Monthly Archives: November 2013

The forgotten doctors

Paucity of attention is a serious crime. Lavishing undivided and undeserved attention is a mental handicap. I find it fascinating that there is intense scrutiny over superficial ripples on the languishing plights of a certain group of caregivers but then fails to even scratch the surface of a plight far worse than theirs.

I am a young physician working in the district hospital of Lahad Datu. I don’t blame you if you don’t know where it is. I didn’t too when I received my transfer letter. It’s located near the east coast of Sabah, but I am not here for a geography lesson. Neither am I here for cheap publicity. I am here solely to testify to the working challenges faced by doctors in remote districts of our country. 

District hospitals face the most arduous of challenges daily. Increasing patient load in district clinics and hospitals is just a paltry issue. Population increases exponentially based on the quality of health care. It is the lack of trained doctors manning these centers that should be addressed. The ministry of health took significant steps in addressing this. Medical officers, graduating specialists and senior consultants are transferred from major cities to ease the burden and uplift the services in these remote districts. But the lack of manpower still prevails. Where did we go wrong?

Most doctors have associated district hospitals to career suicide. Slim chance of a transfer back to the main hospitals in bigger towns have also been cited as a reason. Lack of basic amenities to quench their thirst for entertainment is a prevalent criteria. Families, spouses, multiple breeding children are among the reasons quoted in almost all the appeal letters cluttering the desks of the administrators in the ministry. Some have refused and have even resorted to selective memory loss when it comes to reporting for duty. Given the amount of latitude afforded they go unpunished and even obtain cancelation of their transfer on ridiculous grounds. I don’t deny there are genuine reasons for refusal to serve the districts but I am often left puzzled by the difficultly in being away from home for half a year compared to two or even four years of speciality training. The logic baffles me.

The ministry should make its stand clear. All medical officers, graduating specialists and consultants are given a finite time frame to serve the districts. They should be transferred immediately to any hospital of their choice once they have ’done their time’. No pun intended. If it’s their choice to continue serving the districts then so be it. Do not allow them to hold you ransom for promotions later for their conscious choices. If the velvet glove does not work then it’s time to reveal the iron fist.

It must be made compulsory for all new specialists to serve the districts during their period of gazettment. It should be made as one of the criterion for gazettment. A revision on a reduction in the period of gazettment for specialists serving the district hospitals should also be seriously considered. Moreover, these doctors should be given a significant precedence for subspecialty training over their peers who have refused to serve these hospitals, barring of course the consideration towards special reasons and requests. I believe it is a fair deal. With these efforts in place, graduating specialists will be queuing up to serve not only the interiors of Sabah and Sarawak but the deep bowels of our rainforests as well!

Medical officers in the district should be prioritized for speciality training. It is heartbreaking to digest if medical officers in districts have to compete on equal grounds with their colleagues in bigger centers for a place in speciality training. We should give them a reason to believe that their time serving the poor and needy is appreciated.

Why serve the district you may ask? You serve for the very reason of our existence. We exist to serve, to give a sense of orderliness to the chaos of diseases and to bring forth a sense of security to our patients. It is our duty to sweat blood and grind our sinew for this purpose alone. Don’t the people living in the interiors deserve better healthcare? Can you avert your eyes from these humble folks ravaged by poverty when all they ask is to be given fair and safe treatment? What is the use of our government pouring funds for state of the art facilities in these hospitals without anyone to man them? Good clinical practice and safe medicine starts and ends with the clinicians.

Finally, I will bring to your attention an often disregarded fact. In order to produce competent and safe doctors to empower our districts, we need to continue or improve our current training of young doctors. This should best be left to the practicing clinicians without the interference of the compassionate public and concerned politicians. Please don’t make it impossible for us to do our jobs.

I leave with a quote by George Bernard Shaw,  “ I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations.”