Govt officials lay the blame for staff shortages on medicos, claiming they refuse rural postings despite handsome salaries

The other side of the story Why doctors say no to rural postings
news Public Health Monday, November 28, 2016 - 17:43

An empty hallway greets a couple who walk into the Pavagada taluk hospital in Tumkur district. The 28-year-old woman and her husband sit on a stone slab and wait for the nurse or a doctor to arrive as the information counter lies empty. Locked doors and dirty hallways decorate the broken-down exterior of the hospital. 

About twenty minutes later, a nurse walks out and sees the couple. She keeps on walking. The woman's husband approaches her and says, "My wife has been coughing all day and has developed a fever. When can we meet the doctor?" 

The nurse dismissively tells them that the doctors are not around. The couple mumble about the horrible state of affairs and walk out.

The Pavagada taluk hospital has four working doctors and six nurses, according to the official record. However, only one nurse was seen manning the general ward that housed four patients, who were all soundly asleep. While taking a tour of the hospital, one can see that most of its doors are locked and the doctor's chambers are empty. 

The state of affairs at other government-run hospitals in Karnataka is no different. 

During the winter session of the Karnataka assembly, the Health Minister had proclaimed that the reason for such huge vacancies in government hospitals was because Post Graduate medicos refused to work in taluk-level hospitals despite the state's offer to pay them Rs 1.25 lakh per month.

But just how true is the minister's statement? 

The News Minute spoke to a few medical students pursuing post-graduate degrees to understand their motivation to avoid rural service:

An uncertain future

Studying medicine is a hard and tedious process and by the time an individual completes the PG course, they are about 29-years-old. Most graduates in other fields would have already progressed to senior level in their organisation at this time. 

"This is the age we want to get married and have kids. Like all parents, we would want our kids to study in good schools and colleges. This is not possible in a rural set up," said Vibha Prakash, a PG student from KIMS. 

It doesn't end there as some of them also want to pursue a super specialty course and working in a rural area, medicos say, is not feasible. 

"We have already worked in PHCs after MBBS as per the bonds we signed before beginning the course. We know the horrible condition the hospitals are in. It is one of the reasons why we don't prefer going there," Vibha added.

Poor infrastructure 

It's not a myth. The infrastructural facilities at government hospitals are poor. Dr Satish Kabade, a physician at the Dharwad district hospital said that most of the hospitals lack bio-chemistry equipment to test liver function, thyroid function and renal function, which is why some hospitals don't have technicians. 

The Pavagada hospital has no machine for CT scans or an ICU. The same is the situation in the Dharwad district hospital. 

In order to maintain an ICU, Dr Kabade said, the hospital requires at least two physicians, one surgeon, ten nurses and ten attenders. "The district hospital has only one physician and there are only three physicians in all of Dharwad. Most taluk level hospitals don't have one. Hence it becomes impossible to have an ICU," he adds.

Another concern is that these students are trained to use certain kinds of equipment to deal with various issues. The dearth of such equipment renders them helpless. 

"During our course, we use certain medical equipment for various treatments. Those are not available in the rural hospitals. We are not trained or equipped to handle situations without them. How can they expect us to perform duties without adequate knowledge about dealing with such situations?" questioned Manisha James from St John's Medical College.

Personal safety

Government hospitals are where accident victims get admitted in most taluks. Along with the victim there often comes a mob of angry people and doctors are not in a position to deal with them. 

"I was working in a PHC after MBBS when a group of people came in demanding that the man, an accident victim be treated. The mob descended on me and I was a junior doctor at the time. There were 20 of them at least. I was scared of them. I ran into one of the wards and locked myself in. I did not come out until the cops came. When I have experienced that kind of a situation why would I do it again," said a student from St John's Medical College.

Medico-legal cases

Doctors treating accident victims and those performing postmortem procedures for murder victims are required to appear as witnesses in courts during the trial. The fee of legal entanglements is also a reason why most medicos are hesitant to take up the job. 

"I have seen many graduates get scared of getting entangled in such situations. Besides the safety issue for women doctors, the lengthy legal procedures are also a deterrent," Dr Kabade said.

Systemic failure

Former President (Tamil Nadu) of the Indian Public Health Association, Dr S Elango, said that the failure lies in the state’s policy and the medical education system.

“The current curriculum is built for treating the elite. Medical students must be trained for rural service as well. Working in rural posts must be made compulsory after MBBS and should also be made a criteria medical students must adhere to before applying for PG courses. This solves the problem of rural postings,” Dr Elango said.

He also said that the posting process must be done online. 

“Once a student completes MBBS and is registered with the Medical Council, he/she must be given the posting letter within a day. This must include a proper designation and salary. In Tamil Nadu, MBBS students who apply for PG courses are given additional marks if they have worked in rural posts. These incentives can attract them to work in remote areas as the competition for PG seats is high,” he said.

Dr Elango believes that policies implemented till date to attract candidates for rural posts, have not taken into account the interests of the doctors.