Admin Apathy- Kerala Doctors to Protest State’s ‘lack of concern’


         Doctors and nurses are now  getting out of their own self-imposed moral enslavement. Rather they are now forced to do so, as their lives and deteriorating working environment are becoming impossible to be in. One cannot burn himself in a furnace for eternity, for the well-being of others, especially if others are not concerned.

      The incidents at few places are just a tip of the iceberg. Covid has helped doctors to bring forth their plight. Doctors and nurses not paid for months in some Delhi Hospitals.  Doctors openly ridiculed and scolded by Administrators for no fault of theirs. Even a doctor lynched by mob in Assam and many assaulted at other places. Hospitals vandalized indicate that there is danger lurking for doctors everywhere. Most sad part is that, there are no firm administrative hands to deal with the menace.

     Clearly Well being of doctors and nurses is not being taken care of. They are being used as dispensable disposables. Such system, which is based on exploitation of the health workers, is becoming fast unsustainable. If apathy towards their genuine problems continues, negative attitude towards doctor and nurses persists,  it will kill the empathy towards patients as well.

 Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Government doctors in Kerala to boycott additional duties

    The Kerala Government Medical Officers’ Association (KGMOA) has declared that government doctors will stay away from all additional duties from Thursday, in protest against the government’s apparent lack of concern about the plight of health-care workers who are overworked and fatigued, fighting on the front lines for the past nine months.

  The KGMOA has, however, made it clear that while declaring non-cooperation, COVID-19 care and disease containment activities will not be disrupted.

In a statement issued here, the KGMOA said that apart from ignoring the KGMOA’s repeated demand for deploying additional human resources in COVID-19 care activities, the government’s decision to take away the leave given to health-care workers after continuous COVID-19 duty was something that defied all principles of fairness. This was totally unacceptable, the KGMOA said here.

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Penal Servitude for Doctors, Nurses- Administrators Delight


                         Life for health care professionals like  doctors and nurses is hard in present era, right from getting into medical college, passing the exams, gaining experience, work under new imposed legal environment, with  over-regulation and under the moral burden of over-expectations of society. The benefit of these difficult situation is reaped to the maximum by administrators and overpowering medical industry.

            Despite working amid of a national emergency in Covid-times, the meagre salaries of hundreds of doctor and nurses are not paid for months in Hindu Rao Hospital, Delhi

         Ironically where doctors are punished for small genuine mistakes or even poor prognosis during  medical treatment, the blunders of health  administrators are taken as trivial issues.  More ruthlessness, cunningness or cruelty towards health care workers is possibly becoming an appreciated quality of health administrators.  Why no punishment for the administrators for such blunders?

     Consequently, with no support from society, to whom they serve, doctor and nurses gradually are pushed to a penal servitude. If this is regarded as normal in present era, anyone would wonder, what does slavery constitute?

   No salaries  for doctors for four months

The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to non-payment of salaries.

  Irked over non-payment of salaries for over four months in a row, doctors at Delhi’s Hindu Rao Hospital announced that beginning Saturday, October 10, they would stop attending to patients including those suffering from Covid-19. Hindu Rao Hospital, the largest municipal hospital in Delhi with 900 beds, is currently a dedicated Covid-19 facility.The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to being unpaid for months.Abhimanyu Sardana, President of the Resident Doctors’ Association (RDA) of the hospital, said that several letters and reminders had been sent to Delhi Chief Minister Arvind Kejriwal regarding the issue faced by the doctors, who are frontline warriors at the Covid-19 dedicated facility. “Don’t ignore the basic needs and rights of doctors,” wrote the RDA-Hindu Rao.

            Be it any circumstances like working without any facilities, poor infrastructure, non-availability of drugs, inhuman duties hours over 48-72 hours or poor pay, the administrators would say, “you are a doctor, it is your moral responsibility.”  Armchair preachers and administrators will always remind them of moral duties, but easily forget their own.

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Moral Dilemma: Should Doctors Stop Work-if unpaid?


         From the very beginning of medical career, certain phrases are repeated to doctors and become ingrained in their memory. Be it any circumstances like working without any facilities, poor infrastructure, non-availability of drugs, inhuman duties hours over 48-72 hours or poor pay, the administrators would say, “you are a doctor, it is your moral responsibility.”  Slowly doctors will adjust, keep on working and take hardship as part of their life. Armchair preachers and administrators will always remind them of moral duties, but easily forget their own.

        Humbled by the nature of profession and blunted  retaliation reflexes due to hard training and enormous studies, gradually they become moral slaves to themselves. Enlightened people will understand the situation as attaining higher  level of hierarchy.

      All the problems are taken as  part of “Routine Life of a Doctor.”   The long  Struggle to become a doctor, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.   

          As doctors have not retaliated to deterioration, adapted  well to the slavery, situation is worsening. A  large hospital has not paid salaries to doctors for three months. Now  there is a moral dilemma for doctors: whether to continue work  or not?

Till society understands the concealed sense of enslavement that remains hidden, while performing these duties, the suffering of the profession will not end.  A problem that is clearly visible to every one,  but not admitted till now,  is in itself an evidence for a difficult scenario to be implemented. 

     Apart from moral dilemma, doctors will worry about legal implications. In present era,  amid maze of legal complexities, dilemmas are  unending. Among all such complexities, they have to worry about patients also.

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The resident doctors of Hindu Rao Hospital: indefinite strike from October 5 considering strictly ‘no pay no work’ 

NEW DELHI:  The resident doctors of Hindu Rao Hospital, the biggest medical facility under the North Delhi Municipal Corporation, will be staging an agitation against the administration due to their failure of paying the salaries of the healthcare workers over the past three months, said the president of the doctor’s body Abhimanyu Sardana.

The RDA of the hospital, which is also a dedicated Covid-19 facility, has decided to go on an indefinite strike from October 5 considering strictly ‘no pay no work’. However, essential services won’t be affected.


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Chilling Story: Surgery that Killed the Surgeon Himself


Doctor' suicide or murder by media trial

        Aspiring doctors, especially those who spend millions and golden years of life to become doctors, should know the reality of present era. How cruel the society has become towards doctors.

      Struggling to become a doctor, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.    Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.”

         Not only corona virus, but society may also drive doctors to death.

    The consequence and reverberations of the poor prognosis landed on the doctor, subsequent to the death of the patient.  Media and celebrities usually   have proudly   projected on screen and television that it is right to be disrespectful towards doctors. They have made it appear correct to masses that doctors  be beaten and assaulted, in case there are unexpected results or in case of dissatisfaction. But such  news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession. As incidents are widely publicized and masses following their “Reel Heroes” depicting violence against the doctor is seen as a routine and looked as an   easily do-able  adventure  due to  non-willingness of  authorities to take stringent action.

Kerala: Doctor ends life, medical fraternity blames ‘social media trial’

In a tragic incident, a young doctor from Kerala has died by suicide, reportedly after facing allegations of negligence following the death of a patient in his clinic.

Dr Anoop Krishnan, an Orthopedic Surgeon who used to run Anoop Ortho Care Hospital in Kollam was found hanging inside his house on Thursday. He had also cut his vein before hanging himself. The young medic had also inscribed the word ‘sorry’ with his blood inside the bathroom before he took the extreme step.

The 35-year-old was reportedly under stress for days after a 7-year-old girl who he had operated in his clinic died due to some complications.

The girl who also had a heart condition was admitted to Anoop Ortho Care Hospital for a surgery to fix a bent on her leg. Due to the girl’s heart condition, many others had reportedly declined to perform the surgical procedure.

Following the death of the patient, her relatives had filed a complaint against Dr. Anoop for negligence, alleging that an error in giving anesthesia caused the death. There were also protests outside the hospital by the relatives of the girl and an alleged smear campaign online against Dr. Anoop and his family. This, according to people who knew him had affected the young doctor who had made a reputation as one of the best orthopedic surgeons in the city.

Police said they are yet to ascertain whether the suicide was directly linked to the patient’s death.

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Story of Moral slaves: How Doctors bear full brunt #Covid


              Struggling to become a doctor, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.    Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.”

             The Indian Express has been wise enough and has been able to  express the situation to some extent, which is just tip of the iceberg.

             Low pay and long hours, doctors battle more than just Covid-19.

 Maharashtra estimates it needs 19,752 doctors, nurses and paramedics to fight Covid-19. As on September 15, 12,574 of the posts were vacant. Dr Rajesh Salagare is the only doctor at Raigad rural hospital since March. (Express photo by Tabassum Barnagarwala) Chest physician Dr Pravin Dumne has just done his rounds of the ICU at Osmanabad Civil Hospital and is now fielding queries from anxious relatives. Two hours into the PPE, he is drenched in sweat, with 22 hours more to go in his shift. Dumne has 150 Covid-19 patients under him. Since May, he hasn’t been able to take any break except for 12 days when he himself contracted the virus. Norms mandate one doctor per 10 ICU patients, Dumne is handling five times that. “There are times when multiple patients are critical and I can’t be everywhere. I feel helpless. We are losing lives,” he adds. As another relative complains about the lack of cleanliness in a ward, Dumne says, “I may quit government service once the pandemic is over.” Dumne isn’t the only one feeling the unequal load as coronavirus cases surge in Maharashtra, particularly its rural areas. The state estimates it needs 19,752 doctors, nurses and paramedics to fight Covid-19. As on September 15, 12,574 of the posts were vacant. Of the 1,700 Class I doctor posts (including specialists) the Public Health Department needs to fill, like Dumne’s, only 538 are filled. In May, Maharashtra was forced to ask Kerala for help. Forty specialist doctors came to Mumbai on a bus, to handle critical patient load until July. The shortage is even more intense in rural areas, where urgent advertisements by the government for specialists have yielded little response. In rural Nagpur, as many as 93.6% posts are vacant, followed by Thane at 79%. The last permanent posting in Osmanabad, an aspirational district under NITI Aayog, was three years ago. It needs 150 nurses and 40 doctors. The state government has been deputing Ayush doctors to civil hospitals. “Not all of them can handle serious patients,” Dumne points out. He and Dr Tanaji Lakal are the only two specialist doctors for Covid patients at Osmanabad Civil Hospital. Dumne was moved here from the PHC at Samudrawani village, following the pandemic. Dumne and Lakal alternate working for 24 hours continuously followed by one day off. In July, when Dumne got the coronavirus, he had to join back within 12 days, instead of the minimum 14. The number game In Raigad, 400 km away, Dr Rajesh Salagare has been the only doctor handling the entire rural hospital since March. The three other doctor posts at the hospital have been vacant since 2018. The previous night he was called for a delivery at 2 am; this morning, he was back on OPD duty at 9. “I am just an Ayush doctor. If something goes wrong, I will be held responsible,” he worries. It’s not just the long hours that deter doctors from rural duty. A government MBBS doctor in rural areas is paid Rs 60,000 per month and is expected to be on call 24 hours, their counterparts in Navi Mumbai get Rs 1.25 lakh, and in Mumbai and Thane, Rs 80,000 per month. Navi Mumbai, Thane and Mumbai mandate eight hours on Covid duty at a time, apart from providing hotel accommodation. As a chest physician, Dumne could earn up to Rs 2 lakh in urban areas, instead of the Rs 60,000 he gets now. His August salary came only a few days ago. The 100-bed Covid facility in Ratnagiri depends on Ayush doctors from nearby PHCs. One such doctor, who requested anonymity, says he sees over hundred suspected cases a day. He got his pending salary of Rs 40,000 for four months, till July, only a few days ago. “Everyone calls us corona warriors, but look at how we are treated.” Dr Pravin Dumne (in white) at Osmanabad Civil Hospital. (Express Photo: Tabassum Barnagarwala) An administrative officer at Ratnagiri Civil hospital, who is waiting for his pay since July, shows text messages exchanged with seniors. “If the government doesn’t respect us, why will a doctor want to work here?” he says. Ratnagiri Civil Surgeon Dr Ashok Bolde says the delay in salaries is on the part of the National Health Mission’s state office. Dr Sadhana Tayade, Director of the Directorate of Health Services, however, says, “Salaries are paid on time to doctors.” On why the poor response to advertisements, she says it is because “doctors are scared to work in Covid wards”. The government has begun tele-ICU services to plug the gap of specialists in rural hospitals of Bhiwandi, Aurangabad, Jalna and Solapur. Physicians in another city monitor ICU readings of patients in rural hospitals and call up on-duty doctors to direct treatment protocol. But tele-ICU has not reached every rural hospital, nor can it help everyone.          Next younger generation of aspiring doctors, who is  witnessing to the cruelty shown towards health staff, may be forced to think about their decisions to become doctors.

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Doctor’s death: saved uncountable lives- still not counted


In an era, where Reel Heroes are worshipped and Real Heroes are not    counted even after sacrificing their lives, is an unfortunate  and disheartening for  the whole community of doctors and nurses. It is surprising that  doctors, who saved uncountable lives, did not move the administrators enough  to get them counted.  Such  incidents  are not only  painful to the medical fraternity but also expose the hypocritical  attitude of the administrators as well as  the insensitive approach of society towards health care workers, although everyone expects doctors and nurses to be sensitive towards everyone else. Such indifferent   attitude demoralizes and causes deep discouragement to the front line doctor and nurses, but sadly remains a routine business for administrators. The pain of being  treated like a dispensable disposable remains as  a deep hurt within.

         But at the same time, mere tokenism as an expression of concern is also not desirable. What is really required is a sincere effort to reduce the mortality of health care workers, to provide them better working conditions. An honest effort to find the cause of mortality among doctors and reducing it, help to the families of the health care workers is required. Due acknowledgement and true  respect to their sacrifice  is expected from civilized society.

“382 Doctors Died Of Covid”: Medical Body Says Centre “Abandoning” Heroes

Indian Medical Association has shown its displeasure over  the Government  statement on coronavirus in parliament, which had no word on the doctors who died in the line of duty, and the  statement that the Centre had no data as health is a state subject.  Accusing the government of “indifference”, “abdication” and “abandonment of heroes”, the country’s top body of medical practitioners said in such a circumstance, the government “loses the moral authority to administer the Epidemic Act 1897 and the Disaster Management Act”.

So far, 382 doctors have died of coronavirus, the IMA said. In the list it released, the youngest doctor to lose his life was 27 years old and the oldest was 85.

But while acknowledging the contribution of healthcare workers during the pandemic, the health minister made no mention of the medical professionals lost to the disease, the IMA said.  

“To feign that this information doesn’t merit the attention of the nation is abominable,” the IMA statement read. “It appears that they are dispensable. No nation has lost as many doctors and health care workers like India,” the statement added.

The IMA pointed to Union minister Ashwini Kumar Choubey’s statement that the Union government does not have any compensation data as public health and hospitals comes under the states.

“This amounts to abdication of duty and abandonment of the national heroes who have stood up for our people. IMA finds it strange that after having formulated an unfriendly partial insurance scheme for the bereaved families to struggle with the ignominy of the Government disowning them altogether stares at them,” the statement read.

Such a circumstance also exposes the “hypocrisy of calling them corona warriors on one hand and denying them and their families the status and benefits of martyrdom,” the IMA said.

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Financial complexity of Modern medicine: 25000 hospitals near closure


Financial and legal complexities have been the major side effects of modern medicine, especially for doctors. They are facing  complex  environments,  which are beyond their control. Besides financial and legal complexities, moral dilemmas, facing verbal and physical assaults are creating  complex working conditions. But if doctors are not able to work, who will be the sufferer, does not need an Einstein brain  to guess. Criticized despite their sacrifice and treating the patients, media insults are adding to their disillusionment and possibly  a withdrawal response.

Rates for Covid hospitals: IMA doctors across Maharashtra threaten to stop work if demands not met in 7 days

Doctors with the Indian Medical Association across Maharashtra have threatened to stop work indefinitely if their demands are not met within the next seven days. On September 15, all IMA members who are hospital owners will submit copies of their hospital registrations to the IMA branch offices at various places. These branches will appeal to the state government that they are unable to manage the hospitals with the new rates. “We will urge the state to take charge of the private hospitals,” said IMA Maharashtra president Dr Avinash Bhondwe.

The IMA is protesting against the “unaffordable rates forced by the state government” for Covid hospitals and said it is increasingly difficult to meet the expenses to run the small and medium-sized private hospitals. It has demanded that the government should run all private hospitals.

Bhondwe said at least 25,000 mid-sector hospitals are on the verge of closure. “The government had accepted the proposal to increase the rates for the ICU and give concessions in biomedical waste disposal charges and electricity bills. The government had also agreed to cap the rates of PPE kits and masks for doctors and the rates of medical oxygen used by hospitals were also to be reduced as per the central government’s regulations. This was to be finalised in a proposed meeting with IMA before September 1,” Bhondwe said.

However, IMA officials said the state unilaterally came out with new rates on August 31 and the IMA decided to start their protest at a meeting on September 4. On September 9, all the 216 IMA branches paid a tribute to doctors in Maharashtra and burnt symbolic copies of medical council registrations

IMA Maharashtra convened a meeting of 14 different medical organisations of all the pathies, including Ayurveda, homeopathy, yunani and dentistry, all the disciplines of modern medicine and specialties on September 12. These organisations have supported the agitation and decided to form a joint action committee to work together.

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Aspiring Doctor: Watch the naked administrative oppression


 

Covid has been treated by doctors at great personal cost. It has resulted in even death of healthy doctors and nurses, thousands of them have stayed away from their families, for the  sake of patients. But does that kind of unparalleled sacrifice has resulted in any enhancement of  respect or prestige to the medical  profession. Has the death of medical professionals, while serving ailing fellow human beings  was enough to halt the oppression of this gentle and humble  community by administrators. Was it enough to stop physical or verbal assaults, legal or financial  exploitation. Was it enough to alter the course of oppression  by medical  industry or moral blackmail by society. Sadly it is getting more worse. Doctors and nurse have been reduced to sacrificial lambs, that are easily slayed, when administrators want to put  themselves on high moral  pedestals.

This order of district collector to arrest a doctor for raising a voice for raising serious administrative issues, for speaking the truth and not for some alleged mistake. one naked example of how medical fraternity is being suppressed.
The young aspiring doctors need to watch these times carefully, to understand completely, what they are getting into. Even while embracing death for welfare of other human beings, does not get them deserved respect, one needs to be careful about the coming times.

The contribution of doctors towards society is not recognized rather defamation of medical profession as a whole continues unabated.Doctor's dignity is sacrificed blatantly to prove greatness of administrators.General behaviour of people is far from the sense of decency towards doctors and nurses. Aspiring doctors need to watch bashing of medical profession and all such factors. There is possibility that earning a medical degree puts them at a lower pedestal in society.
 










 
 

What fuels a doctor?


You have to live a doctor’s life or to very closely watch one’s to understand it.

As a young overburdened doctor, still undergoing the rigours of academics, I used to commit certain silly mistakes of commission and omission which my watchful patients and their attendants would easily catch. And they would gladly discount it or let me know not grudgingly. From a twenty year old boy to a fifty plus oldie – that has kept me going.

It is hard getting into medicine. Equally hard studying it and even harder practising it. The litmus test was declaring a patient dead. Even harder , declaring a neonate dead with its face beautified by the large dead pupils. As if it is going to cry just ! It takes quite some heart to do the ultimate job of declaring the undeclarable. And then you come across patients and people your age who tell you they get all sorts of symptoms upon hearing someone die !!

Doctors live fast, age fast and studies have confirmed, they die faster than the general population. Their youth is almost completely absorbed by the vast study material and rigours of one of the most difficult courses.

Once as a house physician, I encountered a school girl with fever admitted in my ward. As a routine I used to check the vitals of around 30 patients morning and evening before the rounds. She used to laugh at me saying that I had nothing better to do than a nurses’ job. It took us almost a week to diagnose her with a blood cancer. She happened to be a cousin of one of my friends. She lost her hair to chemo drugs. Tired of the disease and confines of the hospital, one evening she insisted to go out.  She was so insistent that her mother requested me if I could take her from the hospital to my room. I refused to oblige her under a veil of principles and legality. After the whole night of  confusion, whether to accede to what may be one wish in her last days, I decided to take her out of ward. I prepared  myself  for a reprimand, I would face in the department. Next morning when I reported for duty , her bed was empty. She had massive bleed at night. I cried. That was about 25 years back. I still cry though very sparingly now, on losing a patient.

Only a doctor would understand this.

Looking back , it is not money , it is not anything but a glint of gratefulness in the eyes of my patients and it is the tolerance of my patients to my mistakes that has kept me going all these years. But that desired emotions are lacking somewhere and myself, at times do not feel the zeal  to continue anymore.

  A sense of gratitude in the  eyes of patients that fueled the doctor inside me,  is no more visible now.

Dr Sandeep Chaudhri

Consultant Internal medicine, Karnal (Haryana)

Covid paradox: salary cut for doctors, others paid at home


What a paradox!!  Firstly the doctors were employed on contract basis at meagre salary, only for Covid. At a time when other employees of government getting salaries while sitting at home while doing nothing, these contractual doctors were  drowned in pool of Covid patients, risking their lives.

        Cruel heights of insensitivity and  as an epitome of poor governance,  salaries of these 900 doctors were subjected to  massive deductions. They had no choice, but to resign.

       Ironically, on one hand every one appears to rue about  non-availability of doctors, but on other hand they are given a shabby treatment. For example everyone wants to employ doctors on contractual basis and hence paying them poorly and clearly with an intention to “ use and throw policy”.

Salary cut, 900 Kerala Covid doctors resign
THIRUVANATHAPURAM: Nearly 870 doctors appointed to Covid first-line treatment centres (FLTCs) across Kerala have tendered their resignation over deductions in their salary. They were among the 1,080 MBBS graduates who passed out of government medical colleges this year and appointed on Covid duty on a temporary basis. While they were promised Rs 42,000 a month, what each finally gets is Rs 27,000. “From the amount, Rs 8,400 was deducted in the name of the government’s salary challenge, apart from TDS and professional tax. Now, we are getting only Rs 27,000,” said , state president of Kerala junior doctors association 2020-21. The association has fired letters to the chief minister and health minister seeking their urgent intervention.

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