In the recent years one sector that has transformed itself is the IT sector. The infrastructure, environment, facilities have undergone tremendous transformation on par or even better than the developed countries, so much so that it has become the bench mark for the industry. Health care deals with life of humans. However, they continue to linger in the same old fashion setting a different kind of standard for the hospital. Fortunately, the bleaching powder smell that I have witnessed in my childhood is no longer there. The credit purely goes to better cleaning materials that are available today. As per the mentality of individuals concerned there has been no change at all. In reality, the health care facility should be more hygienic, eco-friendly, so that it helps improving the health and environment helps in healing. The hospitals should be silent. Air pollution, noise pollution should be avoided. Partly the blame should go to the medical professionals and partly to the administrators. Cutting the corners should never be the practice in health care. At least, minimum standards should be defined and implemented.

 

The hospitals abroad are no less in infrastructure comparable to software technology ones. They are absolutely clean, people maintain pin drop silence. One cannot wander around aimlessly. Except some common areas all other areas are access controlled. Only authorised people can enter those areas. In fact all the wards are access controlled. Only the staffs have the key access to get in and out. Anyone else needs permission to get in. Only the required people will be called for the select purpose. People visit only during visiting hours. This is done for many good reasons. Number one, each patient has their own challenges. Some of them need intervention by multiple specialists. All the specialists come at different times. They all need fresh mind and thinking. At times, a lot of deliberation is required to resolve complex issues. They need to plan investigations and treatment. The treatment need to be executed by the doctors and nurses. They need to cater to so many inpatients. So they need to work uninterrupted manner to complete their tasks within the time frame. Secondly, patients too need some rest. Constant disturbance disrupts most of the work. Thirdly, restriction of visitors keeps environment clean. Therefore, the risk of infection gets reduced. This is followed in clean countries where the environment and personal hygiene is so good. Imagine in India people walk from all kinds of contaminations and directly reach our patients. Children are not allowed into the wards as visitors. They have the high risk of contracting infection. Lastly when the number of people is restrained, noise also will be automatically reduced. Especially, with the mobile era people have respect for other’s privacy. Many have the habit of talking loudly ignoring everyone around, some others switch on the speaker mode and continue even in the lifts. Unfortunately, we can afford to buy expensive smart phones with basic courtesies. All these rules are made to facilitate rapid recovery of the patient. This is no way meant to cause inconvenience to the near and dear ones. Off course the communication regarding the patient and progress is important, but it is restricted to authorised attendants or family members that are registered at the time of admission . There are special counselling rooms where the relative is counselled by the treating doctors. In case of emergency they will be informed as and when required.

But culturally we are different. The mentality is that someone is not well they should go and meet them, at least for the sake of attendance. More often it is a disturbance at times traumatic as they have to repeat same story, answer similar questions several times. Recently, I had visited a neuro hospital at Tumen in Russia. The entire hospital was cordoned high rise metal fencing. No one can enter the campus. There is only one entrance and one exit. The entrance is guarded by a full-fledged security office where every one’s identity is recorded with photograph and an ID card given. Without an ID card no one can enter the lobby also. Emergencies have a different access again with a tight security system of different sort . Doctors need such peace of mind to do their best.

Off late the number of medical colleges is mushrooming. In addition, the numbers of students have gone three times high. In my batch MBBS had 85 seats per year. Today it is 250 students per batch. Medical college cannot be equated with any other degree college. The teacher can’t even see every student, forget about knowing. They have to use loud speakers to address the gathering rather than teach and make them learn. This is one part of the story. There is space constraint at every level. Not enough room to sit, study, eat, rest or to attend natural calls. Somehow students are getting adjusted without any choice. When it comes to interns and PGs there won’t be adequate wash rooms and duty rooms. For interns particularly there won’t be any preference as they are the lower most in the ladder. Post graduates are considered literally as labour. No doubt they have to work, get exposed to various scenarios so that they become perfect. But there should be basic amenities and fundamental comforts for them to work efficiently. As such medical profession involves lot of hard work. Fatigue should not compromise the quality of work as well as learning. Each post graduate has to work at times for 36 to 48 hours continuously. They need to maintain and sustain their attention, stamina, and effectiveness. This requires facility to rest, decent wash rooms and place to eat and study when time permits. At the moment the existing facilities are not enough. The one way to decongest is to split them into six monthly batches rather than 250 at a time.

The most appalling thing the country is witnessing today is the lack of safety particularly to the lady doctors and ground staff. Intimidating crowds often unconnected to the patient particular just to create a scene is posing a new type of challenge. No doctor will have any intention to do any harm to patient. Every effort will be put in and no stone will be left unturned. Fighting till the last minute to save a life is every one’s goal. But sometimes results will not be favourable. The ultimate results will be based on many factors not on one single factor or individual. No one deliberately try and do harm to anyone. At the entry point itself everyone will take an oath that “do no harm” . But today’s mind set backed by imperfect knowledge through internet people are becoming suspicious of everything. During the real crisis like Covid only people stood by the public were medical professionals. Forgetting all that and not having gratitude is ok, as we know the memory is short. But at temple doing harm or intimidating is by all means illogical. How can medical professionals perform or work in an unsafe environment? The current happening in the country is totally derogatory and disrespectful for the profession itself. There is no other profession that puts so much of hard work and effort as well as takes such high risks.

If this continues we will have serious repercussions. As such, good number of medical seats is going vacant. Younger generations don’t feel it inspiring rather feel troublesome. One can choose many other options rather than putting so many years of effort and face the music every day and at the end of the day, there won’t be talkers and we continue to suffer by lacking adequate number of doctors. One thing for sure the population will continue to grow irrespective of all this. Those who are already in profession will be disillusioned and move away to better environments. As such majority are moving out of the country due to worsening of the situation year after the year. Most importantly when someone has to work under pressure or fear the quality suffers. In future it will become duty bound like any other profession. Many mid-level hospitals will take the brunt so affecting the health care shift to high end hospitals making health care most expensive than what it is today. The mid sector of population will get affected mostly.

In general, security beef-up across the health care facility or hospital, more so at emergency, critical care is important. Constant digital vigilance systems with rotating camera, patrolling systems should be mandatory. All out-patient services areas and unused areas must be locked and made inaccessible even to the staff. All the clinical areas must be lit well at night including all corridors. This include, support services like radiology, laboratory and other essential services. It’s high time that we adopt Access control to the rest of the hospital allowing authorised personnel only. CCTV vigilance should be provided at all entrances of the hospital including the premises to monitor the activity of suspicious people. Emergency alarm system should be implemented and those on night shifts should alert the entire system by just pressing one button. It works through PA system like any Code warning in the hospital. Police access should be available all the time from the emergency department. At night there should be one emergency entrance to the entire hospital, so that every entrant can be monitored closely and carefully. The same is applicable on Sundays and public holidays.

It is high time the NMC takes note of the events and make necessary guidelines that should be mandatory in infrastructure, facility and safety and uplift the safety of the medical professionals.

Dr. Venkataramana N K

Founder Chairman & Director – Neurosciences,

Brains Super Speciality Hospital, Bengaluru.