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Friday, April 5, 2013

In favor of 'PG doctors for Districts'

Reportedly, health ministry officials are about to enact a piece of legislation that would ensure presence of PG doctors in district hospitals. How good is that?
Of late, a debate or rather expression of outrage is going on among young medicos. The reason is that the health ministry is reportedly about to implement a scheme through which PG or specialist doctors would be sent to district hospitals.

Reading the statuses in DSON and elsewhere, the anxiety of the doctors can be gauged.

Let's start with how good is the proposal to send PG doctors to district hospitals including in remote areas.

Any move to mobilize the trained manpower to people's doorsteps should be welcomed, at least for sake of people's health. Over past many years, medical officers (who have studied under government scholarships0 have been serving compulsory two year periods in stipulated health institutions across the country and that has (hugely) contributed to betterment of health care delivery in district hospitals and primary health centers.

In this situation, a move to mobilize PG doctors to district hospitals is welcome even though any such move should be simultaneous with parallel upgrade of the infrastructures in those institutions.

But as in every other field in Nepal, not every pronouncement carries the meaning that is expressed in words. In the reported move of health ministry to make provisions for such a deployment of PG doctors, many contradictions are seen.

If indeed the ministry wants PG doctors at district hospitals of even remote areas, there are two logical and highly workable methods: First, hire hundreds of specialists through PSC (Lok Sewa) and send them to the districts. Second, offer the thousands of medical officers who are stranded between UG and PG an opportunity to do PG with full government scholarship (as with UG courses) and make a bond with them to serve as stipulated. This way, the queue of people eager to serve in district hospitals after PG will be enormous.

But given the fact that the whole idea is a piece of nonsense brought about by the inebriated ministry officials with the purpose of bolstering their own ego, they appear to be proposing outrageous things: they will trap every person attempting to do PG through any university in Nepal or outside and make him/her sign that he/she will serve a year in government prison, no sorry, district hospital for a year. After passing the exams, they will then prevent the doctor to get specialty license from NMC until the sentence of one year is served.

How the hell can they apply this rule in a country that boasts of democracy and liberty? If the said plan is to work as reported, they will have to first declare that Nepal's governance is also akin to that of North Korea where the citizen has no recourse except doing what the government tells him/her to do. Unfortunately, even though outside North Korea, we live in a country that runs through whims and vested interests rather than by any rule, the reported provision may well come as a piece of legislation soon.

Now, why is a provision of mandatory 1 year in district hospital akin to a prison sentence? It is obvious for every medico. The first few years after completion of PG is the period when one 'learns with responsibility' and there are provisions of senior residency in India and elsewhere where the government is committed to creating quality manpower. Force a fresh graduate to languish in a district hospital without operation theater and other facilities and he will perfectly forget most of what he has studied and loose the skills he has acquired.Then leave him alone to fight for his career in a field where few mafia bosses control the whole business. A prison will be no less troubling.

The perception so far is that a doctor, particularly a junior one with no connections, is a meek slave who can be made to do anything the authorities desire. Moreover, such a provision will suddenly bring shine to the fortune of officials at DOHS who are there to sort out who gets which district in which area. They must be already salivating on the prospects of screwing the PG doctors now the way they have been doing with the medical officers.

It is exactly here that the role of all the young doctors comes. I have seen many people expressing disconcerted outrage at facebook pages and some of them even poking fun at the provision. When a disaster appears to be looming, these are the last things that will tackle it. First of all, every single doctor needs to think with conscience whether the provision is reasonable and is brought with good intention. Then the people with their future at stake have to unite and organize and put a united voice to relevant authorities including NMC. Incidentally, one NMC official was reported in the same news report to have been receptive to the government move.

There is no shame in saying that the government, rather few officials with their vested interests or ego clash with some doctors, cannot force anybody to commit to a provision that has no basis. If indeed the officials are eager at serving the people in far-flung areas of the country there are many more feasible and even welcome ways of doing so including recruitment through Lok Sewa and providing scholarships. If they are not, their true colors should be exposed.

Hereby, I appeal all the young doctors to have a clear position in the issue and put a united voice formally the moment this issues pops up again. Some authorities that can be approached include the NMC which has a central role in deciding whether or not to encourage the government to such a move. Subsequently, a pledge can be made to universities to discourage health ministry from such a move as this totally disrupts the learning process of the young PG doctor. If this is not done, every PG candidate will sign such a contract in a zeal to enroll in a PG course at the earliest but will have to pay a huge price at the future.

After all, we are the ones who have to sustain the health care delivery system of the country. We should help the state in providing quality care to people in all areas of Nepal and we should even demand a rational process of doing so. Even I may be a candidate to apply if government asks us to join PSC after PG and will be happy to serve at district hospital with a relatively secured future. But if government wants to strangle me with so called PG specialty license to force me to serve a sentence, that is absolutely unacceptable. You can surely think for yourself.

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