I'd completed my 365 days of internship here in mangalore, and am now in my one month extensions in comm med and pediatrics, 2 weeks each, which since the beginning of March, I hardly attend. The last one year of working experience was half busy, half free; half happy, half depressing; half useful, half useless. Most the postings i work every single days, eight days a week, while some of them has free Sundays. Most of them are half day duty, while some are 12-freaking long hours. Some of them you work constantly non stop, while some you don't even need to go.
There had been various pros and cons working here in the local hospitals, both private KMC hospitals (KMC Attavar & UMC Jyothi) and government hospitals (Wenlock hospital & Lady Goshen Hospital).
Out of the one long year, most of my time are spent in
KMC Attavar (medicine 1.5 months, Orthopedic 1 month, pediatric 10 days, 1.5 months surgery, Ent, ophthalmology & psychiatry 2 weeks each, and obstetrics gynaec 2 weeks).
KMC Attavar is the main teaching hospital of KMC and it's where most staffs work full time at. My job there is working under the Post Grads, mainly filling the enormous types of investigation forms, collecting the lab report from the computer system, doing dressings, assisting surgeries, and preparing discharge summaries. I don't really
see the patients, or do any
examination unless asked to do so. Working hours is normally 9 to 5, but most the time I can leave at noon if there's other intern covering the afternoon shift. I always take my chance to go to the coffee stall or the canteen whenever I'm free, to accompany Caryn if she's also posted there or just to hang out with friends or solely fill my empty stomach. Though the amount of pt is not many and you don't get to see as various kinds of rare diseases plus you don't do as much as in govt hospital, I enjoyed working there as it's quite hygienic, has many nurses to help you out, being able to communicate with some pt in English, and you can always chill out as your time is not occupied by doing some unnecessary stuffs like in govt hospital. Pt here are normally middle class, and care for the pt are primarily done by PGs. Most the time the prof get to know the case only during their rounds. In fact, the number of pt in certain department or units here are so low they don't fulfill the quota of MCI, and you can observe all the funny way they trying to fill the empty beds with camp pt or just some random old man from the Charity organization of the hospital. One stupid thing is that the big hospital don't even have a proper lab, and they're only able to do some simple blood and urine and stool test. How dumb is it. All reports have to be sent to the central lab in UMC, and there comes all the delay in collecting reports. Imagine one pt is critically ill and we need to know some lab values but the report is not updated in computer, then you call the lab but it take half day to pick up, or they'll simply drop your call or they'll talk in a very rude tone. I hate collecting reports as i find them annoying due to the faulty hospital system.
UMC hospital is the de facto higher end hospital owned by the college. I'd done my surgery posting here as well, and in that 1.5 months I'd been rushing btw 2 hospitals. Only higher class pt are able to afford to come here, and the pt do get primary attentions from the main doctors. But, this hospital building is super old and extremely narrow, and they'd been trying extremely hard to improve the aesthetic value of it by constantly making holes and patching up here and there. So imagine the constant drilling noise besides the ward. The OR is especially tight and limited that the surgeons hardly have a walking space. But at least the hospital has a air conditioned OPD, adequate blood bank, big central laboratory, fast elevators, private air cond ward etc to name a few. Things are done quite fast and efficiently here, but u can see many pt come just for some minor minor illness and the prof will do those minor minor procedures, of which all these is impossible in govt set up. This hospital is like the main hub, where all lab reports are done here and entered into the system here. If one day the lab is burnt down, all the pt in any other hospital will just die. Besides, all kinds of propaganda and advertisement and sponsorship are being promoted to make this hospital famous and to be the main money making machine of the college.
Government Wenlock Hospital is the scariest hospital i'd ever seen when i came. Old, ugly, dirty, dark, smelly, eerie. Thank God i wasn't posted in this hospital at all. I wouldn't want my shirts to stink every day the moment i step into this hospital. I was only posted here for 2 weeks in Casualty posting, something like an ER. Here YOU yourself have the primary care for the pt. Here u see all kinds of crazy cases ie RTA, fights, snake bites, burns, drunk, septicemia, poisoning, acute pain etc. Your job is basically do a triage on the pt, check their vitals, a brief history, refer to the PGs of respective department, and then whatever the PGs ask you to do. You can learn a lot of basic skills here, but the 12 hour duty time is also straining. Especially during middle of night while you are sleeping half way, a drunkard pt came in with head injuries, then after all the basic procedures are done, you have to suture the wound but the half conscious pt is rejecting to be treated, shouting around, moving vigorously around when you try to suture, or removing the bandage after you'd done a hard work to help. All these to me, are super annoying. I mean, why should i care if the pt don't care. He is drunk, lying on the road with a broken head, then some bystander just bring him in to ruin my life. Let them be, let them die if they wish to, let them leave without any treatment if they don't ask for it. Anyway, India has too many useless ppl and their population is over crowded, so it's fine to let all the lower class poor ppl die.
Now comes to
Government Lady Goshen Hospital. I'm here for 1.5 months in O&G. It is an exclusively female hospital, so it's comparably cleaner than General Hospital. The ward duty is fine, you only work from 9am to 12pm, collect blood samples, write some lab forms and discharges and leave. But, there's is the Labor Theater posting of 2 weeks here for everyone, where you have to spend your 12 hour in the smelly, stuffy, unhygienic, narrow labor room. You have to constantly check the mothers' BP to rule our gestational hypertension, keep drawing blood for investigations, give the pt relative instructions to bring the blood sample to different labs outside, collecting reports on phone as they only have a computer and it's always unavailable, help the PGs buy tea and snacks, bringing and waiting for the pt for Ultrasound scan, getting signatures from different medical officers for different forms, shouting "Biki-biki!!(which means "push!!")"and holding the mother in labor , traveling to other hospitals to get blood for pt, and only occasionally, pull the baby out, and suture the episiotomy wound. Besides the last 2 things, others are to me extremely useless. If the hospital is more well equipped and the system has more sense, an electronic BP cuff will be available without me sending hours in taking BP one by one with the broken & inaccurate sphygmomanometer; blood samples will be sent to the lab INSIDE the hospital itself by nurses (no need for pt's relative to take a transport to travel to other lab outside, wait for the report, and come back to show them). Scanning will be done more readily all the time without need to call for radiologist to come and do the scan stat and i write down the report on some random paper on the spot. Collecting reports will be done in seconds using the computer rather than listening to the on-hold tone in the phone. Plus, i do not need to run here and there to get signatures which doesn't make sense if a centralized and standardized communication exist among all doctors. See, because the pt here are so poor that they cant pay a single cent for anything, i have to run up and down to get signatures so that whatever scanning, investigations, blood or surgeries can be done free, and the annoying part is sometimes you cant find the medical officer in charge at all for the signatures. All these are simply nuisance to me. I mean, if anyway the MO is going to sign, if anyway all the pt are not going to pay, what's the point of all these repetitive work which could be demolished right away. That's why i hate serving the poor. First of all, I cant
communicate with the pt in whatever Indian local languages, I don't get to
learn much of the essential knowledge on ways of managing the pt, and
practice basic skills like delivering and suturing, but wasting your time running around hospital doing those extra useless work which are non existent in a more proper hospital setup.
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| The way they dry their OT drapes |
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| count the number of people in the OT. Talking bout asepsis? |
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| How the pt dry their sarees |
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| the haunted corridor |
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| the 'amazing' duty doctor's room |
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| corridor as ward, sick |
After 1 full year of internship, i can confidently proclaim that i do not learn much. I am not at all well equipped enough to manage a pt single handedly, from diagnosing, examining, prescribing, following-up to discharging him/her. I am not perfect enough on whatever clinical skills needed as i was not given enough chances to DO rather than observe. I had totally forgot 90% of whatever theory i learned in my Undergrad time. So what do the internship here prepared us out as?? Zero!! I would dare say the medical system here in KMC is totally broken, fool-UNproofed, and faulty. Intership, for Indian ppl, are just a 1 year break after their hectic final year MBBS, and as a time to study and take up PG entrance exam at the end of it. Moreover, internship in India can be totally
skipped, if you have the right contacts and money.
So what have i done in this one year of internship??
- Gaming. I'd bought a new powerhouse gaming desktop PC and i'd gamed a good number of great games that i'd bought them originally. I play alone, i play with friends, i play online.
- Shopping. Both online and in-store. That's why my Rs8000 i get from college as stipend for internship plus JPA allowance is always finished.
- Hanging out. With Caryn or other friends. Drinking, dining, movie whatever you name..
- Simply resting, sleeping, chilling.
- Knowing new friends. PG or profs or co-interns i'd worked with/under. Yes, though i do not enjoy working in the hospitals here, i enjoyed working with many good doctors and fine people here.
In another month, i'll be going back Malaysia and start my houseman. I have to start from zero once again, both theoretically and practically. How well can i cope? how am i going to manage myself in the hectic 36 hours duty as the other fellow houseman in Malaysia? God Only Knows..
P/S: this is supposed to be broken down to many short entries throughout the year but i was too lazy to write any blog in the last one year. Pardon me for the length of the post.
Updated on 19th Mac:
All doctors have a right to be selective bout their patients.. doctor itself is a career, and in the end of the day, everyone needs money to survive.. that's what specialization is all about: you being more and more selective bout your pt according to your specialty but at the same time your patients scope is greatly narrowed down, mostly towards only the rich and affordable ones.. every doctors have different calling: some would volunteer themselves for free charity to help the poor or in war or disaster; while some would stay in the 5 star clinic treating specific patients..i am sure both are sincerely doing a favor for the community, just that different targets, and the former one is totally a big no for me..on the first day i stepped foot in India, i had much sympathy to the people here, but as years go by, as reality and adjustment and experiences got a hold on me, empathy towards the poor became deeply hidden.
I beg pardon for THAT harsh statement i made, which i do not meant all of it.. it was written solely out of frustration.. maybe the lack of elaborations made it a sick statement..i realized THAT line provoked many, which i do not meant to.. it was an ill written statement, and i feel sorry for it..
"I do not hate poor patients, but i despise a hospital that's full of poor ppl because of the many nuisance i experienced"
"i never refuse to treat poor pt, but i'm greatly annoyed when the pt is ignorant bout the whole sickness and treatment and advices.."
"i will not do harm to poor pt, but i do not disagree that if the poor and lowly ones are lesser, this country would definitely be a better place to live in, that's what civilization is all about"
P/S: i am no God, and i never meant to judge on people (yes i know i am critical and straight forward)..
P/P/S: i do not hate my one whole year of internship here in India, (but actually enjoyed it most the time). i'd never had any problem with the profs, not fought with any PGs or co-intern (which is extremely rare), but in fact i'd befriended many professors, PGs and batch mates (they are 'mostly' great doctors and friends).. i was never drained or exhausted by the end of the day but can still go out to enjoy almost every night, or play in the room (it was a very free working hours i would say, comparatively). All the frustration in the above post came out because at the end of the day as i draw closer to return to Malaysia, i observed that i myself are totally unequipped to face the horrible Malaysia medical systems (which i know that it is totally a hectic, tiring, demanding, stupid and unfair system). I fear for the worse.. i really envy my friends here in India as they would already be recognized specialists by the time i finish my dog-manship in Malaysia..
