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'No running out of patients'

The first strike by resident doctors anywhere in India, in 1969, was led by the Maharashtra Association of Resident Doctors (Mard).

india Updated: Mar 08, 2006 04:38 IST

The first strike by resident doctors anywhere in India, in 1969, was led by the Maharashtra Association of Resident Doctors (Mard). That 16-day strike of 37 years ago called for better living conditions and payment for ‘trainee doctors’, as they were known then.

Why is it that after nearly a dozen strikes (including flash one-day strikes), the demands have remained the same — increased stipend, better living and working conditions, setting up of service rules and, of late, proper security for resident doctors? This time, despite Mard claiming the support of doctors across the state, the authorities have managed to recruit new doctors, after serving de-registration notices to many of the 2,500 striking doctors from municipal and government hospitals in Mumbai and its suburbs.

This was a fear that Dr Ravi Bapat, a founder-leader of Mard, had expressed after his attempts to negotiate in the present impasse failed. Dr Bapat feels that instead of adding on successive demands about increased stipends etc., the doctors should have concentrated on their main demand: security. For the present strike was triggered off by an incident in which the relative of a 50-year-old patient, who died in KEM Hospital, slapped a resident doctor on February 27. And this was the latest in a number of incidents in which doctors have faced violent reactions from patients’ relatives.

Nonetheless, it cannot be denied that the main grouse of the doctors remains the abysmal living and working conditions at these hospitals. Considering that they have not allowed this, and the pressure of numbers, to affect their efficiency with patient care, the situation does seem quite unfair.

One of the main reasons why these strikes fail to get the desired result is that those affected by them are the very poor and the near destitute, who have neither political, economic or social clout. The economic class of patients to come to public hospitals for treatment are hardly in a position to put organised, vocal and effective pressure on the government to find a speedy solution.

There is also the problem of organisational continuity at Mard. The resident doctors at government hospitals are post-graduate medical students, training for their MD and MS degrees after completing their MBBS and internship. This means that the Mard leadership, as also membership, changes every three years. Thus, the benefits of a professional trade union, like following up on past assurances with the bureaucracy and building public awareness, are missing.

The doctors also fail to gather public support because of a common perception that after completing their resident terms, these student doctors would anyway go on to earn millions. So, they should really not complain about a few years of hardship while gaining experience. As it is, the medical education minister has pointed out that since the doctors work in government college-hospitals, they pay highly subsidised fees of Rs 18,000, while the government shells out Rs 4 lakh per student.

It is not as if the resident doctors have not tried to reach out to the public and explain their stand. From staging street plays to shining shoes in public places, they have, in the present instance, set up parallel OPDs to cater to patients. But then, all that the poor patients care about is that they are not getting the only medical help they can afford.

This brings us to the state of public health in Maharashtra. The Centre for Enquiry into Health and Allied Themes (Cehat) recently brought out a status report entitled ‘Health and Healthcare in Maharash-tra’. It noted that the state’s efforts to decentralise primary health care by leaving the implementation to zilla parishads as early as in 1961 had led to a huge rural health care infrastructure.

At the apex, informs the report, are the teaching hospitals in Mumbai, Pune, Thane, Solapur and Nagpur, among others, with 500 to 2,000-bed hospitals that receive patients from all over the country. The cities also have specialist hospitals dedicated to infectious diseases, ENT, etc. The state has 11 government-run teaching hospitals (Mumbai has three, run by the municipal corporation), apart from ayurvedic and unani medical colleges. This number does not include the district level, taluka and smaller hospitals.

However, social activists have noted the trend towards privatisation of medical services and private health insurance companies with great anxiety. In a few cases, it is public outcry that has nixed efforts to privatise, points out the Cehat report. The fear that frequent strikes by doctors could make the government’s task easier in convincing the people that they are better off with private medical services, has been expressed a number of times.

To be fair, it is not as if Mard has only struck work to demand better facilities for its members (though better working conditions do mean better care for patients). In 1984, the 30-day strike sought to oppose the setting up of private capitation fee medical colleges in the state, which, Mard argued, would make a mockery of medical education. The strike was unsuccessful and the record of these colleges is there for all to note.

A solution to the impasse, suggests Dr Bapat, could be the setting up of a permanent mechanism that would review working and living conditions of the doctors every three years. Public health services are simply too important to be left to a periodic tango of prolonged strikes and negotiations.