Tools of the trade

This article is written by Dr. Swikrity Upadhyay (MD Pathology Resident at NAMS) and is published in 'The Kathmandu Post' on 19th May 2070.

"Whenever a doctor cannot do good, he must be kept from doing harm."  

—Hippocrates

A doctor without accessories is merely another layman. Even for a simple task like measuring temperature to confirm fever and prescribe paracetamol, the doctor requires a thermometer. Or for that matter, a ‘routine’ blood pressure recording requires a sphygmomanometer and a stethoscope. This is not to imply that doctors cannot be of any help without their tools. It simply means that they will be less productive and at times, even helpless.

Our government, for the past few years, has been actively trying to improve the general health condition of its people and also help the needy. Along the same lines, the government has enforced a compulsory two-year posting for MBBS doctors who have completed their degree under scholarships from the Ministry of Education to various remote areas of the country. Many attempted to escape this regulation, prompting the government to restrict the release of all legal documents to these doctors. Most new doctors are now compelled to complete the two-year posting before pursing permanent registration from the Nepal Medical Council. It is obviously a step in the right direction and for fresh doctors, it is an opportunity to help those in need while gaining practical knowledge in the process. For instance, a certified MBBS doctor alone can legally conduct a delivery, and with some additional training, can perform a Caesarian Section, simple operations like the removal of the appendix, hernia and hydrocele repair and can deal with various other medical and surgical conditions. It is an opportunity as well as a challenge for the fresh doctors. 

Despite commendable measures, it is still bewildering to see our government remain apathetic to the fact even skilled manpower requires proper equipment and facilities. Every health center with a medical doctor (Primary Health Care Centre and above) should be a properly equipped for safe deliveries. However, without appliances to handle difficult deliveries—whether instrumental or a Caesarian section—the doctor will be reduced to someone who writes out a referral slip to secondary and tertiary centres. A recent case in Mugu Hospital, where a 40-year-old female suffered through labour pains for five straight days at the district-level hospital under the care of a doctor, is not a random example but a routine scenario in hospitals outside the Kathmandu Valley. In such cases, doctors can try to tackle emergencies to the best of their knowledge but lacking proper aid equipment, they are severely constrained. Even the presence of a health assistant or a trained birth attendant during the aforementioned case would have brought about the same result—referral to a secondary or a tertiary centre—in the lack of proper equipment. 

Provisions for basic lab facilities, x-ray machines, skilled birth attendants, provisions for Caesarian sections and instrumental delivery, along with basic medications, at every primary health care centre in the country are enshrined in law. However, the government and the popular media are seem to concentrate simply on the absence of doctors and not the need to equip these health centers with proper equipment and facilities, as laid down in law. If patients at a remote village were taking paracetamol for fever and oral rehydration solutions for diarrhea years before the arrival of a medical doctor, the mere posting of the skilled professional, without equipping the health care centre or the doctor with proper equipment and facilities, will not yield any added benefit to the patients. The doctor should at least have basic lab facilities at their disposal to help diagnose the causes of fever and diarrhea, among the most common afflictions, so that they can better treat the patient. In the absence of such provisions, doctors are liable to over or under-diagnose a case once in a while, making them all the more vulnerable to accusations of malpractice and anger from the patient party, not to mention the discontentment that doctors can feel when they misdiagnose a patient.

The government has so far succeeded in deploying fresh medical doctors to various remote health centres across the country, proving that if it is focussed and gets its act together, it can achieve what it set out to do. Now, the same zeal and effort needs to be applied to equip all these health centres with the minimum necessary equipment and facilities. Once done, these deployed MBBS doctors will be in a better position to make the best use of their knowledge and expertise, helping the government to realise its ultimate goal of improving the general health condition of its people and providing exemplary medical care to all parts of the country.