Of late, there has been a groundswell of opinion against the resident doctors' (MARD) strike all over the state. Myriad voices are being heard. For example, post-graduate students are supposed to get only stipends and no more - what is this talk about pay!? Then there is the opinion that students in this noble profession should not resort to strikes.Letters to editors, and columns by eminent journalists express deep and heartfelt angst at public suffering due to the unfortunate strike. On the other hand, pictures have also been carried in major newspapers depicting the sordid living conditions of resident doctors at tertiary healthcare centres like KEM, Nair, and Sion Hospitals.The system of post-graduate residency as practised in Maharashtra is more than half a century old. Graduate doctors wishing to pursue higher studies were enrolled as RMOs at teaching hospitals for a 2-3 year period, where they were enjoined to clinical duties, eg, OPD attendance, ward rounds, and emergencies. They were given hostel rooms attached to hospitals and paid a nominal stipend to offset tuition fees and the cost of books.Over the years, hospitals have evolved, diversified, and superspecialized. These teaching hospitals became referral centres for not just emergency care, but for difficult diagnoses and intractable ailments. Geriatric OPDs, HIV OPDs, high-risk new-born clinics, postnatal clinics, chemotherapy OPDs came into their own. Interventional radiology, genetic counselling and infertility treatment is today offered at most teaching institutes.One would think, then, that a major recruitment drive must have been undertaken to add so many more healthcare personnel. What happened instead was a bifurcation of specialities into subspecialities, and no new vacancies were ever created. Instead, there was a systematic reduction in post-graduate seats and a decline in the number of government-employed RMOs.So, the surgery students came to man the trauma room as well as the surgical intensive care units. Similarly, the pediatrics resident ran the intensive pediatric care unit, neonatal ICU, and attended deliveries. All this was over and above taking care of one's own wards, rounds, OPDs, pre-operative and post-operative care, and emergency duties. All this was accomplished by simply reshuffling the existing manpower to cater to each related subspecialty. As a result, where OPD attendance and admission rates stand at ten to twenty times those a decade ago, the number of doctors handling it has actually declined.It is indeed laudable to offer enhanced medical care to the population, but overworked doctors cannot be recycled interminably in 24 hours!On the part of the government, there was a systematic abdication of responsibility. Healthcare provision at all teaching hospitals today is the domain of resident doctors. Once and for all, this should settle the confusion regarding the twin status of a post-graduate student/resident doctor.When he is sent to court to depose on behalf of KEM, he is very much an RMO, not a PG student! He represents the hospital completely when handling sensitive medicolegal cases, signing death certifcates, even medical bills. A large share of undergraduate teaching also is left to him. Where, then, is the dichotomy? Why does this doctor suddenly become a PG student when he demands his dues? What stipends are we talking of? Does Rs 3,500 pm offset the annual tuition fee of Rs 17,000?We are talking of men and women, aged 24-32, some married, others with kids, who no longer wish to ask their parents for support. These doctors do not demand leave travel allowance, or insurance benefits. Nor do they ask for medical reimbursement (sickness leave is still deducted from examination leave). They do not ask for free food, or linen. Nor Diwali bonus. They ask for bare minimum facilities required for efficient discharge of duties. And a fair wage packet that enables them to pay their tuition fees (Rs 17,000/- pa), buy their own books and support their dependents.Institutes like Maulana Azad, Delhi, or KGMC, Lucknow, are merely implementing the Central Residency scheme, something that should have been done in Maharashtra long ago.On its part, the state government starts with the empty excuse of bankruptcy, adds the issues of social justice and order for good measure, and tops it up with threats of rustication. We may turn a blind eye to the transport requirements of a kingsize ministry, or an Elton John being hired for the millennium celebrations in the year of the cyclone - but we are unable to overlook the same hospitals paying Rs 500 for 8 hours to doctors on a contract basis!As it stands today, MARD is a very loose union of college representatives. Workschedules of resident doctors do not permit organized union activity. This agitation is an outburst against apathy from the corridors of medical education as well as the health administration.DR ROHIT ARORA
