I have finally finished typing up the transcript for the interview I did with the lead doctor at the hospital I was doing my work experience at. A copy is attached below -->
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Interview questions
LEAD DOCTORà
·
Could you tell me a bit about
yourself Dr. Madhu? A bit of an introduction to you, how you came to do
medicine and so on?
M
My basic motivation to do
medicine was my interest in science. I was a good student at school and worked
hard for good grades and studied medicine at university. See, when I was
little, a majority of the people had only two options, to go into medicine or into
engineering. Although other professions were and are incredibly credible and
hard work, there seemed to be this default choice of either medicine or
engineering. I think this is how India has ended up housing the world’s second
largest population of scientists.
M
After doing medicine at
university I started working in a government hospital to do more of my clinical
practice while I specialised into paediatrics and then set up this hospital.
·
Could you tell me a bit about
the hospital? How did you start it up and when?
M
Shri Madhu Hospitals was set up
almost 22 years ago, in 1992. It was set up after I had finished my
specialisation as a paediatric doctor and had a few years experience practicing
alongside other doctors in a government hospital. I have lived in this area for
most of my life and as it is natural for most doctors here to start their own
establishment, I followed suit and started this hospital for children. I also
am employed by the local government hospital. So whenever there are patients that
require my assistance I would go and help the team out at the big hospital too.
·
Why do you think that it is a
norm for doctors here to usually set up their own hospital?
M
I think this is mainly because
doctors who work for the government hospitals are very underpaid for their work
and the long hours that they put in. we have families and our well being to
look after too but with a salary so small we cannot afford to and therefore
there would be a lack of motivation to do any work. So doctors usually tend to
set up their own hospitals while also providing their services to the local
government run hospital. However this may vary very slightly if you look at the
different states. Some might only work
for their own hospital.
M
There are even hospitals which
are owned by an entrepreneur, who doesn’t have any medical training but has
employed doctors to run their “business”. Nowadays a lot of NRIs (Non Resident
Indians) who are doctors are returning to India to start their own hospitals
here. This is a both a benefit and a disadvantage for doctors like me.
·
Why is it an advantage and a
disadvantage?
M
It is an advantage, especially
for the patients as all these doctors who have trained abroad bring new
techniques and new experiences with them which we may just not have here. And
these new techniques and procedures could greatly help reduce any kind of
unwanted side effects we may currently be battling with here in India and more
specifically Andhra Pradesh. Furthermore, the introductions of new machines
which are much more high tech have really helped us in making our jobs much
easier. We can also train with these professionals to gain knowledge about new
techniques and implement these in our own practices. I feel there need to be
more official programmes where the government aids this kind of integration
between local and internationally trained doctors. After all medicine and being
a doctor is all about constantly refreshing and adapting our knowledge to new
practices and developments.
·
The disadvantages?
M
Well, when these professionals
from abroad set up their big, new hospitals here there is a great deal of
difficulty for us doctors, with a relatively small hospital compared to theirs,
to compete with them. Even though it is a hospital. It also generates our
incomes so it becomes harder to earn a living. Generally all the tariffs for
the treatments are higher in the bigger hospitals and therefore all the higher
class population generally can afford that kind of service. Hospital such as
this one here, which is set in a poorer community (the bigger hospital tend to
be set up in cities and big towns), could be the only ones for miles. Therefore
people living in these communities do not get to take advantage of the benefits
of those bigger hospitals. All in all it is a disadvantage not only for us
doctors but also for the patients.
M
However, it would be very wrong
to say that medics who have trained abroad coming to India are not an advantage
to our health care system here in India.
·
So you are the lead doctor here
and the owner of the hospital.... Are
there any other key figures in the hierarchy of this hospital?
M
All the staff members have very
important roles in this hospital. They have key responsibilities each which
they we cannot underestimate. Right from all my fellow doctors to nurses to the
lab technicians and the cleaners.
M
All the nurses apart from their
medical duties of looking after the patients, administering medicines and
operating the medical machinery, they also help me in keeping a detailed and
frequently updated inventory of all the medicines and equipment we have in the
hospital
M
We have a lab in our hospital
where we process our own blood test results as well as results of other tests.
For this our in-house technicians play a huge role of keeping in time with the
test due dates and organise the results and be very careful not to mix any
documents up. This is a sizable hospital and we have quite a big inflow of
patients and handling and organising all this data is very, very important for
us here.
M
Everyone here knows how
important this establishment is for this community and the role we play as a
medical care institution here. So at all times we have a clear aim and
objective and methodology as to how to manage the workload and tackle any
issues.
·
How is the hospital funded?
What is the balance between the amounts of funding you get from the national,
state or local government compared to your own funding or other private
funders?
M
We do not get any kind of
funding from the government at all – not local, not state or the Indian
government. The hospital at the moment is all self funded – we generate an
income and we spend out of this. But we do get some private funding from well
wishers in the community. The initial start up cost of the hospital was my own
investment along with some private other private investors within my family and
bank loans.
·
How do you manage without any
funding support?
M
We have to be very careful and
ensure that we have budgeted carefully and regularly to keep in track with the
number of patients coming into the hospital. Furthermore, being situated in a
community like this, where some of the population is moderately wealthy while
most are of the working class, we need to be careful to price our services
accordingly. we need to be careful to ensure that the people of the community
can afford to use our hospital and that we provide a quality service, while
also making sure that we don’t get a loss in our finances.
·
Do you think there are any
problems with India’s National Health Service?
M
I think one of the main
problems that we face here in India is the availability of doctors. On an
average, there is 1 doctor for every 1500 people in the country. This has
become better in the urban areas – like the cities where it could be around 1
doctor for every 500 but in the rural areas – in the villages – it is more like
1 doctor for every 2500. This is appalling when compared to the UK or the USA
for example where it is roughly around 1 doctor for every 300 people.
M
Not only the doctors but we
also have a shortage of beds. We have less than 1 bed available per 1000 people
in the population.
M
Also there is a lack of a
nationwide healthcare system or at least a list of rules/ procedures that we
can abide by to provide a coherent service to the population of the country. I
feel there is a desperate need for this as all the private hospitals, including
our one here; we are simply just doing what we want in what we can to help the
population. We need some kind of national objective that we can all work for
and have set targets to do so.
·
Could you tell me a bit about
the ambulance system in Andhra Pradesh?
M
In Andhra Pradesh we use the ‘108’
emergency number to call for an ambulance or some other emergency services. This
is a 24/7 emergency number which not only has a links to the medical services
but also the fire and police services.
·
How efficient is this service
and how would you rate this service overall?
M
The service started in 2005 and
to be honest, the service, although it has become very popular and useful for
the population, it is still in its infancy and growing. At the moment it is hard
for the ambulances to get through, especially at peak rush hours when there is
a lot of traffic; people are quite reluctant to move out of the way. This could severely delay the treatment of the
patient and if unlucky, it may even prove fatal.
·
What changes would you like to
see in the health system on a national/ more local level?
M
I would like to see a national
government plan as to bringing together all the hospitals in the country and
acting as a more united front against the medical challenges we face. But I
fear that it would take many years or even decades before anything is set in
this country. There is a lot of bureaucracy, politics wherever we go. There is
money involved and the size of this task is absolutely huge. So I do not expect
to see any changes in my lifetime but maybe when my oldest daughter (who is
currently in medical school) has set up her own hospital, maybe there will be
some change.
·
As you had notified me before I
came here, there is a bit of political tension in the area. How has this
affected the hospital?
M
As you know the state of Andhra
Pradesh is on the brink of separating into two states. This has stirred up some
political turmoil in the whole area and there have been a significant amount of
strikes and rallies, including many in this area. This has meant that there is
some disturbance in the activities of the hospital.
M
When there is a strike planned,
people don’t want to generally come out of their houses as they are unsure if
the hospital is open etc. This not only affects the business aspect of the
hospital but also we have to think of the patients’ conditions.
M
There will be kids who may have
their consultation due on the same day as a strike may not be able to come into
the hospital and if they do have a condition, their situation may worsen. This
is a huge risk in terms of the health of the community.
M
Also transportation was
delayed, and in many cases even completely disrupted. This meant that some of
the staff was not able to come in to work. Therefore we had staffing problems
on many strike days. This meant we had a dropped ratio of medical staff to
patients. Also the lack of transportation meant that at one point we had a
shortage of oxygen cylinders. We had to cooperate with the local government
funded hospital and some other hospitals in the nearby towns to share the
resources we had.
M
Furthermore there is a lot of
uncertainty surrounding when this is going to end so we will have to plan as
and when any situation arises.
·
How do you think this political
strife has affected the health service on a state level?
M
Obviously there is a lot of
disruption in transport in the whole state. Strikes, Bandhs (where all shops
and services are closed) etc. have effected, I think, most hospitals. Maybe
some areas have been more affected than others due to the spread of all this
chaos. There are stories of ambulances being stuck behind demonstrations which
would be disastrous.
·
Do you think the state
government is doing enough to minimise any affects?
M
The government itself is in a
crisis. The government is trying to counteract all these strikes but the people
will do what they want to do to get what they want. In my opinion there could
be more procedures in place to have more order brought to the state and how the
ambulances move about in the state. As the very least ambulances must get some
priority over these demonstrations. It is after all the matter of life and
death.
·
Are there any social problems
faced by the heath service in terms of providing healthcare for the people?
M
There are. In India there are
some subjects that we don’t openly discuss. Sexual health is one of these
issues. We need to as a country assess our situation and be able to tackle
these problems
M
Additionally, there are some
lifestyle issues we face as well. There may be dietary habits that we need to
address. Diabetes and obesity is one of the biggest challenges we face.
Diabetes more so.
M
There is the lack of education
of sanitation. There are whole communities that are unaware or don’t use any
good sanitation habits. This has lead to the spread of malaria dengue and other
diseases like that.
·
What are the personal
difficulties you faced while starting out as a lead doctor and owning and
running your own hospital?
M
There were, of course, the financial
difficulties of funding the start up. Thankfully, I had a lot of supporting
family members who helped me to secure this money. Other than that, I don’t think I had great
difficulties. I had a clear goal of starting this hospital so I knew what I had
to do. I had some great help from other professionals who had done the same
(i.e. set up their own hospitals).
·
You read Medicine in English, a complex
language for an incredibly complex profession. But you work in quite a rural
area where most of the population doesn’t speak and understand English. How did
you adapt yourself to this environment?
M
I have learnt over the years.
Here in India, after doing the medicine course at college, you would do your
post graduation and then you would have to do a couple of years of compulsory
placement in a rural setting, as part of your training. Also my mother tongue
is Telegu (the language spoken in the region), so I guess when I was little my
mother would have explained complicated things to me in simpler language and it
is a natural thing that I obtained.
·
Could you tell me more about
you rural training
M
We would be placed in a village
where we would be aiding the primary healthcare providers in their communities.
This village usually consists of a population with minimal school education. So
when we had to explain something to a patient we would not only have to
translate our training into the local language but also simplify the
terminology a lot. We would often use gestures to explain to them a part of the
body that they had a problem with. We would use daily household objects to help
them visualise the organ. For example, if a patient had a problem with their
nerves, we would use string or a rope to help them see what a nerve might look
like and explain to them using that.
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