Thursday, February 10, 2011


47 Year Old Doctor

Normally, I have a good deep sleep. I get up naturally. I like waking up. It's not like I think, "Oh, another day has come." The reason for this? Probably, my two decisions- not to take bribes and not to indulge in just anything after duty hours to earn money.

I get up two hours before duty-time. By the time, I brush my teeth and shave, my wife makes tea. While drinking tea, we read the Hindi newspaper together. Then in the toilet, I read the English paper. I glimpse at the headlines. My interest is in reviews or analysis of economic-social issues. If it is not about health, I do not read the editorial. After my bath, I get ready half-an hour before duty time. A woman comes in to clean the house and prepare breakfast. We, husband and wife, while having breakfast together watch the news. If anyone comes to meet us in the morning, we feel inconvenienced.

At the hospital in the morning, there is a tradition where the doctors meet informally. Greetings and casual exchanges take place. Earlier, there used to be discussions of the stock exchange but thankfully, the 1992 scam where doctors lost a lot of money has put an end to the early morning obsessive discussion about money. After the meeting, every one goes to their own department. Routine work-rounds. Gov't health institutions are certainly inadequate. Too much of a workload on doctors and other hospital employees. Indirect wage-cuts are also occurring. Increasing wages is a thing of the past. Now the question is of maintaining the wage you have. These days more and more, the administration treats us as servants of the government where we can be called for work twenty-four hours a day, thirty days out of the month...

For the rural and urban poor, there is absolutely no space to live. At least, they should have a place to die in peace, but political leaders make this impossible. The gov't policy itself is ludicrous- "health at your door." This policy turns us into puppets. The sword of transfers hangs over every gov't employee's head. I have also borne and managed it. Because of proximity to power, I have also exercised some clout. But my conscious efforts have been to not make use of that clout for personal gain. In gov't service, generally there is no scope for specialization. The structure of the 1940's still continues. You're placed anywhere for duty. I absolutely do not like duty in shifts, but have had to do it.

Although, there is an increasing tendency to increase the hours of work, I'm thankful that in the hospitals right now, the doctor's duty is six hours. To deal with hundreds of patients...

Probably, I have become old or aged. I am pained by the increasing tendency amongst doctors to think in money terms- let the patient pay 100, 200, 500 otherwise, delay or ignore the patient! Ten years earlier 30 to 40% doctors considered this way of taking money wrong. Now merely 10 to 15% think so. In medical college, I used to think wherever we are together, we will stop such a tendency. But now I find myself weak, helpless. In these conditions, articulate opposition does not seem to have any meaning.

One-third of doctors in New Zealand are suffering from mental illness. 10% of doctors have dangerous mental diseases. This is the result of tension borne of pressure, of too much work and responsibility. According to a study conducted by Wellington School of Medicine, 441 physicians, 330 surgeons, and 400 pharmacist were included.

Doctors are increasingly becoming money-minded. They consciously take wrong decisions- "there is no need for operation, but operate still because it will make more money"! Desires for car, house, computer, children in costly schools, property...Even after all the dishonesty and cheating, doctors still have difficulties paying installments. Conflict and tension in interpersonal relations has increased.

At two or three p.m., duty is over. Domestic help keeps the food ready. My wife and I have our meals together. In summers, after meals, I sleep for two to two and an half hours. I have no problem in maintaining a regular, daily routine for myself. But where others' company is needed, schedules are irregular. I swim alone, but I cannot play volleyball alone! After duty hours, doctor colleagues get involved in some money-making scheme. Many people keep pushing me to take up some business but I have decided that I need time for myself. I clearly refuse to use my after duty hours time to earn money.

My childhood was one of poverty. During winters, I did not have a sweater. In winter, one must have a sweater. I must not be poor! But I never had a desire for car, bungalow, servants...For my medical college expenses, my family had to mortgage our agricultural land. If the expenses were what they are now, then I wouldn't have gone to medical school. If the bribe of 5 lakhs that is now being taken from doctors to secure employment was being done earlier, I would not have chosen to be in gov't service. My mother has been my inspiration. Around my mother, there used to always be a congregation of women and girls. And she used to cooperate, help, give suggestions about weaving cloth, making good food, dance...Many things are taking place in the world where I can contribute. My heartfelt desire is to make positive contributions. If things improve, I feel good. I enjoy helping people, although my wife does not like this tendency of mine which runs counter to the current pragmatism. My desire is to acquire recognition as a good-hearted, mature person. I absolutely do not like anyone showing pity on me. I do not want recognition on the basis of weakness, but rather on the basis of my good qualities.

In medical college, I had begun to study health problems. My stress has been on community health and treatment. With the community's participation in health matters, corruption and negligence can be easily dealt with. In light of my experience during these years, I find that there is a danger in community participation when it only includes the dominant persons in the community. Again, no space is left for the weaker ones. Health first or social transformation first? Social transformation...But those who have taken contracts to change society- to me, they seem incapable of doing that. They are set establishments. To keep the structure intact is their priority. Therefore, in the arena of social transformation, they are without any importance- I don't see any logic in fighting parties or making friends with them. To overlook them seems proper to me. Practice according to conscience will open up new ways.

After swimming, leisurely walk and games. At 6:30 p.m., I have tea and snacks. Then for some time, t.v. Then I go to the market if necessary. Before dinner, for an hour, I sit with neighbors and chit-chat. Dinner is prepared by my wife. After having dinner at 9 p.m., I watch t.v. till 10:30. At 11 p.m., we sleep.

The rising sun fills my soul with joy. When I have time to take a morning walk, I become reflective. One is surprised that the Indian government did not have absolutely any drug policy until 1987. There is merely an Act in a document which enumerated drugs that could be sold. There is no control of the price of medicines. In 1987, drug price control order was jointly opposed by domestic-foreign, national-multinational drug manufacturing companies. Due to companies' opposition, in 1987, the order covered only 260 medicines. And because of a review that takes place every two years, today merely 80 medicines are covered under the Act. And, do you know what the order says? The printed price of the medicine can be anywhere from 50 to 500% more than the production costs!
Costs = the real cost of the production of the drug + expenses on research + expenses on patent + expenses on brand name.
The difference between a generic name and brand name is itself a wonder. For a fever, the price of a Paractoml medicine is .16 paise. Paractmol is the generic name of the medicine. This Paractmol tablet in its brand name form of Crocin is 56 paise! Propogators of brand-names- film stars, cricket stars- such tactics are very costly for the public.

Production is production. Let's see distribution also. 15 years ago or earlier, company representatives used to give samples to doctors whose evaluation served as the basis for the sale of the medicine. Now, medical representatives do not distribute the samples of medicines. Rather, they manage doctors...If you want a car, get so many lakhs medicine sold, for foreign tour, get so much medicine sold, mobile and expenses, cash! The sponsors of doctors' conferences are drug companies. And, besides companies giving doctors' food and drinks, some doctors arrangements are also made. As a result, 40 to 50% of medicines that private or motivated gov't doctors prescribe are not required for treatment. Half of the medicines given to patients are unnecessary! You'll also be surprised by this- one-thousand patent medicines are available in wholesale at one-third of the price printed on them. I'm not talking about sub-standard or local medicines. Even after supply at one-third of the printed price, patent drug manufacturing companies are ready to give commission for obtaining orders for them! Looting the public's pockets...And free healthcare when the European Union has given the Haryana gov't 20 crore rupees to demolish the very concept of free healthcare. Produce the sentiment that people should pay for their own treatment. Nothing is free, we will have to pay even to die...

Why do we have diseases? Attention is not being paid to this, attention is only on treatment...On the pocket. When I look at technology, computers, then adequate medical arrangements and healthcare seems possible for everyone. But when I look at the social system then...Even then, my desire for improvement does not die. People are not able to live peacefully. Even so, for people to die in peace, I am ready to cooperate with today's helmsmen and to bear their farcical tactics.

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