought of it is making me salivate as I type this out. Thank you so much Pavlov!) that one guy sold on the railway station. We ate it on our ways in and out and I believe one who has had that will not be forgetting it in a hurry!
The real pleasure was in being there with people who were great friends (and still are) of mine! One of the most difficult times in the career of a medical student is Internship. The work hours are long, the bosses are (more often than not) crabby residents, the work itself is almost always unrewarding and menial… but a lot of these issues can be bypassed if one gets good friends to work with in course of Internship. And I was lucky to be in the best of company when it came to internship. Not only did I have friends to work with, I had them to laze off and spend leisure time with as well. I am sure few intern groups have bonded as much as ours did. This was also instrumental in making our rural posting a fun stay. What otherwise may have deteriorated into a boring, uninspiring post where one worked all day and spent almost all the off-duty hours in a drunken haze (booze was cheap in the place… come to think of it booze is cheap in almost all religious hotbeds. Coincidence?), became a raucous fun riot thanks to them.
I would like to tell Dr. Sujoy Chatterjee (Surgery resident, AIIMS – guy in blue tee), Dr. Manidipam Chatterjee (Anesthesia resident, CNMC – guy in red stripes) and Dr. Sitangshu Chatterjee (Co-perspirator in PG toils – the third guy on the pedal-van) that with me in tow, we formed the most awesome intern group ever. Thanks for the memories. I hope the joy of those days never fade.
Well, sorry for the sappy, nostalgic post. It will be back to regular programming from the next post onwards – where I dissect the latest plan to send post-internship MBBS doctors to villages for a year and thus extend medical training by one more year. Stay tuned.
Scepticemia 
Internship certainly is a terrific period. Sharing out responsibilities, bearing responsibilities, learning/ arranging the ‘great-indian-jugaad’, observing the docs and learning the actual practical ways (compensates for all the rote-learning of the previous 4years)… Internship connects us with the people- the patients and for me for the first time ever the enormity of the title-the degree we are earning came into picture. The fact that we ‘practice’ stuff on patients really freaked me out but yup thats how it has been done always and that is how we learn.
Its been just a week since I finished my internship and I already miss it! It certainly was the best of times….
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I could not have put that any better… you know what, its time you woke your sleepy blog and wrote stuff like this up! 🙂
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To Those concerned:
Appointment of Doctors for Rural Healthcare
The present idea of the Health Ministry of Government of India to extend MBBS course by one more year and post them in rural Health Centres for one year is hare-brained and least to say is stupid and absurd, for the following reasons.
After completion of medical studies, no one is competent enough to practise without the help and supervision of senior doctors. At that junior most level, they do depend on a great deal of laboratory and medical imaging services to make proper diagnosis and treatment. These facilities are grossly inadequate at the rural level.
All that the Government is achieving is to sacrifice the poor and ignorant villagers as “guinea pigs” for future medical practitioners and possibly as a population control measure.
Furthermore, the young doctors are looking for more experience before they start on their own practise. It is the time for them to get married and enjoy life after five and half years of gruel and hard work and study to pass MBBS. It will be a sadistic policy for the Health Ministry to impose this punitive posting for these young budding doctors to be imposed on the ignorant and poor rural flocks.
Will all the elected members of the Government at all levels, High Court and above Judiciary and all first class civil servants at all levels will be submitting themselves and their family for their medical care to these junior doctors and only junior doctors for their medical needs?
As an alternative, viable, useful, more humanitarian, compassionate and effectual alternative is to appoint all those doctors, nurses and paramedical staff in service after they attain the age of fifty+ years to be posted to rural areas and allow them to be in service up to the age of 75 years.
In today’s lifespan, it is possible for one to work up to the age of 75 and almost all doctors do work to that age anyway. Give them 50% additional salary for rural postings.
The rural people will have confidence in such experienced medical persons and in all likelihood, a doctor continuously working in same rural area will know the persons health need and will be in a position to give the best medical care.
It is imperative that these doctors should not be transferred and should remain in same area for the duration of their service. The cost will also be much less than a young and fresh doctor’s treatment.
Kishore Kumar
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Very well put Sir. I was not condoning the move to send Interns to the villages by themselves. We had an attending physician overseeing us (at least officially). So things were a little different. I think after we complete our PGs, we must serve in rural areas for a year. That is more viable,
As for sending 50+ year people to the villages, I do not think that will work out, mainly because then the policy makers themselves (most of them being older or close to 50) would have to go do the service! 😛
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Well this is the problem with “city guys”. they think that this retrogressive step by the MCi is “positive” only cause they romanticise it…
1/ of course you did have fun staying their for 15 days or maybe a month–everyone loves change. but would u love staying their for an entire year.
2/ If you did stay longer you did realise that rural peopleDO NOT only suffer from “diarrhea, scabies, upper respiratory tract infections and UTIs” . They also suffer from all complicates diseases which on follow up wpuld only frustrate you
3/ unlike in internship when you could have fun by going around in rickety bicycles or wash your hands off obstertics care..when actually posted in rural places you would be required to be on guard 24*7 (almost all heakth centres have JUST ONE doctor)
4. LAST AND MOST IMPORTANTLY. WHY SHOULD HEALTH OF RURAL PEOPLE BE ON THE HANDS OF UNEXPERINCED PEOPLE(“people who do scutwork for residents)?? HEALTH SUD BE EQUITABLE FOR ALL… the governement just wants to fool the aam aadmi by showing that they have send doctors to them whil in reality they are not that !! (remeber u get the mbbs degree only after the rural stint) IS GOOD QUALITY HEALTHCARE ONLY FOR URBAN PEOPLE/….??
STOP ROMANTICISING AND FEEL THE HARM THIS IS GOING TO DO FOR THE COMMON PEOPLE AND DOCTORS ALIKE…
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Well, you are right of course. All these are very valid arguments. I support sending students to serve in villages, but not interns. They should be sending the PG guys for a year. That would make more sense and that would also provide some specialist care for the villagers as well.
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How much of experience is experienced enough? 3 years, 5 years, 10 years?
What does anyone mean by GOOD QUALITY HEALTHCARE? Does it mean advanced diagnostics (CT/MRI/Cath labs), superspecialty services like cardiology/ oncology etc?
If we wait for such dreams to materialize for every citizen of the country, we will have have to wait perhaps forever. We have to reach a compromise, somewhere between delivering the GOOD QUALITY HEALTHCARE and NO HEALTHCARE.
The purpose of MBBS teaching and 1 year of internship is that a graduate should be able to identify the common ailments, treat what he can and have the capability to judge which cases require referral. There are district hospitals to refer to, but somebody should be there in the villages to make that decision.
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Excellently put, Alex! I must say I enjoy reading your well thought out comments on my posts. I agree that at the junior level docs need to go serve in villages, but maybe post-internship is a little too early, considering the fact that in MANY places internship is just a namesake activity and people end up learning nothing and only mugging MCQs to crack the PGMEEs.
I think once we are done with PGs we must serve a year in villages. That gives the villagers some specialist care and solves the problem of the lack of docs both!
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Great. I feel all Doctors must do rural service so that the rural poor in India gets the best of care in life, We must always serve the rural population Its a obligation we owe to our society which made us DOctors. I enjoyed reading the article/
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You are right Kusuma Kumari I just remember how we enjoyed in Moodabidri working at the Hospital. We not only enjoyed the posting but you found a perfect match for you at Kodyadka too Hope you are enjoying Kusuma Kumari
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Suddenly found this post of you while searching for something else on the net. So much of fond memories. Thanks for this post. Just one thing to say, till now, whenever we visit Tarakeshwar, we never miss that guava-mix. May be it’s time for a re-union.
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Ah… fond memories indeed. Thanks for leaving a comment and inciting me to read the post once again. 🙂 It really is time for a re-union. Cannot believe it has been 13 years since we joined Medical College. We are growing old!
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I feel all Doctors must serve in rural areas. 99 percent of health issues can be tackled at primary care levels and only 1 percent needs expert care. I feel only people who wants to serve the community may become Doctors
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What India needs is better preventive care than apex hospitals MBBS course be structed in such a way that they are trained as GPs and not specialists. We must make all effort to train good MBBS doctors their training should be in PHCs and CHCs and and not at apex hospitals We need to change and think differently Time we change our outlook India needs to look ahead of creating good GPs We need only few specialists and more generalists Time we look forward and create good GPs
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In my humble opinion internnship should be at community health centres and not at medical college hospitals. Only then they will get good exposure to general practice. Its time we stop doing internship at larger teriray care hospitals. To become a good GP whats needed is training in common medical problems at community level and this can achieved only if they work in community hospitals. A roration in medicine obgyn paddeatrics surgery and skin is whats needed . Current idea of internship in medical college hodpitals is not correct
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You are 100 percent right Kusuma Kumari
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