COMPULSORY RURAL INTERNSHIP FOR MBBS GRADUATES: A JUSTIFIED NEED OF THE TIME FOR THE BETTERMENT OF RURAL HEALTH SERVICES OR A FORTIFIED CHANGE OF THE SYSTEM TO PALLIATE THE CRUMBLING RURAL HEALTH SERVICES??
5th July,2012,Thursday,10am: A mail from the Organising secretary,MEDICON 2012,Amrita Kalantri, MGIMS Sewagram reads: you have been shortlised in the top 10 students for the panel discussion to be held on 12th july,2012 at MEDICON 2012.You will be interviewed for the top 3 positions shortly either via a skype meeting or over the phone. Let us know your convenience.
WHOAAA!!!(My expression while still at the clinical postings!)...i have been shortlisted!! The next moment the expression changes..posted in surgery,final year term practical exams,journal completions,etc etc...m doomed!! I surely can't go...
The biggest hurdle being the practical exams whose dates had yet not been declared and in most probability were going to be held the next week i.e. exactly coinciding with the conference dates.Was about to miss this golden opportunity i wondered then. But as the day passed i got restless...i want to go...can't miss this chance was the only chant going through my mind all day long. In the evening i informed Amrita about all the hurdles i was facing,she encouraged me to try and make it to the event. Then began the countless rounds of thoughts on exploring all the possible means of how i can attend MEDICON 2012,be it just for two days!
6th July2012, Friday: The dilemma still hangs in...still undecided...no idea at all if actually the exams would be conducted in the next week...no one had an inkling...we were told it will all be finalised by saturday .Even saturday was also too late for me to decide anything. But now nothing could be done..the wait for even 24hrs seemed so long!!
7th July,2012, Saturday: Almost on the verge of throwing up over the state of confusion! But the relief came in soon...my exams were not happening in the next week except for a re-exam of surgery which was scheduled on next saturday! Nevertheless, being the confused soul that i am always...i was still in two minds as i would be missing those "crucial" 3-4 days of final year as they say!Thought of discussing it with parents...blackmailed them a bit about completing my missed studies,etc after coming back and the green signal was given...and i was IN!!!
8th July2012,Sunday: Totally delighted,excited,charged up!! Was sinking in the feeling that i am GOING!!! but again a hurdle...it was sunday...no ticket bookings...had to wait till monday...
9th July 2012,Monday: Tickets booked in the morning(damn lucky to get confirmed ticket just one day prior to the travelling date!!). Packed my bags in the evening with whatever stuff i could find at home as half of my things were at hostel! In the night got a mail from Anshu ma'm about the details for the panel discussion. The shortlisting to top 3 would be happening at sevagram on 11th july. Perfect timing i thought..i was reaching the same day! Did some researching for the panel discussion in the night...getting some basic statistics out of google, the existing news articles about the issue, reading up people's views about the same, the ministry's plan for the future docs,etc.
10th July 2012,Tuesday: Left for sevagram....travelling alone without any friends/family member for the first time for such a long distance...this was going be a special journey i thought...and it definitely turned out to be one...read along to know why...i know you all might be thinking why did you all have to read that crap and i should have spoken straightaway about the panel discussion..but that was the so called " behind the scenes" . By the way...sorry but you have to listen to some more drama ahead and then the real story about the " COMPULSORY RURAL INTERNSHIP" begins!
11th July,2012,Wednesday: Reached sevagram @4:30 in the morning..the place feels homely...this was my 2nd visit to sewagram after the regional conference in january 2011...some of them had become my friends and i was in constant touch with them since then. The travel committee guys had come to pick up at the station,accomodation was provided,evrything almost set. No chaos at all. I went into flashback mode..MEDICON 2011...when i was in the organising committee..evrything had seemed so chaotic...so unsettled...but then i realised...no one knows the inside story...might be this is the same feeling the delegates had when they had come to Mumbai. When i reached the conference venue...i was like WOW...again NOSTALGIA!! Looking at the registration desk buzzing with activity, the volunteers running around mending their tasks, the breakfast area full of delegates enjoying their morning snacks with the spark in their eyes which said " we are looking forward to have an intelligible and fun time here!". Meeting everyone again and especially the warmth with which people at sewagram treat you, you just can't miss the feeling of being home! I am sure all the delegates must have felt the same!!
Most of the day was spent helping the volunteers and interacting with the faculty. Got to talk to Deo sir(as all students fondly address him...Padmashree Dr.M.G.Deo). As he was one of the panelists i told him how nervous i was of interacting with all the biggies on stage. But the comforting human that he is, he boosted my confidence by saying " You have to speak for yourself...unless you do that you are not going to be heard...make yourself heard,prove your point..make the most of the opportunity that you have got". This pep-up talk vanished almost more than half the tension i had. Got to know in the evening that myself with Hrishikesh Nachane from K.S.Hegde Medical college and Sutanay Bhattacharya from North Bengal Medical College had got selected as the top three to represent the student community. In the night, post dinner, was thinking of what would happen the next day..would i be able to even open my mouth in front of all the dignitaries tommorrow?? Dr.Abhay Bang, Dr.Binayak Sen, Dr.Rakesh Biswas, Dr.M.G.Deo, Dr.Vinaykumar, Dr.Lalit Dandona! phewww...doctors par excellence...all having accomplished great things in life and me... just a final year medical student!!! Goshhh...a big day ahead i thought...and just switched off my brain's battery and tried to doze off.
12th july 2012,Thursday: And the big day had dawned!!!!! Had the delicious breakfast and went to attend the morning session...listening to Bang sir, Deo sir,Vinaykumar Sir,Binayak Sen sir and Roli Mathur ma'm was simply fabulous...its like they talk and you imbibe...they are like charcoal who adsorb all the impurities in your thoughts and purify your set of ideas about things....there's no other way about it at all! And that's what is unique about MEDICON...it has set a benchmark above all the other conferences because it has gems imparting and sharing their views with the young research minds in a manner they understand beyond the boundaries of medical schools. It gives the students an opportunity to showcase their research work at an international level wherein their work is judged by such imminent personalities.We get to learn and improve our mistakes and above all a broader view of how things are and how they should be. At 2pm,lunch time,i was almost a nervous wreck...the time to be on stage for the discussion was near...4pm!! As every minute passed,with every stroke of the second i had palpitations!! Finally the time had arrived...looking at the huge stage set-up, a chill ran through my spine. My reaction was...Oh-My-GOD!!! Anshu ma'm being the moderator of the discussion spoke to all the three of us if we would like to speak for anything specific. We told her our preferences of topics within the issued we would like to highlight. The next moment the comperes made the announcement "And we will start with the panel discussion now...we invite all the panelists to come on stage and take their seats"...Felt like one of those drumrolls when Amitabh Bachchan is about to announce the winner of fastest finger first!
Every one was seated and Anshu mam started introducing all the panelists...she also introduced the topic of discussion "COMPULSORY RURAL INTERNSHIP" in brief and said "First we would like to know the students view about the compulsory rural postings, and i would like Pradnya to start with this..." I never knew i would be the 1st one to speak of all!! Would have prepared an opening speech otherwise...but nonetheless,this was the moment i needed to cease as deo sir had earlier said...and i started off..."A very Goodevening to all the dignitaries ....". Felt a bit shaky initially but as i spoke the confidence grew and i mentioned the various issues we medical students were facing: 1) The burden of rat-race for the PG-entrance exams(an MBBS Doctor holds no value today and specialty is a must!!) 2) The extension of the course duration from 5 and half years to six and a half years which would be too long for any undergraduate student.(especially the girls) 3) The responsibilities of the family that parents expect us to undertake 4) Are doctors the only need in rural areas?? Do they not need other development in areas like infrastructure,basic lifestyle changes,water supply,hygiene,etc,etc?? 5) Why do they not have a compulory posting for engineers and other professionals whose help is also essential in improving the basic necessities in these areas? 6) And if only doctors...why fresh graduates?? We can even have senior doctors who will be better off than us in understanding the problems in these areas and provide solutions accordingly on the "felt needs" of the people. Why make those poor villagers guinea pigs for fresh medical graduates? 7) And even if they still want us to be posted in rural areas atleast better facilities of housing,water supply,food and the drugs to be provided to the villagers should be made initially. They should also make better arrangements for the doctors to stay, for their security, for their help some local staff must be assigned. Just giving a better pay package does not solve the issues.
Next Sutanay spoke broadly on the other problems being faced by the villagers and how solving these problems would solve more than 50% of the health problems in these areas. Hrishikesh spoke about the bitter feeling of the medical students when they see their peers earning a postgraduate degree/going abroad and earning double the wages we earn as starters! He mentioned the truth that all of us always have in our minds as medicos. It does creates a sense of insecurity amongst us for sure... 10 yrs of your life to settle down with sacrificing much of the fun our other friends have is too much. We do not want to crib about it all the time as we choose this profession but definitely we can have a better system of education which would not tax us so much.
Further the dignitaries spoke their views about the issue. To my amazement all the doctors agreed that it was not correct to coax students into the compulsory rural postings and that we can come up with better solutions for the same. Dr.Binayak Sen highlighted a very important point,he said "we should not think that simple people's disease can be cured by simple doctors". How simply put but so very true!! That is what i meant when i said we do not wish to make guinea pigs of these villagers. He explained that we should take the issue of health in rural areas seriously..."if we urban people do not prefer fresh MBBS graduates to treat us,how can we send them to treat the poor...this again means we are making discrimination within those who can afford to avail a better health system and those who cannot". Dr.Vinaykumar spoke about the US health system wherein the urban and rural population is given equal advantage of the health infrastructure and so the whole spectrum of health services functions so well in the US" he said.
Dr.Abhay Bang maintained that the approach to medical sciences has changed over the years,instead of teaching bed-side medicine students are taught more of tertiary care medicine and that is why we cannot expect fresh medicos to handle such responsibilities. He also raised the issue of the PG-entrance exams which had made students vulnerable to MCQ Books rather than the practical aspects of medicine. Dr. Rakesh Biswas also reinforced this view. He emphasised that the medical curriculum needs to be changed with the stress on basic sciences and that clinical medicine be taught alongwith these basic sciences so that students develop a better clinical acumen and do not depend on investigative procedures to treat a patient! Dr.M.G.Deo brought forth the picture of maldistribution of doctor's in rural areas alongwith the statistics which proved beyond doubt that the Government has been inefficient in the management of rural health services. A different view was presented by Dr.Lalit Dandona. He was in favour of the rural postings. He highlighted some relevant points 1) Through this we can give back to the society 2) Doctors play an important role in rural areas as they are the binding factors of all the issues in these areas. 3) This posting will help the undergrads in their personality development
Then came the issue of social obligation and social accountability. As Anshu mam had asked beforehand I had chosen to speak on this topic..my viewpoints on it were...firstly, if the government spends on us and asks us to serve the society in return we have no issues.....but then why only us? Doesn't the Government spend money on educating engineers or architects?? Then why are they not asked to sign any bond or serve in rural areas in improving the infrastructure? They can leave for the greener pastures without any hassles but when a medical graduate has to go abroad even to acquire knowledge the whole issue of social accountability flares up. Secondly the obligation part...if we ourselves do not wish to work in rural areas we can find a hundred loopholes in the system and get away with it. For example the current rural posting of 3 months during the 1 year period is manageable by various means. I am sure everyone understands what i mean to say by 'manageable' and 'means'. It is so because students need time to prepare for their entrance exams and these three months become the crucial slogging time for these exams.So how can we be assured that the same would not happen with the 1 year thing? The desire to serve the society must come from within. We are not primed enough to be responsible towards the society. We can compare this to the soldiers who fight for the country.The responsibility of handling the security of the country is inculcated in them alongwith the physical training. Whereas we,from the beginning of the course watch our teachers,seniors,etc who opt for private practise or go abroad. Hardly,some of them think about serving the poor and needy. The lack of such role models is also a factor for students looking down upon rural service. We can sensitise the students about serving the poor and the needy through some social activities at the college level. In a few colleges like MGIMS,Sewagram, the students in their 6th semester are divided into groups and each group adopts a village.They take care of the village's healthcare throughout the allotted period. Though they score marks on this activity i am sure atleast some of them adapt the sense of responsibility towards serving the poor in the villages.
On this issue, Dr.Binayak Sen gave a very apt example of the mission hospitals by the Christian community. Students who have been learning in the mission colleges are supposed to serve in these mission hospitals.But here they learn under their senior supervisors. They are trained to practise medicine with their ongoing studies. So this does not become a burden for them. They happily learn to serve their community. If this style be inculcated in our curriculum as well, might be rural postings wont be shrugged by students. Dr.M.G.Deo also reinforced his opinion that we have lack of 'good' doctors which has to be met with. To take rural healthcare to the remotest of villages we need roads that connect us to them in the first place!
A totally enlightening and different perception of the entire scenario was provided by Dr.Abhay Bang. He said " When we come to professional college we are mature enough to be 'our own heroes'. So rather than finding some role models outside we should look for the inspiration within ourselves to be different and be the wind of change in the society". Very well said and the point was well taken by all the students as an applause rose through the auditorium. Must say i was awed and inspired by his way of analysing things and putting them to the audience in an simple manner. Further he also brought to the forefront the concern regarding the Quacks practising in the rural areas under the tag of doctors. The main reason for this was the lack of qualified doctors not available to serve this population. And when people malign us doctors of being inefficient we blame that it is the quacks who serve these people and strict action should be taken against them. But that again leaves them with no health services at all as we say we do not want to practise there and the vicious circle goes on. So rather than playing the blame game we all need to work towards serving the rural areas by formulating some solution. He also voiced the opinion that rather than specialists we need good doctors and that people should take into consideration the clinical skills of a person and not just the degree. To reduce the burden on the students the PG-entrances should be done away as a separate exam and be inculcated as a skill based exam at every step of the MBBS years. Thus, the student is a clinician at the end of the course and has his PG-Entrance aptitude tests results ready as well. In this way, students will be able to complete their internships with the desire to learn more and not the thought of bunking to spend time with MCQ books!! The medical curriculum itself needs an overhaul if some good solutions be formulated rather than forcing MBBS graduates into compulsory rural service he reasoned.
At the end a brainstorming session with questions from the audience proceeded. Anshu mam summated the whole discusion in a matter of minutes highlighting the issues faced by the students and the possible solutions deduced from the opinions of the experts bringing the session to an end. The applause of the audience proved that the debate had matched the expectations they had come with. The panelists had a quick photos session and then every one proceeded for tea. Got quite a few compliments on my ability to put forth my views boldly and firmly. Still have goosebumps everytime realising that i have shared stage with such imminent personalities!!
Sorry again! The drama doesn't end here...it continues... I left for home that night itself...how much ever i wanted to couldn't stay back for the rest of the two days...remember the surgery exam i mentioned at the beggining?? I missed the cultural event which i wanted to attend so badly!! Anyways had to be content with participating in the panel discussion!
13th July,2012, Friday: Reached home. In the night when i updated on facebook about the fantastic experience i had at the panel, i came to know about the panel discussion being published in the Times Of India,Nagpur!! That too with our names in it! Seemed a big glory to me! Couldn't have asked for more.
P.S. Th year 2012 was my hattrick @ MEDICON...every year that i have been associated with medicon i.e.2010(associate delegate), 2011(organiser), 2012(associate delegate again!), it has always been an awesome learning experience...i am sure it must have been to each one of us who has participated or organised it anytime!!
5th July,2012,Thursday,10am: A mail from the Organising secretary,MEDICON 2012,Amrita Kalantri, MGIMS Sewagram reads: you have been shortlised in the top 10 students for the panel discussion to be held on 12th july,2012 at MEDICON 2012.You will be interviewed for the top 3 positions shortly either via a skype meeting or over the phone. Let us know your convenience.
WHOAAA!!!(My expression while still at the clinical postings!)...i have been shortlisted!! The next moment the expression changes..posted in surgery,final year term practical exams,journal completions,etc etc...m doomed!! I surely can't go...
The biggest hurdle being the practical exams whose dates had yet not been declared and in most probability were going to be held the next week i.e. exactly coinciding with the conference dates.Was about to miss this golden opportunity i wondered then. But as the day passed i got restless...i want to go...can't miss this chance was the only chant going through my mind all day long. In the evening i informed Amrita about all the hurdles i was facing,she encouraged me to try and make it to the event. Then began the countless rounds of thoughts on exploring all the possible means of how i can attend MEDICON 2012,be it just for two days!
6th July2012, Friday: The dilemma still hangs in...still undecided...no idea at all if actually the exams would be conducted in the next week...no one had an inkling...we were told it will all be finalised by saturday .Even saturday was also too late for me to decide anything. But now nothing could be done..the wait for even 24hrs seemed so long!!
7th July,2012, Saturday: Almost on the verge of throwing up over the state of confusion! But the relief came in soon...my exams were not happening in the next week except for a re-exam of surgery which was scheduled on next saturday! Nevertheless, being the confused soul that i am always...i was still in two minds as i would be missing those "crucial" 3-4 days of final year as they say!Thought of discussing it with parents...blackmailed them a bit about completing my missed studies,etc after coming back and the green signal was given...and i was IN!!!
8th July2012,Sunday: Totally delighted,excited,charged up!! Was sinking in the feeling that i am GOING!!! but again a hurdle...it was sunday...no ticket bookings...had to wait till monday...
9th July 2012,Monday: Tickets booked in the morning(damn lucky to get confirmed ticket just one day prior to the travelling date!!). Packed my bags in the evening with whatever stuff i could find at home as half of my things were at hostel! In the night got a mail from Anshu ma'm about the details for the panel discussion. The shortlisting to top 3 would be happening at sevagram on 11th july. Perfect timing i thought..i was reaching the same day! Did some researching for the panel discussion in the night...getting some basic statistics out of google, the existing news articles about the issue, reading up people's views about the same, the ministry's plan for the future docs,etc.
10th July 2012,Tuesday: Left for sevagram....travelling alone without any friends/family member for the first time for such a long distance...this was going be a special journey i thought...and it definitely turned out to be one...read along to know why...i know you all might be thinking why did you all have to read that crap and i should have spoken straightaway about the panel discussion..but that was the so called " behind the scenes" . By the way...sorry but you have to listen to some more drama ahead and then the real story about the " COMPULSORY RURAL INTERNSHIP" begins!
11th July,2012,Wednesday: Reached sevagram @4:30 in the morning..the place feels homely...this was my 2nd visit to sewagram after the regional conference in january 2011...some of them had become my friends and i was in constant touch with them since then. The travel committee guys had come to pick up at the station,accomodation was provided,evrything almost set. No chaos at all. I went into flashback mode..MEDICON 2011...when i was in the organising committee..evrything had seemed so chaotic...so unsettled...but then i realised...no one knows the inside story...might be this is the same feeling the delegates had when they had come to Mumbai. When i reached the conference venue...i was like WOW...again NOSTALGIA!! Looking at the registration desk buzzing with activity, the volunteers running around mending their tasks, the breakfast area full of delegates enjoying their morning snacks with the spark in their eyes which said " we are looking forward to have an intelligible and fun time here!". Meeting everyone again and especially the warmth with which people at sewagram treat you, you just can't miss the feeling of being home! I am sure all the delegates must have felt the same!!
Every one was seated and Anshu mam started introducing all the panelists...she also introduced the topic of discussion "COMPULSORY RURAL INTERNSHIP" in brief and said "First we would like to know the students view about the compulsory rural postings, and i would like Pradnya to start with this..." I never knew i would be the 1st one to speak of all!! Would have prepared an opening speech otherwise...but nonetheless,this was the moment i needed to cease as deo sir had earlier said...and i started off..."A very Goodevening to all the dignitaries ....". Felt a bit shaky initially but as i spoke the confidence grew and i mentioned the various issues we medical students were facing: 1) The burden of rat-race for the PG-entrance exams(an MBBS Doctor holds no value today and specialty is a must!!) 2) The extension of the course duration from 5 and half years to six and a half years which would be too long for any undergraduate student.(especially the girls) 3) The responsibilities of the family that parents expect us to undertake 4) Are doctors the only need in rural areas?? Do they not need other development in areas like infrastructure,basic lifestyle changes,water supply,hygiene,etc,etc?? 5) Why do they not have a compulory posting for engineers and other professionals whose help is also essential in improving the basic necessities in these areas? 6) And if only doctors...why fresh graduates?? We can even have senior doctors who will be better off than us in understanding the problems in these areas and provide solutions accordingly on the "felt needs" of the people. Why make those poor villagers guinea pigs for fresh medical graduates? 7) And even if they still want us to be posted in rural areas atleast better facilities of housing,water supply,food and the drugs to be provided to the villagers should be made initially. They should also make better arrangements for the doctors to stay, for their security, for their help some local staff must be assigned. Just giving a better pay package does not solve the issues.
Then came the issue of social obligation and social accountability. As Anshu mam had asked beforehand I had chosen to speak on this topic..my viewpoints on it were...firstly, if the government spends on us and asks us to serve the society in return we have no issues.....but then why only us? Doesn't the Government spend money on educating engineers or architects?? Then why are they not asked to sign any bond or serve in rural areas in improving the infrastructure? They can leave for the greener pastures without any hassles but when a medical graduate has to go abroad even to acquire knowledge the whole issue of social accountability flares up. Secondly the obligation part...if we ourselves do not wish to work in rural areas we can find a hundred loopholes in the system and get away with it. For example the current rural posting of 3 months during the 1 year period is manageable by various means. I am sure everyone understands what i mean to say by 'manageable' and 'means'. It is so because students need time to prepare for their entrance exams and these three months become the crucial slogging time for these exams.So how can we be assured that the same would not happen with the 1 year thing? The desire to serve the society must come from within. We are not primed enough to be responsible towards the society. We can compare this to the soldiers who fight for the country.The responsibility of handling the security of the country is inculcated in them alongwith the physical training. Whereas we,from the beginning of the course watch our teachers,seniors,etc who opt for private practise or go abroad. Hardly,some of them think about serving the poor and needy. The lack of such role models is also a factor for students looking down upon rural service. We can sensitise the students about serving the poor and the needy through some social activities at the college level. In a few colleges like MGIMS,Sewagram, the students in their 6th semester are divided into groups and each group adopts a village.They take care of the village's healthcare throughout the allotted period. Though they score marks on this activity i am sure atleast some of them adapt the sense of responsibility towards serving the poor in the villages.
13th July,2012, Friday: Reached home. In the night when i updated on facebook about the fantastic experience i had at the panel, i came to know about the panel discussion being published in the Times Of India,Nagpur!! That too with our names in it! Seemed a big glory to me! Couldn't have asked for more.
P.S. Th year 2012 was my hattrick @ MEDICON...every year that i have been associated with medicon i.e.2010(associate delegate), 2011(organiser), 2012(associate delegate again!), it has always been an awesome learning experience...i am sure it must have been to each one of us who has participated or organised it anytime!!
U made the post on such an apt day! :)
ReplyDeleteLoved it.. :*