It took 7 days for the government to reach an agreement with the doctors on strike in Kerala. If you are one of those who raised an eyebrow when you heard about the news of doctor’s strike, you need to understand why they were doing so, before you play the blame game. Were all the issues solved?
Healthcare system, an Overview
Kerala, the small state in the south of India can boast of it’s high literacy rate and advanced healthcare facilities, only when compared to the other states in India. In order to understand the real status of healthcare system run by the state government, one has to occupy the shoes of either a patient or a doctor.
READ : Healthcare in India
Public healthcare in Kerala is run under two administrative departments. The DHS (Directorate of Health Service) and DME (Directorate of Medical Education). The medical colleges and other medical education centres in the state comes under the DME whereas the public hospitals like PHCs (Primary Health Centre) and CHCs (Community Health Centre), Taluk and District hospitals comes under the DHS. There are about 1200 such public hospitals in Kerala where approximately 4000 doctors provide health services. Only the doctors working under the DHS participated in the strike which meant that the functioning of the medical colleges were not affected.
You must read this article to understand the various duties of a doctor working in a government hospital in Kerala.
Some of the major areas for which the strike was conducted are discussed below :
Namesake Upgraded Hospitals
There were only 5 government medical colleges in Kerala when I joined Calicut Medical College in 2003. But, now there are 12 and they were all upgraded to the medical college standards without installing the basic infrastructure needed to function as a medical college!
Instead of improving the quality of services provided at the public hospitals by increasing the infrastructural facilities, the government is trying to build up new hospitals and medical colleges with inadequate manpower and lack of even the most basic facilities. They periodically upgrade the PHCs to CHCs and the CHCs to district hospital by just changing the name of the institution. No other infrastructural changes takes place during these upgrades. The biggest malady happens when they upgrade ordinary district hospitals into medical colleges! By making sure that the facilities and healthcare services available at the public hospitals are meagre, the common man is forced to depend on private hospitals spending money which they do not have in the first place. The common man should think again as to whether the government is really helping him or not.
The flash news scrolling in the television reported that the doctors were striking just to avail 2 days duty off after one night duty. There are no better fact twisters than the news media in this country and they have got it wrong this time too.
A recent government order asked the doctors working in public hospitals providing inpatient services to work for 17 hours straight. This order came into effect when the doctors doing night duty at the hospitals were already taking 12 hour duties. The government passed this order because of the staff crunch which they were facing. Instead of appointing more doctors and asking the Public Service Commission to speed up the process of making more doctors available at the government hospitals, they simply took the shortcut and decided to put additional burden on the existing doctor’s spine.
This kind of non humanitarian stuff doesn’t take place in any other parts of the world. How can you imagine a doctor to take the right decision and provide good quality health service when he/she is exhausted?
Lack of Infrastructure
In a state where government jobs are considered as symbols of social status, doctors in Kerala find it unappealing to work in the public hospitals run by the government and there are many reasons behind it.
There are at present 26 medical colleges in the state and it is not the deficiency of young doctors that is creating the acute staff crunch in the public hospitals.
Lack of infrastructure at these hospitals forces the young doctors to compromise on the quality of health services that they can provide. Whatever the young doctors had learned during the 5 years of their medical education has to remain in their minds and books and cannot be applied in real life (not in these hospitals whatsoever). More attractive salary, favourable working hours and the opportunity to learn more with the availability of state of the art advances in medical science are other reasons for the drift among doctors.
The shortage of doctors in the government hospitals is making the lives of millions of common persons miserable. They are finding it difficult to get proper healthcare services at an affordable cost.
Simply providing free essential medicines to the public is not enough. It has to be supplemented with providing other quality services at the right time.
The laziness on the part of the government to bring about improvements in the public health sector is actually helping the corporate hospital managements. This issue can only be solved by providing adequate staff pattern at all the levels of healthcare and by investing more money to strengthen the existing hospitals by improving it’s infrastructure.
Government doctors in Kerala have been on indefinite hunger strike for the past 7 days. You must be thinking that when doctors conduct strike, the common people are affected. But, who is the real culprit here? It is definitely not the doctors alone. One should really question the government who have forced the doctors to do this. The doctors are striking for improving the quality of healthcare system in the state and the government are solely responsible for bringing the matters wherein a strike was necessary. The strike was aimed at improving the quality of healthcare services as well as to make the public aware of the situation.
Doctors who are members of the Kerala Government Medical Officers Association (KGMOA), started an indefinite hunger strike on the 9th of September to bring about positive changes in the existing healthcare system. The decision to go for an indefinite strike was not taken as a quick decision. KGMOA have been demanding the changes to be implemented for the past 2 years and every time they were given false promises by the government. One must understand that during the strike, the Out Patient Department and/or other essential hospital services were not compromised. Only the special duties assigned to the doctors, training sessions, meetings etc were boycotted.
Kerala Government Post-Graduate Medical Teacher’s Association (KGPMTA) have also supported the strike started by the doctors working under the DHS and have asked the government to take the right decision before they extend the strike to the medical colleges administered under the DME.
The meeting conducted today, the 15th of September to reach an agreement for ending the strike included the leaders of KGMOA, the Health Secretary and the State Health Minister.
Decisions were taken to create new posts for doctors in 31 Taluk hospitals across the state. This will be done in order to start Casualty (Emergency Department) services in these hospitals. Vacant posts of doctors in the hospitals would be filled in a time-bound manner.
Duty arrangements shall be made in such a way that doctors would not be insisted to take 17 hours duty within a 24 hour period. But, they will have to continue the 12 hour night duties.
Government however were reluctant to change their policies regarding the conversion of District and General hospitals into medical colleges.
The strike has definitely helped to bring about some changes in the healthcare system in Kerala state and to make the people aware of the fact that drastic changes are very much required in this sector. It may not take long until you hear the news of the next big strike by doctors.