Okay, now

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Relaxed, maybe good for blood pressure. But how about life?

How about in your prime, when you are young and strong? You are relaxed with your situation- very much comfortable with it. 8 hours of loadshedding a day, noise, pollution, crappy leadership in the country, mis-judged policies. Hooliganism and anarchy. Injustice. If you are relaxed and do nothing about it. Then your situation is not going to change, you have to speak when you need to, fight when you need to stand up against something. (my)Old saying- it is more difficult to be on the wrong side- they might look intimidating- but they can’t fight. Because righteousness is always a bigger sword.

So don’t shy from confrontations- for there will always be. Problems don’t solve by itself, they need to be nailed down. And you can’t depend on anyone else to solve your problems. You got to do it on your own.

No that takes time too. And effort. I am at a situation where I need all my efforts to be best placed to my studies, so I can specialize early enough, make good money by 40s and then do what I want to do for the rest of my life. Most of the people would end their life at what I want to achieve at forty. But I want more- much more. My dreams don’t end with good house, cars and family. I want to get into politics, I want to write, I want to make the difference that I believe in. For that I need a base- to know that I have done for my family- made enough money to live by comfortably. Because getting into politics is a slow process. It will undermine my existence at first, they will all downplay my capabilities. I might even implode. So it’s a survival strategy- that I earn first. Become filthy rich. I am not going to ignore my family’s needs and put the country first. Yes, I do have big plans for the country. But I don’t believe in sacrifices. I don’t agree with bigger the sacrifice, bigger the difference. I will (okay, say selfishly) do with my personal priorities first. I am not a selfless hero.

Thus, I have to stop procrastinating now. I have been in an intellectual coma for a very long time. I have to come out of it. Be alive. For the time, is passing by. And if I don’t build a foundation for my future now my dreams would never realize. If not for dreams, what is there to keep living?

About love, I have loved. Truly, most wonderfully and most sickeningly. It would not be something entirely missing in my life. Though I miss being in love, I can’t afford time to cajole one. So, I will put that in my ‘in a while list’.

I have a long way to go. And fast. So I need to work hard.

Robert Forst said,

Woods are lovely, dark and deep

But I got promises to keep

Miles to go before I sleep.

Miles to go before I sleep.

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On Revolutionary Medicine

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The life of a single human being is worth a million times more than all the property of the richest man on earth.’ Che Guevara, 1960.

Upon being hit by jet liners in the terrorist attack of 9/11 the Twin Towers of New York City collapsed and turned into rumbles within minutes. Thousands of people were buried inside. Brave American men, fire fighters, first responders along with many civilians volunteered to help, amid lots of smoke, dust and pain.  As a consequence of unprotected exposure to pollutants and trauma, many of those who volunteered developed a variety of respiratory illnesses ranging from pulmonary fibrosis to cancer. Many had psychological terrors like PTSD. When they sought for healthcare in American hospitals, they were denied such, as their insurance did not cover the deliberate exposure of oneself to hazardous conditions. Paying on your own is way too expensive.

As depicted on a documentary called Sicko by Michael Moore, some of these patients sail on speedboats to reach Havana, Cuba, where they receive free checkups, treatment and plenty of medicines to take back home.

Even if we doubt the facts laid by Moore, there is one thing we can all agree upon- though highly sophisticated, the capitalist-styled profitable healthcare system of USA is non universal and thus, a non-existence to many of its own citizens.

Cold war is over. Capitalists have emerged victorious in all but one front- provision of free and high quality essential services to all, like police service for security, emergency responders for fires or any other calamities, health and education. Yes, I deliberately put doctors, teachers, firemen and policemen in the same context, because as much as it is the responsibility of the government for the peace and security of its citizens, it is, for universal health and public education. There can be another discourse on education. This time we talk about health.

Driving around Kathmandu, I see many hoarding boards of private clinics and hospitals. They advertise of services and make promises- like a fairness cream would promise a glow. Such an utter commercialization of health care- it breaks my heart. If you delve in deeper, you can realize the ugliness behind posh medical facade. There are many private hospitals in the city with ‘marketing officers’, whose sole duty is to call ambulance drivers to negotiate commissions for bringing a critically ill patient to them, which is often as high as 4000 rupees. Imagine the size of the bill on discharge.

Poor patients are often denied proper medical care. Every other day some newspaper runs an impromptu piece on how a patient died due to a doctor’s negligence and hospital got vandalized. How government hospitals are understaffed and unclean. And about corruption in purchase of life saving drugs like misoprostol.

But all these examples represent merely the tip of an iceberg. Everything that is wrong with existing health care system is due to chronic lack of vision and planning in making of health care workers, doctors and dispatching them for duty.

 

Making of a doctor

Despite being a profession underpaid and overworked, exploited and allegedly, mundane- our society fancies in their sons and daughters becoming doctors. With dull economy, a medical job might look more secure than other things, so there are many who want to become doctors- which is not bad at all- so many people signing up for a service oriented profession like this. But there’s a catch- we don’t have proper medical education system in our country. We have just one government medical college providing about 40 undergraduate scholarship seats, and rest of the private or semi private institutions serve the desires of aspiring doctors, but in a very high price. It costs at least 4 million to become a MBBS doctor. The prospect is as grim for post graduation studies. Scholarship seats are so few, an aspiring doctor has to either provide his service elsewhere like USA or Australia or pay as high as 10 million or even more to specialize.

Medical education should be free, and to the deserving students. Because the profession is such- where you work really hard through med school and the whole life; where study and work are lifelong priorities; subduing personal comforts or family life; where you skip meals or sleeps for strangers called patients.

The irony is, society expects doctors to invest like a businessmen and serve like a clergyman. It simply cannot happen.

Prof. Dr. Govinda K.C led a fast unto death against such a system, a part of it. Motive behind was to make post graduation scholarships available and of high standards. But despite medical doctors all over the country striking for several days, it could not bring anything tangible. It is because neither our brotherly organization NMA nor governing body NMC has realized impending failure of the system. Or even if they do, they are too happy to complain with the commissions provided by private colleges. But I am not. I worry for the moment when someone in my family gets ill and needs a sophisticated medical care. USA or Singapore or Delhi is beyond everyone’s reach. We have to improve our system and survive here.

 

Where does all the health budget go?

Yes, we do get an ample amount of budget for health care. This covers the salaries of government medical staffs, which they receive for attendance at their institution, and their bhattas which they receive for doing everything else. That is okay, in light of meager salary they obtain for such a hard work (which indeed is, if they work as per norms and needs). But a big chunk of it is wasted through a syndicate of NGO/INGOs with collaboration of health bureaucrats especially during June/July, at the closure of fiscal year- in programs and projects hurriedly planned and carelessly executed. Global Fund provides huge financial support to the government to be spent through partner organizations, and they work- mostly on paper and reports. With most of the aid bearing managerial cost of the projects, they fail to bring any tangible change. To improve overall health of the people, to reach the goal of ‘Health for all’ as we signed in Alma Ata in 1978, all this money should instead be used in establishing a proper health education system in the country, so we can have skilled and willing-to-serve human resource. After all, we cannot depend on foreign aids for the health of our people.

 

How to solve?

A scientific and sufficient health service delivery system, reaching people.

A medical education system to teach, train and produce doctors, nurses and other paramedical staffs.

We have 3600 VDCs in the country. Each VDC has a Health Post, the basic unit of our health organogram. It should have a Health Assistant incharge, with 2 AHWs. Co-existing birthing center should have a staff nurse with 2 ANMs. At next level is a Primary Health Center covering an electoral constituency, which we have 240. Since it provides OPD services to a larger number of and referred cases from Health Posts, in-patient along with 24 hours emergency services, it should have 3 medical officers (doctors) with 2 HA and 5 AHW. Birthing center at this level should have a nurse with Bachelor’s degree, with 2 staff nurses and 5 ANM. PHC will also be overseeing all the community level preventive health programs like immunization, infant care, hygiene etc, rendering NGO led activities redundant. It will be a cost cutting measure in long run.

Each district hospital should be able to treat 80 percent of the cases. After all, it is a health center for the whole district. It should have a double team of consultants (there should be at least two of medicine specialists, gynecologists, surgeons etc) so that one of them can be available all the time; nobody can work 24 hours a day and 365 days a year, thus. It should have a team of 6 medical officers and other paramedical staffs in proportional ratio.

Zonal hospitals should become tertiary centers; teaching hospitals. With ICU, CCU and higher specialists, it should be able to solve 90 percent of the cases. It will have highest flow of the patients, highest concentration of doctors, labs and everything. Since lack of free medical education is a core issue, each of these 14 zonal hospitals will have excellent medical schools, providing 50 scholarship seats for undergraduate studies every year (a total of 700!), to deserving candidates- irrespective of caste, sex, or hometown- but based purely on merit- for we want the best to become doctors and deal with our life and sickness, not the lesser competent.

Such academic centers will not only produce free education to aspiring doctors and nurses but also vacancies for professors- who will now be available at zonal levels. They will mentor post graduate students. With two PG seats in each faculty (including both clinical subjects like medicine, surgery and basic sciences like anatomy, pathology etc)- we will be producing about 30 specialist doctors from every zonal center.  Multiply that with 14 teaching hospitals- we will be providing higher medical education to more than 400 doctors every year, which is a great leap from existing 40. With residents to work round the clock in such hospitals providing meticulous care to patients, service quality will greatly improve and upon graduation they will serve at district hospitals, replacing the consultants who will now become a faculty at zonal teaching hospital. Not only will there be a constant production of medical graduates and specialists, there will be a system of service at all levels, as a clinician and as a teacher- and a timely retirement.

 

With highly sophisticated zonal centers, we would not need the namesake sub regional hospitals. Regional centers will take care of all unsolved cases. Here, professorships will be awarded to consultants, and higher specialization courses will be offered. It will also be the center for skill based trainings and research- where we will invent and devise ideas to revolutionize medical science, provide something to humanity. There will be government pharmaceuticals producing high quality drugs and these medicines will be provided for free- just like medical care would be.

Further, some highly populated districts can have two or three district-level hospitals of equal stratum and formation, each one of them responsible to zonal centers. Big cities can have a couple more; in addition to specialized centers for trauma, heart, kidney etc. But this new plan will discourage people to cluster around cities, since (availability of) health facility is one of the reasons why people migrate.

One might ask, what will be the role of private hospitals and medical colleges, then? They should be graciously thanked for the service they provided when there was none, and asked to seek business elsewhere, for healthcare is not a business and it should be free, for all.

The system as it is, is already a mess and on the verge of a breakdown. If we really want the state of affairs to improve, we- the people, the doctors, the clients, the stake holders should do more than just lament or charity. We need to work on similar plans and preserve to the realisation.

This whole idea might appear audacious to many. I would like to quote Che again, ‘At the risk of seeming ridiculous, let me say that the true revolutionary is guided by a great feelings of love.’

 

Dr. Chirayu Regmi

(who is doing his part at a primary health center in Shrigaun, Dang)

 

 

 

 

 

 

 

 

 

Why should you be nice to doctors?

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A hi fi patient of political background in a government hospital- met with an apparently minor accident- was lying in a bed allocated for ER staffs doing night duties. Well, the privileged one, I said. He’d already been screened for major injuries (none found) by my subordinate when I arrived, and was surrounded by a couple of ‘well wishers’, and he was talking excitedly to someone on mobile. When I reached to examine him, he gestured like a movie star to wait and let him talk, which would take a while.

 I thought ‘what an ass!’ I went away. I came back later to see the patient- after all, its my job, still thinking ‘what an ass’. Now the number of visitors had remarkably increased, who wouldn’t go away despite being asked to make room for examination. I hurriedly did the needful, my mind wondering and wandering over many things, for stimuli- there was plenty. Later, upon cool reflection I realised I could not see and manage the patient as well as I could have, and it was NOT my fault.    

A medical doctor such as me writing this article makes it look kind of vain, but all I am trying to do is state the matters of fact.

Society has regarded doctors highly since forever. Part of it comes from the noble cause they work for- saving lives, healing disease and making people feel better, a part for the meticulous hardships of the profession and a part, for the long hours they ungrudgingly work for.

But mostly, it is a mere psychology- a belief and hope of patient that this doctor will look after me better if I am nice to him. Since medical care is not a commodity with a ‘quality control’, one has to believe in what comes out of the head of the medic. Even with thousands tests and charts to make a diagnosis, clinical assessment by a doctor is still the core of management. And this, a doctor does by going through huge database he’s created in his head while in medical school and years of practice. He has to do that within the little time frame allotted for consultation. And make a presumptive diagnosis, suggest some tests and with some lab guidance thereby obtained, prescribe a suitable medicine- again analysing the side effects, adverse reactions and compatibility of the drug with this particular person. All that done, while tending to patient, nodding head to attendants and smiling. So you wouldn’t want to bring negative thoughts into head of a doctor and bother him with that while he’s trying to solve your problem- while he has intricate details to think of.

Treating a patient is like taking exams- patient asks questions with signs and symptoms, and we treat with answers. And like we’d prefer to take exams in a comfortable environment as far as possible, with as little noise and as few things to bother, we like to be thinking only about treating the patient while treating the patient. We are humans too, we get angry at harsh words, arrogance bothers us too.  We might not hesitate to mop up a bleeding artery, or dissect a putrefied corpse for autopsy, but an uncomprehending unrelenting mob outside the Emergency room makes us nervous too.  Obviously, it is the patient who has to suffer for the whole drama.

Doctor patient relationship is much like being in love. And you can’t force anyone into loving you, you rather sweet talk them to agreement.

Personally I am, all love towards my patients. I work hard, I study so I can help my patients better. I fight with hospital management to improve things in the hospital. And I do understand patients can’t be sugar candy at the time of accidents, troubles, and disease. But it’s a psychological thing, and a smart thing to do- being nice. 

How to Study Effectively and Get Good Results?(Tips to Medical Students)

Having done fairly well in my medical graduation course, here are few tips for fellow students on how to manage themselves during the course, keep themselves motivated, and study. Some of things I did and things I wish I had done during my college days.How to Study Effectively and Get Good Results?(Tips to Medical Students).

How to Study Effectively and Get Good Results?(Tips to Medical Students)

Med School provides perhaps the best substantiation for Charles Darwin’s theory of natural selection. For here we see in its cruelest form of the survival of the fittest. Not the smartest, as one should expect. But the fittest to cope with the inhuman pressures, the demands made not only on the brain but on the psyche…”

—Doctors by Erich Segal, 1989

Having done fairly well in my medical graduation course, here are few tips for fellow students on how to manage themselves during the course, keep themselves motivated, and study. Some of things I did and things I wish I had done during my college days.

Step 1:

Decide if you really want to have a career in Medical Science. Not just good money and great deal of respect and recognition, there comes equally great responsibility to serve mankind. There will be many sleepless nights, lots of work, tons of mental pressure, and you will have to go through hardships which you would never come across otherwise.  If you are the lazy kind- this doesn’t suit you. Do something else. Don’t even bother going through hassles of entrance preparation. Or spend chunk of your dad’s money. This is the profession that demands profound knowledge, decent skill, great dedication along with utmost sensitivity and constant vigilance. Think you can manage that? Hop in!

Step 2:

Welcome to Med School

Find an appropriate place to live in. Somewhere you don’t get disturbed. Someplace with good food nearby. Place you can crash anytime and sleep tight.  A roommate you can get along with. Because this place will be your home for quite sometime now.

Look at your syllabus. In all Medical Schools, during the first and second years, you are required to study basic subjects- Anatomy, Physiology, Biochemistry, and additionally Microbiology, Pathology and Pharmacology in some. Then Community Medicine and Forensic Science joining midway. Medicine, Surgery and Gynecology & Obstetrics along with their branches – Pediatrics, Dermatology, Psychiatry,  Ophthalmology, Head Neck and Otolaryngology, Orthopedics, Radiology, Radiotherapy, Anesthesiology, are reserved for final years. Clinical Skill requires a different approach(tips vide infra). For the theory part, its almost similar technique for all the subjects,

At the beginning of the each semester, just look at and make yourself familiar with what you got to study. The Books.

Weekdays

Then when classes begin, be very attentive in your classroom. Because what the they say is somehow important, be it for exams or clinically.  Jot down what your teacher says. Make your own short hand technique- so you could write fast enough. Try to write nicely. Don’t write on loose sheets that you’d lose the other day. Make this notebook your permanent one. One good technique is to write only on one side of the pages. Then when you study the topic by yourself- you can make your own notes on the other side.

At the end of the day, there’d be three or four new things you’ve learnt.  Go back to where you live-hostel or home. Don’t think about Study at all for next 4-5 hours. Take a little nap. Entertain yourself. Take your time to enjoy, relax. Play some sport. Exercise. Walk/ Run. Go on an evening date. Just make sure you still got 2-3 hours to go through what you’ve been taught during the day.

  1. Read the notes you took in the classroom.
  2. Open your text book. Read the related topic. Read everything like you’d read novels. DO NOT try to mug up. Just make an effort to understand.
  3. Read again. This time Mark and highlight the ‘things to remember’, the important points. Try to remember the definitions, values, names etc. Practice by writing down in your rough sheets.
  4. On the other side of pages of your class notebook, make your own note- try to write without looking at the book. If you can’t, its alright to take a peek.

(Do this, one topic at a time, in one setting. Take a break after you are done with one. Don’t haste just to get it over with. If you don’t feel like studying this particular day, its okay. Don’t study when you don’t want to. Spend your time charging up your spirits. But keep in mind, you got to catch up, the next day or on coming weekend.

This way, by the end of semester you will have a wonderful notebook for fast reading during exams. And a course book which you’d have familiarized yourself well with. Plus, you’d be fairly acquainted with all the topics. That’s more than half preparation for exams already done!

During weekends

You ain’t got a date to go out with? Okay. But You sure got friends to fool around. Hang out, go watch a movie, talk love, talk matches, talk politics, talk about everything on earth(expect studies). Find time to rekindle with your old hobbies. Read novels, jam up with your guitar buddies, write poems. Better, go home to see your mom, dad if that’s possible. These are feel good factors. Have a life every weekend, because that keeps you going  for rest of the week.

(During your final years, you will spend much time in the hospital. Doing evening wards and stuffs. Since you won’t get time to enjoy your weekday evenings like I said, make sure you have fun on weekends!)

But spare one weekend, one holiday  every month to revise everything read and written since the last. Don’t take trouble mugging up.  Just go through, one more time.

Clinicals

By clinicals I mean the clinical skills. You need to have sound clinical knowledge- the theory. Watch carefully and imitate in the wards. Learn the techniques. Keyword here is practice. Practice in patients, practice in mind. One particular thing I’d do was, I used to imagine I am with a patient and imagine myself doing the procedure. Step by step.

You can also write down all the steps and the manners they should be executed in a notebook- and while you practice on one friend (or patient) and ask another friend to watch with the notebook on hand. And mark the mistakes you made or steps you missed. Practice until it comes naturally to you.  Do this and you will save a lot of time during exams.

 

Holidays

We love holidays. Major holidays define our engagement by themselves, be it Dashain, Tihar, Eid or Christmas.  We do what we are supposed to do. Its wonderful being with the family, after pretty long intervals. For me, every time I used to go back home, I used to feel huge sense of responsibility for the hopes and dreams my mom and dad saw had me. It made me feel guilty when I was living a careless/carefree life, not doing what I was supposed to do, not living upto their expectations .  This sense of remorse, caught me hooked me up with devotion dedication stuffs. For how happy my mom and dad were to hear my good results- all the trouble I took, every efforts I made, all the time I spent with books- it made it all worthwhile.

Work hard, get good results. One sure shot way to make your parents proud of you. Now, you want that. Don’t you?

Plus, religious holidays give us time to foster our faith. To make promises to that Deity we believe in, and to ask for Good lucks. Goodluck’s good.

On other holidays that come scattered. Some you can relax.  Some you got to keep your head down and study. Revise class notes. Make more notes. Clarify few topics by going through text books again and again. Try to remember the things to remember. Practice techniques. Just be loyal to yourself. You will know which

Exams

You can’t prepare well for exams right before the exam. Its preparation throughout the year. But the final touch matters. Prepare mentally for exams. Realize how big and important this is, and how sincere you have to be, but don’t get intimidated. Keep your cool. Did you do like I said all the time, last semester? If you did, I think this exam is going to be a piece of cake for you. And even if you didn’t (I myself did not, though I wish I did) there’s no reason to panic. Now don’t waste your time. This one month or something, eat book, sleep book , drink cocacola(trying to sound worldcup- such is the magnitude). Ignore things that disturb you, avoid thoughts that make you sad, bid farewell to activities that gulp your time. Still keep your feel good factors, like talking home or to your good friends.

Read every topic. Read notes you’ve made. Talk with seniors about important questions and discuss answers. Everyone have their own style of study. I like to sit on chair with ‘related’ books piled up on the table. Everything I might need to check out, within my range. I like reading and trying to remember the points while I scribble down on paper. And I start a topic and finish it. I make notes on pieces of paper and paste them all over my table and walls. ACRONYMS is something everybody is fond of and I like them too. I’d share some on my future posts. I like to study in a silent room. I’d like coffee too. This is my style. By now, you’d have your own preferences. Choose the style that suits you.

Just Before Exam

Eat good clean food. For the dinner night before, not much calorie but protein (yes I had googled it out). As for breakfast, I couldn’t go to exam hall on empty stomach. But some prefer to eat nothing. Suit yourself.

Sleep. At least four hours. Or at least sleep some.

In viva formats, its sometimes possible to know what questions examiners tend to ask. What patients  are provided for short and long case examinations? Who’s the external? What has he specialized in? Internal? Good idea to go through his lectures one more time.

While you can take your time, think and then write for written form of exams, for viva and practicals, the reaction time is too little and often it so happens that you fail to tell something you know very well or blurt out something stupid. So your mental workout is got to be strong. When you walk down the hall towards the examiners, when your heart is thumping hard and fast, tell  yourself  this, ’I am going sit in front of them, they are going to ask me questions, and I’m gonna do ******* good.’ Confidence

 

And one more thing,

Goodluck!


Results came out!

Our final year exams ended on 21st September. I came back home for this vacation which would last until results. In the mean time I had chance to travel to some good places like pokhara and souraha, that makes up for another section in this blog. Just making a point in here, it was quite is a while (17 years!) since I’d been last to that wonderful wonderful place. Love it so much that mark my words, I’m gonna have a house in that town.

Dang and Bhairahawa too, on my visited this time list. Dashain and Tihar, with my family after long. Thats the highlight of these two months. And I was pretty useful around home too 🙂
And finally retiring somewhat nervous, anxious, hopeful and eager wait result came out on 15th November. In a nice way actually. I switch off my cell phone when I go to sleep. So early morning I wake up and turn it on, I see the sweetest message saying I passed. Then I was like yelling ‘Baba, mommy, I passed..’ and everything’s been wonderful since then.

Thanks to my family, friends and teachers for everything. I am a doctor now. Thats some identity.

Joining my intern soon, by 26th november. I will keep updating.

Why I choose Medical Science to study?

I never planned to become a doctor. But after my schooling that seemed like best and cheapest option for me to get out of the house and live independent somewhat. I managed to get scholarship and I got sent to Bangladesh to study a 5 year MBBS course. A totally different kind of study is this- learning all about how my own body is built up, how it works, how it suffers and what can be done about it.. This suddenly became so interesting. Plus I love the prospect of dealing with something new everyday, a new patient or a disease and dealing with utmost care and trying to make him feel good. This is by far the noblest profession, or atleast it is meant to be.