Serving the rural people better, medically

The mother of the incumbent director of the National Institute Traumatology and Orthopaedic Rehabilitation (NITOR) reportedly fell sick at her village home in Dumuria upazila of Khulna district recently. The NITOR director got information about his mother's illness at around 2pm. Since there was none at home at that time, the director telephoned the upazila health and family welfare officer to send one of the doctors of the health complex to his home. But the latter, allegedly, resting at his Satkhira residence at that time expressed his inability to send anyone because of shortage of doctors in the upazila health complex in question. However, his mother was later taken to a hospital in Khulna by the male members of the family.

The incident, according to a report published in a vernacular daily, made the NITOR director realize how helpless rural people are at the time of medical assistance need. The incident deeply saddened him, the daily said quoting the NITOR director. However, what is happening in and around the NITOR every day to poor patients coming across the country leaves one to believe that the incident has little bearing on him.

What the Dumuria health officer did was not right. But his information that the health complex had shortage of doctors was absolutely correct. The problem is nothing specific about the Dumuria upazila health complex. Most public health facilities in rural areas have been encountering this problem for year after year. All the government moves and pleadings by successive heads of governments and health ministers to motivate the doctors to remain present at their rural workplaces and serve the poor people there have not worked.  

More than 75 per cent of the doctors of government health facilities at upazilas and rural unions have deserted their workplaces on different pretexts.

The government in 2014 appointed 6000 doctors in one-go to rural health centres through the 33rd Bangladesh Civil Service Examinations. A report published in a vernacular daily recently claimed that most of these doctors have either left their workplaces in the name of higher studies or on some other pretexts.

The government health facilities located at distant places from urban centres or district headquarters are the worst sufferers. In some cases, 80 per cent sanctioned posts of doctors are now vacant. Doctors sent to these facilities do usually manage transfers to some other places or leave for long duration to take part in higher medical education.

The fresh medical graduates demonstrate all good intentions and willingness to work in rural health facilities while trying for government jobs. But once they secure the jobs, it does not take too long a time for them to change their stance. They start lobbying to get themselves transferred either to Dhaka or other places of their choice soon after their appointment to rural health facilities. They conveniently forget the Hippocratic Oath that tells them to serve the sick people first with full dedication at any place.

Many upazila health complexes do have quite expensive medical equipment, but those are hardly used in the absence of the required number of doctors and technicians. The main reason for so many rural patients thronging the government hospitals in Dhaka is the shortage of doctors in rural health centres.

There is no denying that most upazilas lack amenities that ensure a minimum comfortable living for young doctors. But that, however, should not deter them from working in upazila or union health facilities, particularly when other entry level BCS officers are working at upazilas without much trouble.

Why are young doctors so reluctant to work in rural areas or places outside Dhaka and major cities?

Undeniably, the major urban centres do attract more and more people by their glitz and glamour. But there are other reasons. Young doctors are witness to relentless efforts of their seniors serving in major government hospitals and other health facilities to remain in Dhaka for indefinite period. The senior doctors continue to stay in Dhaka through lobbying for the sake of their money-spinning private practice. Such an attitude of the seniors has been encouraging the young doctors to follow suit and make lobbying to stay in Dhaka or places of their choice.

What has been more damaging is political interference in the appointment and transfers of government doctors. Doctors' organisations toeing political line are largely responsible for erratic behaviour on the part of these doctors, young and old. The leaders of pro-ruling party doctors' organizations are always found surrounded by mostly young doctors seeking transfers and postings. Had these organisations been devoted to true professionalism instead to becoming political lackeys, things would have been altogether different. The development, however, is nothing unique for the doctors. Other professions have also become victims of political divisiveness and none appears to be interested to stem the rot.

If the government is really willing to encourage doctors to serve the rural people better, it should shun the practice of favouring the latter on political considerations. Moreover, it should devise some other means so that young and mid-level doctors find postings in rural areas somewhat attractive.

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