Trigger warning: mentions of death and other traumatic instances related to Covid-19
The teaching hospitals and medical colleges of this country are practically the only public-funded and government-run, tertiary medical centres in this country. Thus, they become the only sources of expert medical care for the vast majority of the population of India.
The strategy to fight Covid-19 in India was not only exploitative of young doctors, but also discriminatory towards the poor of this country And, its architects were senior bureaucrats and senior hospital administrators, with the latter being too eager to please the former.
In decent and just societies, battles demanding high technical skills are fought by the most experienced veterans of special forces, and not by new recruits who are still learning the ropes. The trainees are preserved, to fight in the wars of the future. But, the opposite of that happened in India.
These centres of medical education that were supposed to be the last bastions of defence, their: postgraduate (PG) students, resident doctors, interns, and even MBBS (Bachelor of Medicine and Bachelor of Surgery) students, were pushed to the frontline.
Much of the seasoned workforce, which is maintained and also paid for by the government, comprising of doctors who had already completed their specialist training long before, only saw proven Covid-19 positive patients, from a safe distance.
Alternatively, they sat in their homes with their stethoscopes gathering dust, fighting the Covid-19 war online, dispensing their orders via internet messages on WhatsApp, and taking virtual consultations on Zoom.
The modern Hippocratic oath only guides us to help and do no harm, it doesn’t ask us to sacrifice our lives like soldiers. What young doctors in medical colleges did during Covid-19 was beyond their mandate and duty. It was heroism.
What was precisely unethical about it was the extremely disproportionate distribution of workload and risk, across the hierarchy, as compared to non-Covid-19 times.
Also, now that we have only have one third of the PG residents that we had at the beginning of the pandemic, the situation is worsening. The delay in NEET (National Eligibility cum Entrance Test) PG admissions is also responsible for the same.
During Coronavirus times, medical educators forgot that their pupils have paid the fees for, and enrolled in postgraduate courses in: anaesthesiology, dermatology, surgery, psychiatry, orthopedics, ophthalmology, pathology etc.—and not for a Master’s or a diploma in a single disease called Covid-19.
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Hospital administrators forgot that the oath they took in their youth was to heal and comfort patients suffering from all diseases, not just those caused by the Coronavirus.
Together, with the bureaucrats, they bid their time in their pristine offices, behind polished desks—roleplaying as armchair generals in a very real war, the kind of which they have never fought as soldiers in the field themselves.
During the Covid-19 crises of 2020 and 2021, when the entirety of the burden of Covid-19 was thrust, and unfairly so, upon the shoulders of these young heroes; and the centres of medical learning they work in were relegated to the singular purpose of Covid-19 management, the whole infrastructure of specialised healthcare delivery to the common Indian citizen collapsed.
They called us resident doctors the “Covid-19 warriors”, but the truth is: we were never more than cannon fodder and the people of India were just the acceptable collateral damage.
The allowable blood loss; the unimportant, invisible, forgotten, unaccounted, rotting, smelling, casualties of this war against Covid-19, strewn across the banks of the rivers Ganga and Yamuna.
And, it is the people of India who are bleeding again… not just due to lack of platelets in their blood, but also due to a lack of PG doctors in their hospitals.
Between the two extremes of healthcare i.e., Anganwadis and medical colleges, nothing much was functional in a meaningful way.
The latter wasn’t even available for patients who might have been very sick from other illnesses, but weren’t Covid-19 positive, as almost all apex and tertiary centres where medical education takes place, were turned into dedicated Covid-19 centres.
Where else could policy makers have found such an easily exploitable, concentrated pool of bonded labourers called resident doctors, if not in the teaching hospitals and medical colleges of India. Our hospital adminstrators were only too happy to oblige.
With their degrees held hostage, resident doctors were an army of slaves. Technically, this was not so different from how construction companies in the Middle East withold the passports of migrant labourers as ransom, to extract their labor.
This was the easy way out, because building disaster management capacity ground up, by strengthening primary and secondary healthcare infrastructure would have been hard. The right thing to do always is. It was a strategy that was bound to fail.
In my opinion, it was never the plan of ruling class to actually resist the spread of Covid-19. It seems like they only intended to wait it out in safety. There were hardly any elected representatives or bureaucrats available to face the people who had voted for them, and paid their salaries (via taxes)… Except on Twitter and Facebook, where they were just angling for VIP beds.
People were seething with anger and demanding answers, and rightfully so. They weren’t subjects of a despot, but were citizens of the world’s largest, democratic state. A state that abandoned them in their most desperate hour.
Any sign of the republic of India ceased to exist, except for the resident doctor standing in a makeshift ICU (intensive care unit), drowning in the sea of death surrounding them. We became the lone target for all the misplaced anger and rage of the breathless masses, hungering for oxygen.
It became clearer than ever that if these medical institutes form the bones of the ailing, but still relatively functional body of public funded tertiary health care in India, then the resident doctors are its very flesh and blood.
In the aftermath of Covid-19, what we are left with is a tertiary health care and medical education system, which is now more cachexic and anemic than ever before, because of delayed admissions of incoming PG candidates.
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We are without new blood to reinforce the ranks of our valiant Covid-19 warriors, who now are physically and emotionally exhausted from the stresses of this plague, at both professional and personal fronts.
We too, have lost loved ones or have loved ones who have lost their livelihoods, as happened to people from other walks of life. And, we haven’t had the luxury of paid staycations and work from home, to recuperate.
It wasn’t just the hard work and isolation. Some of these residents made the ultimate sacrifice: death.
And, those who survived their martyred peers, have already sacrificed the most important time of their academic career to Covid-19, i.e., one and a half years of PG training, during which they were supposed to acquire skills and knowledge necessary to earn their livelihood as specialists, for the rest of their lives.
The lack of juniors to train, has not only left them overworked, but also disrupted the flow of medical education the way it happens in a medical college, at the patients’ bedsides, from senior to junior, every generation.
Not everything can be learnt from the books, or else medicine could have been a distance learning or correspondence course. This has compromised the only tertiary health care delivery system that is accessible to common man for many years to come.
Why are the residents and the poor patients they treat, being made to suffer for the complacency of bureaucrats, indecisiveness of the judiciary, as well as the personal ambitions of politicians? Why is the politics of this nation is devoid of any semblance of policy?
And, why are the poor excuses for policies we do have, devoid of any sensitivity towards the the weakest, poorest and most vulnerable sections of the same society we claim to be a part of?
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For all the mistaken and false equivalences between doctors and soldiers, this one is actually true: it is in such times of exhaustion, desperation and injustice, that soldiers rebel against their generals.
Conviction in the hour of crisis and courage in the face of doom are admirable. But, callous stubbornness against the righteous will of the people just for electoral gains, is abominable. This can only happen when checks and balances that operate in a polity before and after elections fail, when a society has got its priorities and values wrong.
We have got enough mandir–masjids, what we need is more resident doctors working in our medical colleges, because we know from the previous Covid-19 waves what is actually useful when a calamity hits.
We know from the farmers’ protest that democracy is about more than just the right to vote, it’s the duty to be defiant against injustice.
A medical college, without a new generation of doctors to educate, defeats the very purpose of its own existence. What is a teacher without his pupils, after all?
One and a half year later, when the pandemic seems to be finally receding, our medical educators have got no pupils to train, while the ailing masses suffer, hospital administrators and their bureaucratic overlords are still sitting in their ivory towers, glued to their seats of authority and power, while the capital city burns in the fires of dengue.
From the windows of their high castles, the policy makers, the decision makers, have thrown all notion of accountability into these flames. Maybe, from such heights, bodies on burning pyres look like the inviting, warm embers of bonfires on cold, December nights.
Indifferent or ignorant of the reality, they are contently soaking up its warmth without any sense of alarm.
Inside their gated colonies, the privileged might be insulated enough not to feel too much heat from the resident doctors’ rebellion, but power and money don’t guarantee safety from the burn of the Omicron variant.
This delayed-counseling crisis might not be on purpose, but it is an unintended consequence of disastrously poor, policy implementation.
One thing is certain: it was not anybody’s priority. Before the residents started their protests, how many heads of these prestigious institutes had dared to raise their voice, or wrote letters demanding expedited NEET-PG counseling to their political masters?
We ask our teachers and mentors to find the courage to do so and join the protesting resident doctors, not just in words but action. Resident doctors have taken up this movement on their own so far.
We ask our directors and deans to be part of the fraternity, and not just heads of their institutes, if they really care about medical education, patient care, or still have the faintest memory of what it meant to be a doctor.
The author is a resident doctor in a medical college. They think of themselves as a healer and a poet.