Are They Really Responsible?

By Sharif Atiqur Rahman

Whenever we talk about our health issues, the professional group, which immediately comes into mind are the physicians. They are the key figures in providing health service in the hospitals. Hospitals are not clean; nurses are not giving attention towards the patients; doctors are not giving medicines free of cost; hospitals are providing below standard food - for all these irregularities and mismanagement in hospitals we hold them responsible without any hesitation. We accuse them as “irresponsible’, “uncommitted”, “money-hungry” and “below-standard” professionals. But are they really responsible for all that is going on in hospitals?

Students in medical colleges are very much concerned with the health service. They are the future doctors and their service is very important, as it is the just graduated internee doctors who provide the first and primary diagnosis and treatment to the patients. It is alleged that the medical students are not sincere in their studies and they are not preparing themselves properly for their professional lives. But are they provided with proper educational environment to become a skilled doctor?

Some medical students and doctors were interviewed to find out the reasons of these allegations and accusations. It is true that some doctors are insincere and not committed to their profession. It is also true that some medical students are depending on their political power to earn their bachelor degree instead of studying. But they are very few in numbers. Most of them are eager and trying to provide the best possible service towards the patients. But there are other reasons, which prevents them from doing so. There are lapses in medical education system and there are problems with hospital administration. In both the cases the medical students and the doctors find themselves in a helpless condition. But unfortunately they are the ones who are held responsible for all the mishaps.

Lapses in Medical Education:

The making of a skilled physician largely depends on the education a medical student receives at the medical college. Unless we ensure quality medical education, we cannot accept that the young doctors will provide proper service in the hospitals.

1. Weak Academic Background: At present students of medical colleges are selected through a competitive examination. The most meritorious boys and girls with brilliant results in SSC and HSC can qualify. But most of them are at a loss when they find that the education they received in the past 12 years is too inadequate to give them a strong base to receive this huge volume of knowledge of this unknown subject.

Almost all the books of medical science are written in English. The lectures are also in English in most of the cases. Even if it is in Bengali, it is full of medical terms in English. A large portion of our student lack in skill over English language. Besides in SSC or HSC the introduction they get with some biological terms are in Bengali. So it becomes difficult for them to follow the class or to go through the suggested readings. A British funded project has been adopted to improve the English language skill of medical students. Abdul Muqit, a 4th year final examinee of Mymensingh Medical College, rightly pointed out that lacking in 12 years educational life could not be covered up with 3/6 months course.

An interesting point to be noted that in the HSC level biology, students have to read in-depth about cockroach, earthworm and frog; but about the human body they need not study anything which could help them in 1st year courses like anatomy or physiology.

2. Weekly Holiday: The pressure of study in medical colleges is huge. But surprisingly while all other educational institutions have only Friday as weekly holiday, in case of medical colleges both Friday and Saturday are the weekly holidays. This puts unnecessary extra pressure upon the students and also upon the faculty members in weekdays. Students have to attend the classes from 8-00 am to 5-00 PM; then they again have to attend ward classes at 7-00 PM. Besides, they have to study in library and at home/hostels. Faculty members have to take the same amount of load. This creates negative impact on the ability of the faculty to teach and of the student to receive.

3. Hostel Accommodation & Environment: Most of the medical colleges do not have sufficient accommodation arrangement in the hostels. Natasha Khurshid of Sir Salimullah Medical College said that, eight persons in a small 15’ by 20’ room is congested even for living, not to speak of proper study. Here, some 1st year students have to stay in a room originally meant to be the dining hall. Even if seats are available, one has to depend on the will of the student political leaders. It is unlikely to have a seat at the hostel without expressing political allegiance to the ruling student group. The food that is served in dining halls is below standard. The students either have to cook food themselves (which is not legal), or they have to eat at restaurants (which is expensive). With all these problems one should not accept anyone to attain his/her best.

4. Faculty Members: Some medical students said that some of the faculty members are not up to the mark. This happens mainly for two reasons. Firstly, the medical education sector has become highly politicised and sometimes instead of merit or qualification, political influence plays the greater role in the appointment and transfer of faculty members. Secondly, a good educational background not necessarily ensures a good faculty. For teaching a complicated subject like medical science, it needs special skills to be developed through training. Unfortunately there is no such arrangement.

At the same time, there is no uniformity in the distribution of faculty members among different medical colleges. Some departments in Dhaka Medical College or Sir Salimullah Medical College are overburdened with professors, while in the case of medical colleges outside Dhaka posts are lying vacant. Obviously the standard of education varies and suffers..

5. Educational Environment: One of the most important things that hamper medical education is the size of the class in medical colleges. In ward classes students are supposed to get practical orientation with the patient and the disease. For the said purpose the size of the class can be 15 to 20 at best. But if it consists of 35 to 40, one can easily imagine what these students are acquiring.

Medical education also needs equipment like slide projector, over-head projector, x-ray view box etc. which needs electricity to run. In case of power failure (which is very common in Bangladesh), there is no backup arrangement for generators. The existing ones remain out of order most of the time. Besides, having a lecture for 150 students in a classroom or a ward class at night without electricity is simply impossible.

Ziaur Rahman, a final year student of SSMC, pointed about the need of education counsellor for the students. In case of any problem related to their studies, students do not have anyone to guide them or turn to. At the same time, libraries and reading rooms are not spacious enough and well equipped.

6. Dropout of Female Students: More than 50% of the students that get admitted in medical colleges are female. As boys are more extroverts than the girls, it has been observed that girls are more sincere than the boys in their studies. Automatically they are expected to do better in their profession. But due to our social atmosphere a good number of these female students get married in their education life. Eventually their studies are hampered, and some even have to stop their studies due to family pressure. The female doctors are also not willing to go outside the big cities. Some are so determined that they would leave the job, rather posted in rural areas. This dropout of female students and doctors surely creates negative impact on the health service.

Problems in Hospitals:

Some of us possess a wrong idea that doctors are responsible for the overall administration of the hospitals and they are mostly accused and held responsible for the irregularities. But the reality is different. Medical treatment in hospitals is a group work among the doctors, nurses, third & fourth class employees and the hospital administration. Lack of commitment from any of these groups hampers the smooth functioning of the hospital. The patient suffers and eventually the doctors are blamed even if he/she is totally committed. It cannot be denied that due to the negligence of doctors some accidents take place in the hospitals, but in most of the cases they are held responsible for what they have not done.

1. Third & Fourth Class Employees: All the doctors and students those who were interviewed expressed their utter dissatisfaction with the third and fourth class employees. The union of third and fourth class employees and their political connection have made them “astonishingly powerful”. Most of them have an attitude that they receive the salary for their attendance in hospitals and for the assigned works the patients must pay them. Sometimes they even take money in the name of the doctors. Whenever any action is about to be taken against them, they threaten the authority by calling strikes. Doctors have the authority only to make an official complain against them to the hospital administration; but on many occasions such complains resulted in the transfer or harassment of the doctor. A Professor of a renowned medical college hospital (unwilling to express his identity) said that the root of such power on part of the employees is the political party. An MP or a minister is more willing to maintain the support of the employees’ union rather than to ensure proper working environment.

The appointments of fourth class employees are not transferable. With this advantage they are working in the same hospital from generation to generation resulting in absolute hold in the hospital administration. A doctor has to depend greatly on these employees to provide proper medical treatment towards the patients. As these employees are not accountable to anyone, doctors have to depend on their will.

2. Hospital Administration: It is the responsibility of the hospital administration to ensure the necessary environment for proper medical treatment. Doctors complained that the hospital administration is not co-operative. Hospitals are not clean. There is lack of sufficient light in the wards. Food is below standard. Supply of medicine is inadequate. All these problems are supposed to be taken care of by the hospital administration. But in most of the cases, the hospital administration tries to avoid the responsibility with an excuse of shortage of funds. An internee doctor of Dhaka Medical College Hospital was expressing his frustration – “Nobody can imagine the problems we face in giving treatment to the patients!”

3. Extra Pressure of Patients: Most of the hospitals have to accommodate more patients than its capacity. The resources are not enough even for the capacity patients. When doctors have to serve more than the capacity with the same amount of resources, eventually they cannot give proper attention and service to all of them. Doctors are blamed that they keep the patients in verandas or floors; but when all the beds are full and still they have to admit patients on humanitarian ground, they have no other way but to place them in the veranda or on the floor. Similarly, they cannot provide free medicine to all the patients and they have to ask the patients to buy on their own.

4. Facilities in Hospitals: Another problem that doctors face in providing treatment is with the equipment. Most of the times these life saving equipment remain out of order. Even if these are in good condition, the supporting accessories will be out of stock. So the doctor has no other option but to send the patients to private clinics and diagnostic centres for necessary check up.

We have to consider all these facts and instead of criticising the physicians, we should try to give the necessary support to the warriors of this noble profession. We have to understand that only the doctors will not be able to improve the situation in the hospitals. Here are some suggestions that the policy makers can think of for the improvement of services in hospitals –

  1. Emphasis should be given on the development of English language skill in school and college education.
  2. Syllabus of biology in SSC & HSC level should be more improved and pragmatic. Course should be designed as a “pre-medical” subject. Students should be taught the biological terms in English.
  3. Only Friday should be the weekly holiday for medical colleges. This will remove the extra pressure of studies from the students and as well as from the faculty members.
  4. College authorities should establish control over the hostels and allocate seats to the deserving candidates impartially.
  5. Appointment and transfer of the faculty members should not be politically influenced. Government rules regarding appointment and transfer should strictly be followed. Faculty members should be distributed evenly among all the medical colleges. Faculty -student ratio should be balanced.
  6. Medical colleges should have necessary logistic support to ensure proper education.
  7. Service of third and fourth class employees should be announced “most essential”. The “mastani” culture of the unions has to be dealt with strong hands. Here political parties have a vital role to play. They have to stop patronising the unlawful demands of the unions. Making their jobs transferable can be thought of.
  8. Service of all the personnel in hospitals should be accountable. Hospital administration should ensure the proper environment in the hospitals. Any sort of corruption should be severely punished.

These measures will definitely improve the condition of the hospitals. But out of these measures, one can bring about a drastic improvement in service i.e. effective control over the third and fourth class employees. We believe in the freedom of labour union, but this does not allow anyone to play with the lives of the mass.

The author is a Research Internee, Centre for Alternatives.