I did my undergraduate and internship in Mumbai and Pune and these were some of my experiences and observations. These were true about 15years ago and some things may have changed- I hope for the better.
Three groups of doctors are particularly prone to be
harassed. Interns, First year resident doctors (JR) and those perceived as
‘outsiders’ to the Mumbai clique.
INTERNS
NB- interns coming from outside Mumbai are called 'externs' by the native doctors.
In all hospitals in Mumbai some of the orderlies, Nursing
staff and other ancillaries are insincere in their work. Plus there is a perpetual shortage of staff at
this level and the shortage is often made up by contractual staff of poor
quality and commitment. So work is left unfinished. These folks are protected
by their Union and the law henceno action can be taken against them. Adding to
this is a (?real/ imagined/ created) shortage of patient materials like
needles, syringes, trays, dressing materials, cleaning and disinfectants, etc. But
in medicine work has to be done. Now. So when the crunch happens in a
particular ward or hospital (which is always happening) all the pending work is
pushed on the medical interns.
The typical medical intern in Mumbai and Pune does not any training in medical skills. They actually get trained in how to become good
orderlies, technicians, nurses and fixers to manage logistical failures. All
they do is- collect blood and other pathology samples, label them, transport
them to the laboratory and then keep follow up with the different departments
to track the reports and collect them. They wheel the patients for different
tests. They change dressings. This work
is usually done under continuous warnings and screams of nursing staff about
availability of limited supplies- you cannot use even a centimetre more of
dressing or be given another syringe if required. All this work has to start early in the
morning and continues until the Resident doctor in- charge permits the Intern
to leave. The only two things the Intern
can hope for is to have a sensible Resident in charge and that the Resident
will be responsive to his good work and conduct. The worst treatment is
reserved for Interns who are perceived as ‘outsiders’ due to their caste, rural
background, gender or being transferred in from other cities or institutions
for internship. Usually interns do not live on the hospital campus so they also
have to handle housing, commute, deal with dirty hospital toilets and zero
resting facilities. They also are paid a pittance for their work. So while a
Resident works several hours- the Intern is working the same hours without a
salary, facilities or hope of learning any meaningful skills.
Ideally the work of the intern is to examine, work-up and
plan treatment for simple cases which can be managed in a ‘primary care’ or
general practitioner’s clinic. They are supposed to discuss this and implement
the care and follow up the patient. They are supposed to observe the management
of complex cases so that they understand when specialist treatment is needed
and what it constitutes. They are supposed to attend rounds with Residents and
Consultants to imbibe the thinking and management process. Under supervision,
they are supposed to learn to perform simple and emergency procedures. At the
end of the day they are supposed to go back and do case based reading so that
the learning is consolidated. This is how interns are trained in other States,
not in Maharashtra however. As we use
interns as spare labour for miscellaneous odd jobs in the hospitals we are
compromising on their training- a typical doctor now has completed internship
but has neither confidence nor skill to manage a primary care facility
independently. (It is reported that interns are no longer keen to attend
hospital because the Post graduate entrance exams require them to spend time
mugging multiple choice questions- never mind if they have the skills of a
doctor or not- but that is not being discussed here now).
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