Why Resident doctors are agitated, and what ‘Neros’ ought to do even as COVID third wave knocks on the door

India’s fight against Covid-19 pandemic has been chequered by systematic patterns of pristine buffoonery, ad-hocism, breathtaking incompetence, deceit, and spectacular failures begging for accountability.

The post facto (after the second wave of the delta variant trumped all records of collective public torment) achievements on the vaccination front are yet to be tested in the coming round of the war against the omicron variant. If one can draw any comfort from it, the one continuity that seems to outsmart this mendacity is that our Nero continues to be as boastful as ever in the midst of all encompassing mendacity.

No war can ever be won when the warriors themselves are sought to be undermined by the generals. The corona warriors, who were once lauded with tali, thaali and rose petals, are now being thrashed by the police on the roads, abandoned as they find themselves in this fight against the pandemic. It is important for the people to understand why the resident doctors in major hospitals of Delhi are on strike.

The successive governments in India, in avid pursuance of the neoliberal economic policies, to serve their benefactors, reduced the public health system in India to all but a skeleton. However, when it came to fighting the pandemic, it is the publicly funded medical college hospitals, and other public tertiary care hospitals which proved to be the bedrock of anti-covid efforts.

It is in this process that we were made aware that sections of the skeletal remains of public health care in the country also had muscle and blood, howsoever emaciated and overworked, in the form of Resident doctors.

Indeed, it were these Resident doctors who bore the brunt of the pandemic onslaught, roughing it out in the emergencies, wards and intensive care units of the big public hospitals even as the generals went behind their fortifications dispensing care online.

The term ‘Resident doctor’ is an omnibus category that moves up from the lowest pedestal of an intern (a doctor at the entry portal whose graduate degree is incumbent upon completing internship postings in various disciplines), non-academic junior resident (i.e. those medical graduates who are not yet into a post-graduate degree course), academic junior residents I, II and III (doctors who are pursuing 1st, 2nd or 3rd year of a post graduate MD / MS degree), and lastly the highest pedestal of senior resident doctors (those who have completed their MD/MS and are pursuing a three year senior residency).

Vacancies at the lower pedestals are created as those at the senior levels either move out having completed the duration of their residency or they move to higher pedestal. In order to keep the patient care going in the medical colleges and the tertiary care hospitals, new recruits need to be drawn into the system every year.

To a large extent, this requirement is fulfilled by the NEET (National Eligibility Cum Entrance Test) Post Graduate entrance test for MD/MS and diploma courses in various clinical disciplines.

Without any foresight or comprehension of pandemic planning, this supply chain was disrupted with the government deciding to postpone the entrance test that was to be held initially on April 18, 2021. The entrance exam was finally held on September 11.

However, despite the result of the same having been declared on September 28, the counselling of the successful candidates and the consequent admissions have been held up due to an ongoing legal challenge in the Supreme Court of India owing to the opacity around the definition of EWS (Economically Weaker Section), a new category for which reservation in admissions has been introduced.

In the meantime, doctors in the final year of post-graduation have passed out, while those in final year now are hard pressed for their exams, which leaves the second year post-graduate students as the only ones left to do much of the clinical work.

This is also the batch which has spent most of their time providing care to the Covid patients irrespective of whether they joined to become anesthetists, or orthopedicians, surgeons or any other specialization. They have had next to little chance to pursue their core discipline, let alone complete their PG thesis.

Having worked 100 to 120 hours a week as the pandemic was felling patients like nine pins, physically and emotionally exhausted, now they have no support in the form of a fresh batch of trainee doctors whom to train for the challenges ahead.

With another wave of pandemic knocking at the doors, and the mandarins, their political masters and the lordships taking their own sweet time in resolving the matters of policy, usurious extraction of labor from bonded resident doctors who need to depend on the tender mercies of the absentee ‘Generals’ for obtaining their degrees seems to be the expedient for providing clinical care in pandemic times.

What has been stated above are but the most superficial of the consequences of a situation where monkeys with shaving blades have produced many a bloodied faces – that of the individuals and of the entire health services system.

Only time shall lay bare the more profound consequences of the systematic systemic disruption that owes to institutionalized stupidity that has come to rule the roost in the country.

Before concluding, it must be stressed that the transaction of attrition has not been one sided. With the deliberate whittling away of publicly funded health care, the concept of care has been morphed into coverage, and patients have come to be viewed as consumers of health care; indeed, even as Hindu and Muslim consumers who need be segregated even in health facilities, and terms like corona jihad became new additions to the science of epidemiology.

With the perceived “commanding heights” of medical profession, which at one time rested with the publicly funded medical colleges, shifting to the private corporate hospitals, the spirit to serve the people has been badly mauled by avarice. In the process, the medical profession at large, and its most vibrant section, that of the medical students and resident doctors, which ought to be motivated by superior ideals, acquiesced to the changes wrought in by the ruling elite. The miseries being faced by this section owe in no less considerable terms to this acquiescence.

Its’ time that we be reminded that the ordinary people of India still look up to us; that we are but an integral part of the people; and that we are nothing without the people.

As regards the Neros of the situation, dawning of good sense can never be too late to come.

Amen.