Readers Write on Junior Doctors' Strike

May 30, 2007

Dr. Arvind Sinha wrote on May 30:

Sir

I read the letter of Dr. Nag on Junior Doc's strike. I fully appreciate his viewpoint and the hellish environment these docs have to work. If any govt is so worried about patient welfare and improvement of conditions - let them pass a law - "Every government servant, MLA, and MP should always be treated at a state government hospital or PHC". Unless the Babus and Netas feel the pain and misery, they will never try to improve the health status of hospitals.

History is replete with evidence that whenever a babu or a neta is sick he hushes to Apollo or Escorts by special aircraft, why can't they be treated at the local PHC or govt hospital, after all they are suppose to make it work!!!!

When I use to work in the medical emergency of 12 beds, they were 2 oxygen cylinders falf filled - making it very difficult for an intern to treat the serious cases - who was responsible??? The netas and babus were sleeping over this issue - Let them be treated at these hospitals and then they will realise the sufferings of the common man!!!

With full support to Junior Doc's Forum
Dr. Arvind Sinha

Amit Anand wrote on May 28:

I was just too ashamed to read the news on the striking junior doctors. Ashamed of my place of birth. Still red-tapism runs so high in Bihar. Whether it was the fault of the high hands or the doctors is one thing but people dying for the lack of medical attention is another thing.

I am a Bihari now out of India. Seeing this place makes me think how backward India is, forget about Bihar and the mentality of Biharis. I just wonder how these doctors ignored the fatal pleas of ailing patients. Just too shameful an act.

(Note: This letter came before Dr. Nag's letter was received by PatnaDaily.Com).

Dr Pankaj Kr. Mishra from London writes on May 30:

I read the comments of representatives of junior doctors of PMCH and also the comments of those who are feeling 'ashamed of their place of birth' following the strike by junior doctors.

I am a graduate of PMCH who left Bihar a more than a decade ago. I have been their several times recently also. Dr Nag and his colleagues have got some genuine grievances that needs to be looked into. The junior doctors in Bihar are really living in pathetic conditions. They are very poorly paid ( that also sometimes they don't get paid for several months) and are usually a exploited lot. Interference by politicians is a national phenomenon and we should be ashamed of being 'Indian' ( if at all we are ashamed) and not ashamed of being a Bihari.

We need to create suitable environment to ensure excellence in clinical care. Media should play an active role. Just sending a few reporters to report on 'interesting bits' wont help.

Ashutosh Niraj, MD, from Detroit, Michigan writes on May 30:

Letter written by Dr. Nag is indeed the reflection of the tip of the iceberg. What he wrote is not only a reality but also a summary of a serious issue. Although response from Mr Amit Anand may seems appropriate after hearing the tragic news, Dr. Nag's letter has tried to explain the intricacy of the situation. As far as medical profession outside India is concerned, in USA, the same situation was prevalent about a decade ago. However it did not surface in terms of the residents going on strike as government' officials were diligent enough to respond to the residents concerns and ACGME enforced the rule of 80 hours per week on all residency programs. I personally feel that in a situation when nobody (including media) cares to highlight the poor condition of residents and when a resident is on the verge of fighting for his survival, their decision to go on strike should not be categorized as medical negligence. I agree with Dr. Nag, the root of the evil lies somewhere else. In this situation, concerning government officials should act to resolve the residents concerns and have a back up plan in a situation like strike. Of course, I am writing all this despite the fact my parents and siblings who are still in Patna, have to rely on the fragile Indian medical system for their care.

Bimlesh Kumar of Noida writes (May 31, 2007):

I am aghast at the attitude shown by the junior doctors who rather than take responsibility for the death of the patients have shifted the blame on their professors and the seniors doctors. If anything these junior doctors should have taken a cue from the time when the junior doctors at AIIMS continued to attend to emergency cases even when they were on a hunger strike over the quota issue . They are what should be really termed as a doctor rest everyone else for me a medical practitioner who does his job, charges a fee and goes back home.

About the problems at PMCH, what Dr. Nag says is correct that they have to work hard but to say that they work in inhuman conditions, ahem ahem, that’s taking things a little too far. If the doctors so clearly know the physical infrastructure at PMCH and the low internship stipend, why do they come to PMCH in the first place? They have plenty other options where they would get better pay and better working environment, what stops these people from choosing these option. As they say if you cant bear the heat of the kitchen, better stay out. Taking a cue these baby cribbers should better find other options for themselves and leave the patients to the mercy of “less meritorious students” who otherwise wont crib day in and day out about stipends and working conditions. What the poor people of Bihar (rich anyway go to private clinics) need is doctors with a desire to serve the people and not guys who want full freedom in doing their work in the autocratic way they want. Ask these morons if they even obey their old age professors who have served the humanity for whole of their life. The answer will be a LOUD NO.

Next comes the question of attitude. Go to doctors in PMCH and see them talking to poor patients, you’ll realize that these junior doctors have a major attitude. They believe they are no less than GOD and so should be treated like that only. How many of them attend their duty and follow the time schedule? You will have a huge queue of patients in front of a doctors room and the GOD would make them wait as he’ll be busy on his cell phone. Is that what you call work ethics? I have seen instances when a patient in a serious condition when brought to the emergency ward would be surrounded by 3-4 junior doctors who rather than attend to the patient would discuss among themselves the reasons/symptoms leaving the patient to lie in pain. Mrs Rekha Modi may have been wrong in putting her notes on the patients file but the fact is the junior doctors not just in PMCH but at any other medical college of Bihar take their rounds duty casually and a patients safety is the last thing on their mind. If relatives of dying patients were to start protesting against the attitude of these doctors, I am just wondering what their reaction would be? Maybe resort to another strike. For these money minded morons, all that matters is how much they end up making after doing their course . And please we don’t need to learn about ethics and moral values from such spineless people.

Prakash Mehta from US writes (May 31, 2007):

I am surprised at the response of the junior doctors on their latest strike that reportedly resulted in seven deaths at the PMCH.

I have a few questions for these whiney doctors: Did anyone stick a gun to your head to join the PMCH? Did you not know that such 'inhuman' conditions prevailed at the PMCH before you decided to join this hospital? Did you not know what the stipend for junior doctors were? No? Then don't blame other people for your mistakes.

Have you guys ever seen or heard about sweat shops in China, India, and many other countries where kids and adults are making Reebok shoes and designer jeans, that you prefer to wear, and are forced to work 18 hours at a stretch without any break? That, sir, is inhuman. What you are describing is are mere inconveniences. Those kids in the sweat shops are not educated and have no choice but to waste their lives in those dark factories unless a human rights group intervenes but you sir, are educated. If you don't like your working conditions, quit whining and leave PMCH. No one is forcing you to stay there.

How many strikes have you organized in last 3-5 years? Too many to count. How many patients have died because of your arrogant approach? Again too many to count. But you always have someone else to blame for. This time it happens to be Rekha Modi. While she may be wrong in telling doctors what to do, you people are ultimately responsible for the welfare of the patients whether you like it or not. And if you don't like it, quit and move on with your life. Go to Delhi, Pune, Mumbai, UK, USA. Who's stopping you? Just quit complaining and playing with the lives of patients.

The truth is, like everything else in India, you are first trained to join a union and that union with vested interests dictate terms on you. It's not so difficult to understand your plight. You like that imagined power that comes with joining such unions, and you like to display that power every once in a while.

Once or twice, people can understand and sympathize with your causes but strike by junior doctors of PMCH is a regular feature on all Bihar media. You have cried wolf too many times.

I dare you to quit your jobs at PMCH next time you have the urge to go on a strike. But you will not do so. You want to have the cake and eat it too. That's the truth, sir, and the truth hurts.

Ravindra Kumar writes on May 31:

I am quite frankly surprised at the response put up by these junior doctors. You may be the brightest, but you are certainly not the most compassionate humans. If you do not like the PMCH, the terms and conditions you have to put up with the system in PMCH, just quit PMCH and find another hospital to work. What do you think? You are royalty and the whole world should align according to your whims then only you would start serving these poor people who came to your doorsteps because they could not afford to get treatment at some other ultra-modern and costly hospitals?

If you do not like the system, do not hold the poor patients to ransom. If you do not like the conditions, do not kill them to show that many more are going to die unless your due royalty status is bestowed upon you. There are better ways to highlight your plight than killing these poor patients. Does your oath mean anything to you doctors, Dr. Nag?

Next time you begin to feel the urge to complain, do not let a dozen patients die to make your point. Bunch of whiners.

Naren Singh from USA writes (June 1, 2007):

The PMCH junior doctors went on strike just because some Rekha Modi, a NGO lady tried to dictate her own style of care and ironically she is a sister of deputy CM of Bihar. Many of the patients died because of lack of the very much expected care from those Jr. doctors. One of the Jr. Doctor, Dr. Nag confesses as 'It happens'. Well, end of the day, 'SHAME'
on you doctors.

There were several different ways available to complain such interference from an influential lady like Rekha Modi. Though, you great Jr. doctors, chose to punish the poor patients by going on strike and so sudden.

Other question strikes immediately that what was PMCH management doing when these doctors went on strike, abruptly. How come they did not have any auxiliary arrangement to take care of ailing patients?

Without doubt, it's a "DIKHAA DENGE" kind of hegemonic act displayed by those Jr. Doctors of PMCH and beyond that they go on PatnaDaily and confess that 'patients died and it happens'. You folks certainly have lost much of your genuine credibility what you could have achieved without going on strike.

Well, Rekha Modi may be asked by her brother to keep herself in limit. You, the so called doctors may get all hi-fi gadgets. Your salary could be risen to general surgeon's salary level. But, the soul of those poor patients who did lose their lives just because your own "Dikha Denge" tussle, will never forgive you. You will have to live with this 'blot' in your heart and head for your rest of your life. The question is, do you have any sensitivity left to feel that 'blot'.

The Bihar government must be doing a full blown investigation and find as which party is the real jerk of this 'kill the patients' saga. They should be punished at full extent for the murder of at least 7 patients. Whether, it is Jr. Doctors, The PMCH management, The doctors Union or Mrs. Rekha Modi.

Alok Kumar writes (June 1, 2007)

I fully appreciate Dr Nag’s point. One also has to take a look into the conditions junior doctors work in and also to appreciate the fact that if one is seeing death on a daily basis, (which one does in ample measure in govt hospitals) it’s natural to get slightly detached.

While having a discourse with many junior doctors I found out that they are more human and compassionate than most of corporate denizens like us. I also found out that there are too many cases of interference by patient’s relatives/big shots and it also results in some scuffle where junior doctors might get thrashed. Even they continue to work partly for huge workload govt hospitals offer and partly to treat variety of cases one gets to treat. If I have to blame anybody then I would blame the system and not junior doctors whose dedication to their chosen profession is more than people lecturing from US, UK. Writing from afar is fine but experiencing the conditions is definitely very different.

Ujjwal Kumar from UK wrote on June 1, 2007

Well, general public shaming on doctors by their own view point and doctors believing themselves right in their own view. Jis desh ki janta jaisi hoti hai, administration and leader bhi waisa hi use milta hai.

That's why doctors are also suffering and public is also suffering. Well done, keep fighting both of you.

Personally, I pity on junior doctors, when the patients died what the senior doctors and consultants were doing at that time?

Reza Sami from USA writes on June 3, 2007:

Here are some uncomfortable aspects of why the majority choose the medical profession in India, which itself raises some stark moral and ethical questions.

1. 99 % of people opt for the medical profession because of the money. Money that is to be made out out of human suffering. Every student from high school onwards wants to study physics, chemistry, and biology during the "plus two" years of education for the sole purpose of becoming a doctor. Nobody wants to become an environmentalist, zoologists, or botanist. It is "doctor" or nothing! Any profession, any interest apart from medicine is deemed useless or inadequate and student who does not make the medical college entrance examinations is considered a gross failure in his general life. The medical and pharmaceutical professions used to be noble ones where the oath of Hippocrates was as sacrosanct as the oath taken by those becoming monks or priests. Whether this profession remains thus ( at least in India ) is questionable.

2. This "doctor" syndrome is prevalent among the Indians living abroad as well when by hook or by crook a medical education is an absolute must (nothing else!) for their children. Medical college admissions are as fiercely competitive abroad as anywhere else, and a medical college degree costs $150,000 to $200,000. Realising the huge potential of those candidates who fail to make the grade to get into a regular university cheap "medical institutes" have cropped up like mushrooms in the Caribbean islands such as Granada, Bonair, etc. Lately China has got into the act and is offering "dirt cheap" medical degrees which allow one to qualify for the US medical license. However, even these cheap degree institutes still cost around $100,000. Their catchy television ads are familiar on overseas Indian TV channels. The "catch" is that these institutes are solely for the purpose of the USMLE (US license examination) and are not worth the paper they are printed on for a medical career anywhere else.

3. In comparison to item 2 above, the universities in Bihar offer reputed and recognised medical education for a sum that is so little that it could be considered free. The only expectation from the students is a little dedication and sincerity to helping the sick. Given the pitiful conditions of our hospitals the least the patients can expect is a little sympathy to die with dignity. Unfortunately even this is not an option. Corpses are routinely pilfered from the morgue to end up on the dissection table or these are dipped in acid baths to strip the flesh away and provide skeletons for anatomical studies.

Unfortunately the goal is to use the resources of the state and the taxes paid by lesser humans to acquire a medical degree and move on to greener pastures in pursuit of the "big bucks". To top it all there is a violent protest and strikes whenever a little more dedication or ethical standards are requested.

Not all doctors are like their Indian counterparts. Doctors in Africa, France and Europe have founded the institution "Medicine sans Frontiers" (Doctors without Borders) where dedicated medical teams heroically fight to save lives in the zones of war, famine and disease in the poorest, war-torn, and disease ridden areas of the world. They work for a pittance risking their lives in the process. One of the doctors of Medicine sans Frontiers has a crippled leg, yet on crutches he staggers in the blazing tropical climate of a remote village in Congo to his hospital for a 12 hour work day. This doctor has a degree and fellowship from the University of Illinois and he could very well have had $250,000 practice back home. Yet he chose the conditions under which to work. Given the prevailing ethical standards in India it is not surprising that the number of Indian doctors serving with Medicine Sans Frontiers is very few.

It is not suggested that every doctor join Medicine Sans Frontiers but little more dedication and little more kindness will go a long way to dispel the hostility that the people are generally displaying against doctors.

Ujjwal Kumar from UK writes on June 6, 2007::

When junior doctors are on strike, what the senior doctors do, can you answer? Sitting in their private clinic and earning more money! Everyone knows that when some patient gets admitted in medical college, they get admitted under some consultant like assistant or associate professor. They don't get admitted under junior doctors name. Effectively, that means it's responsibility of senior doctors to save life of these patients at all cost. So if during strike some 5-10 patients die, I don't see any reason why a fleet of consultants cannot save these 5-10 patients by their own.

If you go to UK or USA, senior consultants do all the minor and petty works of ward by themselves. Why can't Indian consultants do it. Because Junior doctor has to get his MD/MS from that consultant!!

Further, talking about ethics, what about ethics of police/bureaucrats/politicians? Are doctors the only one who are king or queen of ethics? I agree human life is supreme, what about opening morning newspaper and find someone dying for some petty reasons.

I may be wrong, I wish I should be wrong, but in India cost of human life of poor is nothing. And the rich get all sort of fancy treatment anyway and they never come to government hospital for treatment. Would Rekha Modi or her party would ever come to PMCH for treatment - NO NEVER. Just compare to western world and you would know what is the value of human life.

If you speak about ethics and value of human life, sincerity at job; you will have to bring change from bottom to top.

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