Tuesday, February 22, 2011

diary as an intern

I’m an intern physician… I’m at PHC Valsang… and it happens to be one of the topmost PHCs in Solapur district. And here are many drugs, I never see in my hospital… though it lacks some fundamental investigation techniques, it seemed to be near perfect to me as a primary health service center… provided that you refer the patients to the necessary higher center when the need is apparent… and this doesn’t sound bad. But…

I hate that ‘but’… but it is there. I don’t want it, but it is there. This polished structure, this cleanliness this cool behavior is now I feel is sheep’s skin worn by bad nasty careless educated wolves…. Enemies of health working as health care workers. I feel it, that these webcams are foolish, morons or idiots… machine things having no IQs….. or maybe I’m an idiot.

As usual today there were many patients, with their usual complaints, and with their own usual theories about their complaints, and with their usual wrong beliefs and wrong health habits. And as usual I try to explain them the things, the importance of minor activities and good health habits and their effect on health… that ‘saline’ (their term for iv fluids) are not energy doses and that (pain killer) injections are not the solutions for every health complaint. And I usually succeed in convincing the patients and making them to understand their health problem at least an outline of it f not in complete… but then I face the complaint of the MO and even of the attending staff and class four servants that I ‘spend’ or ‘waste’ too much time on patients… and the crowd is very big and I’ve to check the patients in fast………..

Today I encountered a cheerful forty year old obese woman, a butcher’s wife (her weight was apparent by her size, though I didn’t actually weigh her). And she was there to tell about the ‘weakness’ of the right side of her body… there was no obvious loss of functions… and when asked about the onset of her weakness, she described an episode of profuse sweating with transient confusion which was followed by the weakness and the weakness had reduced then… she had not consulted any doctor. This was a mini stroke a herald of a catastrophe. I asked her about her blood pressure, and she told me that she was taking one blood pressure tablet for high blood pressure once upon a time which she stopped as someone told her that her BP was normal… I wanted to measure it, and I took her to the MO’s chair. He wasn’t there and I got a chance to examine the only BP apparatus in this PHC… it is fixed to a stand near the MO”s chair. And to my horror, its release valve is malfunctioning! And I got the reason why the MO tells that the BP of every patient I send to him as normal… even that of those having symptoms of angina. I somehow stopped the airflow and her BP was 210/ 150 mm Hg……………… stage two, very high.

I reached the drug store to find some suitable drug for her… only to find out that the ramipril and hydrochorothiazide tablets over here are the dolls decorating the showroom… the pharmacist refused to give those drugs to her. And I asked sir about what to do with that patient, and guess what that lady got- atenolol that too just 50 mg…….. aten 50 for bp 210/ 150??? He said after looking at my shocked face that what’ll happen if our stock of ramipril ends… the patient can’t afford it, so we give this one affordable- atenelol 50 mg! Then why the hell are you keeping that drug in your drugstore… I can’t guess, and can’t understand the logic behind this… the logic behind having the drug and not giving it to the patients who require it. Atenolol blunts the CNS… makes people dull as an adverse effect… and we must give any drug after evaluating its need or benefits and the potential harms it can cause. And if a better drug is available, we must give it instead of some crude one… I really can’t understand the logic behind giving her atenolol when ramipril was available.

And I see them telling a patient to get his forearm massaged at home with a gel after a trauma and when by examination fracture was apparent with no x ray advised and no immobilization was done. And I see infants getting prescription of nimesulide syrups… and I feel what if this’ just a bad dream and I’ll get up and I’ll see that this isn’t true… but it’s not… it is the truth. And I face it, everywhere… everyday and continue to hope that at least at some point of time this’ll change and we’ll live in a healthy happy world.

Am I really mad to dream what I dream? Is it possible to make some improvement? Is it possible to make the health service perfect… to make everyone healthy and happy? Can the world in my dreams exist? I don’t know… but I can’t stop thinking of it and trying for it… as if I don’t think of my dreams, I think nothing! And someone has beautifully told me that dreams can come true, without that possibility nature would not have incited us to have them… and I believe in him.

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