Junior resident doctors at Kerala government medical colleges are urging officials to restart their academics as well as the functioning of specialised departments, while limiting them from performing COVID-19 duties. The doctors, who are postgraduate students, must complete a three-year course in a specialised medical field. Before the pandemic, they were assigned duties in their own departments alongside their classes, but since 2020 they have spent the majority of their time performing COVID-19 care and treatment. The doctors are concerned that if the situation continues, their studies will be extremely limited and their knowledge of specialised subjects will be impacted.
Dr Ajithra M, a junior resident doctor in MD Psychiatry at the Government Medical College, Thiruvananthapuram, wrote on Facebook, "After the COVID-19 first wave, the second wave came and more COVID-19 wards and ICU wards were opened in government medical college hospitals. But how many new doctors were appointed in these medical colleges? House surgeons and PG students are doing COVID-19 duty. The PG students receive admission through entrance examinations for the specialisations in General Medicine, Surgery, Orthopedics, Psychiatry and so on. They came for a three-year course. COVID-19 will not end soon, so if PG students continue to do COVID duty when will they study their own specialisation?"
Dr Naveen R, Secretary of the Kerala Post Graduation Medical Students Association, told TNM that they were being exploited through compulsory COVID-19 duty.
"All the COVID care happening in Kerala is because of PG resident students. We keep direct contact with the patients and seniors just come for rounds in the morning. Till now, we haven't demanded anything but we’ve reached the limits of our exploitation. We have no quarantine off days. We have to be on duty for 12 hours, in which 6 hours are inside the ICU. Apart from that, we are not allowed to take leave. If there is no COVID-19 duty, we have duty at our department, mainly in casualty," he said.
Theory classes continue through video conferencing apps, but practical sessions in their own specialisations is almost negligible.
"For the last one-and-half-years, we have been getting no experience in our specialisations. Though other departments are not fully shut, only emergency surgeries are taking place. Out of seven or eight wards, all are taken for COVID-19 care except one or two,” he added.
Dr Shameem Muhammed Kattathadka, another resident doctor at Thiruvananthapuram Medical College, said that the 2019-2020 batch has completely lost their first year due to COVID management, and now their second year will also go in the same way. "Many outpatient departments are almost closed. Now if the third wave also comes, all the three years will be gone," he said.
Naveen notes that students have been diligently performing COVID-19 duties without complaint till now, due to the challenging situation the pandemic has created as well as the fact that few others would step forward if they refused.
"Authorities say that they will admit patients in the medical colleges. But we are being exploited. In Thiruvananthapuram, they doubled it from 700 to 1400 ICU beds. They were able to do that just because we residents are working here," he said.
He points out that the Regional Institute of Ophthalmology, one of the finest specialist hospitals in Kerala, is being used for COVID treatment, which means PG students who are specialising in Ophthalmology are managing its COVID care.
The junior doctors have alleged that they are not given weekly offs in a consistent manner, and they often work 12 hours a day, while other doctors work six hours.
"The students don't get enough sleep, or time for the rest of their academics. Many of them are stressed out. We don't even get a day off in the week," Ajithra writes.
Naveen said that it was not easy to crack the entrance examination to get PG admission. "For them it is an easy way out, but after a lot of struggle and hard work, we are denied our academics," he said.
He also noted that the number of patients to other departments in government hospitals has reduced significantly due to ICU and general wards being used for COVID-19. Shameem stated that these patients will have to approach private hospitals for their medical treatments, which is often unaffordable for them.
The situation in all the government medical colleges of Kerala is the same.
Ajithra writes that many of the students are undergoing severe work pressure and stress due to a lack of rest. "You have enough time, why wait more? Are we waiting until some PG student takes an extreme step out of mental stress? Are you waiting for a scapegoat?" she writes.
"If academics are not restarted, there will be a time where specialist doctors will treat patients without having much knowledge on their speciality," she writes.
Naveen also shares the concern over what will happen to their careers if they don't learn now. "After completing our course we can't even satisfy our conscience that we learnt anything in our specialisation. Doctors who specialise in surgery just attend theory classes without seeing surgery... how is that possible?" he says.
Students are seeking decentralisation of COVID-19 treatment so that other departments and medical colleges can start functioning normally. They point towards a major shortage of staff and lack of proper planning as the reason behind this issue.
"Why do we need to focus COVID treatment on medical colleges? They are training institutes. We can make use of general hospitals, taluk hospitals etc. New recruitment should be done through the National Health Mission," Naveen said.
Apart from Kozhikode Medical College, no recruits through NHM were conducted, he says.
Kerala Government Medical College Teachers Association has written to the state government several times seeking more recruitments to the health sector.
“Even before the pandemic, only 70 to 75% of staff vacancies were filled in Kerala's health sector. In some hospitals in certain districts, the patient doctor ratio was 100:1. So when the pandemic began, this situation worsened. Maybe the department is not getting doctors to fill vacancies,” KGMOA state general secretary GS Vijayakrishnan told TNM.