AM I A VICTIM OF MY PROFESSION ?( VOL. III) TRANSFER TO A NEW PHC

AM I A VICTIM OF MY PROFESSION ?( VOL. III) TRANSFER TO A NEW PHC

Dr. Gangadhar Sahoo

While working in Talpali PHC, my first place of posting against all odds, I got a letter from the Government to attend a training/orientation program in the District Headquarters, Sambalpur for 30 working days . My joy crossed all boundaries. At least I could get relief for 30 days . Till then I had not surrendered my hostel room in VSS Medical College,  Burla. So I was making my way up and down from Burla to Sambalpur. In the middle of the training program I got a transfer order to Dava PHC where I had to join after my training was complete. Dava  is one of the remote most places in Sambalpur District, bordering MP( now Chhatisgarh). It is a village. Communication to that place was very poor . Only one  bus was running from Bargarh town to Dava during fair weather. During the rainy season the road was cut off because the fair weather road was submerged in the Tel river.It was in the Padmapur Subdivision which is around 30 km away from Dava . The block headquarters is Jharbandh which is just 12 km away from Dava. 
The cause of my transfer was that the medical officer post was lying vacant after the transfer of Dr.Gachhait who had stayed there for a long period. He was very famous there. He was very much skilled in sterilization operations, especially in female sterilization operations . Since his transfer the sterilization camps could not be conducted because of lack of operating hands. At that time sterilization operation at PHC level was given utmost importance. Therefore I was deputed to work at Dava PHC against the vacant medical officer post. After getting that letter I had a sigh of relief because of a few reasons. I would be the head of the institution and moreover there was no competition. The problem of food and shelter would be solved for the time being.
After the completion of my training, I was relieved from Talpali PHC to join Dava PHC. It was the month of November. I came by that only bus running from Bargarh to Dava via Padmapur. It reached Dava at around 5pm in the evening. The moment I got down I was overwhelmed to see the hospital staff and the villagers in large numbers waiting at the bus stop to welcome me . It was the first ceremonial welcome in my life. I was taken on a procession to my quarters by all .

It was a three roomed quarters furnished with two hospital beds, one table, four chairs and a mini freeze supplied by UNICEF, operated by a kerosene lamp . In the compound there was a bathroom and a manually operated latrine . I was extremely happy with the facilities and the service rendered by the hospital staff. A few staff were staying in the Govt. quarters with their families, adjacent to my quarters. I was fortunate to get a cook who was the best in his business. 
I was not accustomed to the administrative work of the PHC. Apart from the hospital work , the paperwork, particularly the monthly payment of the staff, report returns of the family welfare department and public health department was cumbersome. I had to attend monthly meetings once every month conducted by SDMO and CDMO . Those two meetings were more difficult than the PG examination. The PHC medical officers were given monthly targets which included family planning targets, mainly sterilization operations. They, who were not able to achieve their targets were treated like hard core criminals. I had never heard such foul language a CDMO/SDMO could use against the medical officers. I was a victim of such cruelty many times.
Here I am describing my experience of one  monthly meeting conducted by the CDMO, Dr.Nrusingha Mishra. He was known for his  short temper , foul language and rowdy behavior. Doctors were afraid of facing him in the meeting. On one fateful day , activities of my PHC  were discussed. In all fronts my PHC was defaulter. I was asked to explain the reasons for failure and the steps to be taken to improve the activities to fulfill the targets.  My reply didn't satisfy him . He charged me as a defaulter  citing the example of my predecessor Dr. Gachhayat in whose tenure my PHC was the best performer. He threatened me of dire consequences if I failed to achieve the targets . As a bonded labor I was not in a position to argue. Others advised me to keep quiet and tolerate it because it might be counter productive. When I asked the medical officers of other PHCs how they were managing. Very politely one replied to take it easy. He said, " We are seasoned to listen to this type of theatrics every month. The targets were so whimsically fixed that even God tries He can't fulfill those. So as faithful employees, we just listen to what the CDMO says and after that we immediately forget . If we react we can't  lead our normal day-to-day life . Next month we will manipulate the figures and present it in the meeting. You have to follow it . When we were new , we were reacting like you . But everything was in vain . Get relaxed . Never take it seriously. Follow us . Enjoy your job 29 days a month. Keep one day for this nasty business ."
After coming from the monthly meeting I called a meeting of all concerned of my PHC . I entrusted the health assistants, ANMs and LHVs to fix their own targets and start working to achieve that . The main focus was on increasing the number of sterilization cases. As per plan a few camps were arranged. Ten to 20 cases were fixed per camp . Camps were arranged mostly in the village schools. There was no selection criteria nor any evaluation protocol. The operation theater was the class room , the operation table was the teacher's table ,the recovery space was the floor and the torch light was the light source . Against all odds , OT was being started on two tables. One health assistant and myself were the two operating surgeons and one ANM was the only OT assistant, assisting two tables at a time.Instruments were sterilized by boiling in water with help of a kerosene stove . Anaesthesia was local and vocal. After completion of one case another was  occupying that table as if it was a music chair competition. Then patients were handed over with money for loss of wages , few government supplied tablets and were sent to their villages. The modes of transport were bullock cart , bicycle or by foot. Post operative care was a miracle. The operated cases were recovering without any complaints and starting their domestic work immediately. I strongly believe that it was the miracle of Divine power. After doing a postgraduate course in a medical college I knew how a patient was evaluated and operated in full fledged OT set up . Still then we were facing problems. But under pressure we were taking undue risks by playing with innocent lives. If by chance any problem would have occurred no CDMO would have come to your rescue. Rather they would put all the blame on you for not following the guidelines. It was a double edged sword. If you do you will be blamed for any eventuality and if you don't you will be decorated with bad remarks.
One day a sterilization camp was arranged in the Jharbandh block headquarters hospital by Dr. Mohapatra, the medical officer in charge. We were known to each other from our college days. He was one year junior to me . He had joined the hospital after completing a postgraduate course in Biochemistry. It was his first posting. I was the lone operating hand on that day . More than twenty cases were registered . As usual no evaluation even a blood pressure check up or Hb% estimation was done. The last case was an overweight lady of 30 years with two children. That lady was a bit apprehensive . I was anticipating some problems during the operation . I counseled her to cooperate for 5 to 10 minutes and recite  prayers during the operation. God is there to take care. With usual procedure I started my preparation. She started straining resulting in pushing out the intestines. They were reposed into the abdomen. That exercise of pushing out and pushing in continued. Anyhow with much difficulty I completed the operation. Instead of 10 minutes it took 30 minutes. All the medical staff as well as her relatives were worried. It's natural. During this turbulent exercise with the intestines, I had an apprehension that the intestine might have been injured. That was the first problematic case I was facing. Fortunately it was a hospital setup. I advised to hospitalise the case and observe her overnight as a case of suspected intestinal injury. Her relatives were explained about the situation and why she was being admitted. They were very simple people. They obliged and cooperated in every aspect. As per the protocol she was kept with nil orally and intravenous saline . It was around 3pm when we took our lunch. But the ghost of intestinal injury was haunting me . Officially I had to inform the SDMO and if required the patient might be transferred. How to inform? There were two ways. One was to send a special messenger to meet the  SDMO . But the preferred way was to talk to the SDMO over the phone. Telephone facility was only available in the post-office. For that we had to physically go there  before the office was closed. Fortunately the esteemed postmaster was there. He had to contact the SDMO through a trunk call. He tried till 10 pm but failed.We lost the hope of informing the higher authority.  Our only hope was to observe the patient till morning and pray to God . I  applied whatever clinical knowledge I had . Fortunately the patient had not shown any sign of intestinal injury. In the morning she was ambulatory . She had passed urine and was passing flatus. On examination she was afibrile, abdomen was soft and bowel sounds were heard. So the fear of intestinal injury vanished. In such a situation the surgeon could do nothing if any complications had  occurred . Neither you could get a specialist service nor you could transfer the patient. Only prayer, nothing but prayer can save you. The best thing was that we had not panicked. 
The patient was discharged with usual advice. Her husband touched my feet and said, "You are our God. You saved my wife lest my three children must have been orphans."
Things to ponder from this horrible experience. 
1.Doctors were treated like slaves . They were forced to do inhuman acts to fulfill the unrealistic targets imposed on them .
2.The mothers who were volunteering for sterilization operations to prevent population explosion were treated like guinea pigs .
3.Female sterilization operation is a major surgery. The Government guidelines are there regarding this operation like any other operation. But practically nothing is f
But the whole cadre of health systems were after achieving targets. The doctors both trained and untrained at the peripheral hospitals were over stressed . They were punished for not achieving targets. 
If any complications or mishap was occurring the poor doctor was bearing all the brunts. No higher officer/authority was coming forward to protect them. No CDMO or SDMO was ever penalized for pressurizing the doctors to do all unethical and brutal practices. 

Against all odds I as a specialist felt that I was a victim of my profession . Whenever I was operating, I was doing so in the name of God. Knowing fully well that I was disrespecting the Hipocrates Oath which I had taken when I entered into the medical profession, I was doing everything as part of my prescribed duty(KARMA).
I always feel the presence of the Almighty in the operation room .

Prof Gangadhar Sahoo is a well-known Gynaecologist. He is a columnist and an astute Academician. He was the Professor and HOD of O&G Department of VSS MEDICAL COLLEGE, Burla.He is at present occupying the prestigious post of DEAN, IMS & SUM HOSPITAL, BHUBANESWAR and the National Vice President of ISOPARB (INDIAN SOCIETY OF PERINATOLOGY AND REPRODUCTIVE BIOLOGY). He has been awarded the BEST TEACHER AWARD of VSS MEDICAL COLLEGE,BURLA in 2013. He has contributed CHAPTERS in 13 books and more than 100 Scientific Articles in State, National and International Journals of high repute. He is a National Faculty in National Level and delivered more than 200 Lectures in Scientific Conventions.He was adjudged the BEST NATIONAL SPEAKER in ISOPARB NATIONAL CONVENTION in 2016.