Resident evil

Ruchira*, a resident doctor in the first year of her MD programme at a private medical college in Aurangabad, is on the phone with me at 9 in the night, weeping hysterically. “I’ve been working for the past 80 hours and I don’t want to do this any more. I’m leaving the institute right now... no amount of work I do will keep my supervisors satisfied. My health has gone for a toss, I’ve developed fibroids and PCOD. It doesn’t seem likely that I will pass this year. This is a losing battle.”

Coming from a family of doctors, Ruchira grew up in a house above her parents’ hospital and had always dreamt of becoming a gynaecologist like her mother. The tribulations of the medical profession are nothing new to her, yet, after graduating with an MBBS from a Pune college and seven years into the profession of her choice, Ruchira was desperate to quit-and-run.

Her problem, like that of other medical students across the country, stems from an acute shortage of doctors — 0.7 for every 1,000 patients in India, according to the World Bank.

The Medical Association of India mandates no longer than 12-hour shifts for medical students pursuing an MBBS or MD degree. The reality is starkly different — the chronic imbalance in doctor-patient ratio sees medical students ending up as easy labour with exploitative hours. “You are expected to volunteer 48-70 hours continuously in one shift,” says Ruchira. Protests are rare or quickly suppressed as a matter of course in the industry. “No one acts like it is impossible. Everyone wants to concentrate on their life beyond this ordeal.” This is perhaps unsurprising, given the ground realities of medical education in India.

Each year, the 400 medical colleges countrywide enrol 47,000 students to the MBBS stream. There are even fewer enrolments for MD residencies, leading to a mad scramble for seats. The Delhi government had on March 16, 2015, issued a circular restricting duty hours in all city hospitals to 12 a day, which can be extended to 17 by the hospital director or medical superintendent. A ground-level inquiry shows a different picture altogether.

A recent documentary, Placebo by Abhay Kumar, throws more light on the situation. Kumar spent three years in the country’s most reputed government medical institute, AIIMS, and found it to be a den of suicide and depression for the doctors-in-waiting, who are pushed into a vicious cycle of pressure from the moment they decide to join the institute. Kumar began surreptitiously recording the goings-on at AIIMS with a handycam after his medico brother sustained a self-inflicted hand injury during the protests that rocked AIIMS over a suicide on campus. The protagonists in the documentary do not resort to any such extreme step; nevertheless it is clear that each of them is physically and mentally impacted by the work pressure, which they take as natural.

All the residents, who happen to be the cream of the country’s medico community, have disturbingly made peace with the less-than-ideal situation. They continue in their unnatural work-shifts, which result in long-term damage to their well being.

Equally, the film brings to light the apathy of the authorities towards the problems faced by the students, to the point of driving some to suicide. “They feel it is fair to make them go through this kind of rigorous training, as a doctor’s job is considered to be the most coveted in our country. It is bootcamp training,” says Ruchira.

Additionally, the country’s medical residency system confers a disproportionate amount of power on the immediate supervisors and teachers, leaving room for misuse. Pallavi Singh*, a resident doctor at a government college in Bengaluru, has a hard time coping with her recent injuries — a fractured leg — and the harrowing work schedules.

“It gets better in your third year, but in your first and second years, you are basically the bottom of the food chain, the unpaid interns of the medical industry. Protesting can only land you in more trouble, especially if word about your complaints goes out.”

Her medical condition has made hospital rounds especially excruciating for her, even as a recurrent bout of pancreatitis has worsened as a result of skipped meals.

“There have been times when I haven’t brushed my teeth for two days running, forget eating food. If we can get some time between 48-hour duties to catch a wink for a half-hour or so, we are thankful,” Singh says.

Ruchira’s parents did warn her about the hardships in store in an MD programme. Her brother, a surgeon, underwent equally gruelling hours, but Ruchira had been confident that nothing could deter her from her goal.

Now she admits she would think twice before asking her children to follow in her footsteps. She also believes that this sad state of medical education is peculiar to India. “Why do you think so many doctors prefer going to the US, despite the fact that they have to study all over again, as certifications aren’t similar in both the countries? It is a much better life there, with a better doctor-patient ratio, and humane work hours. Moreover, it is not enough if you do an MBBS in India. Till you get an MD degree, you are as good as a clerk, and your income will not do justice to the years of study you have put in.”

Kumar’s film highlights the mental impact that the ruthless schedule has on medical students. Placebo ’s protagonists are shocked by the realisation that not one among them knew what their fellow student who committed suicide was going through, despite all of them staying in the same hostel.

Kumar’s brother Sahil decides to quit medical practice, learns to write with his left hand as his right is incapacitated, and ultimately joins the Indian Foreign Service. It is his final act of rebellion against the unfair residency system.

At a public screening of his film at Delhi’s Centre for the Study of Developing Societies last month, Kumar had commented: “I began making the documentary as a very personal response to what my brother was going through at the moment... I hadn’t intended on making a documentary on the conditions of medical students at all, but what I witnessed left me determined to tell this story — a curious situation from which no one comes out the winner.”

Ruchira has returned to her residency in Aurangabad, and brushes aside any mention of her breakdown with, “Oh, I’ve seen worse in patients. I’ve got to live through this year, for what awaits me.”

*Names changed to protect privacy

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