Two doctors were having a leisurely lunch on the banks of a river. While eating they noticed a body floating in the water. Both jumped in the water and dragged the person out of water and started resuscitating him. While busy saving the person, they noticed two more bodies floating in the river. They jumped again and dragged both out and started providing first aid. Again they noticed that many more bodies were coming their way. One of these doctors jumped into the water again to save them while the other, instead of jumping into water, started running upstream.
The doctor in the water shouted to his friend: “John, you don’t want to save them?”
“First I need to find out why they are falling into the river,” answered the second doctor.
The moral of the story is that instead of focusing on symptoms, you need to find out the actual cause and treat it. Providing clinical care after certain numbers becomes impossible for any health system unless you figure out why people are getting sick in the first place and by providing preventive strategies at the basic level.
Even though this story is narrated in an epidemiology textbook (Gordis), it’s true across all subjects and fields. Recently there is an onslaught of Facebook reels and TikTok videos, where senior decision-makers (both politicians and bureaucrats) are visiting hospitals and dressing down medical superintendents and senior medical staff working there. Without trying to understand the root causes of failure of the health system, they are focusing on peripheral issues like: instead of token number 90, why is token number 91 seeing a doctor? An immediate investigation was ordered right there. Why was the flowerbed not cleaned and had dead leaves lying there? I am not making up both these incidents, as I have seen uploaded videos of these officials. And yes, there are some serious issues like prescribing outside medicines, especially if they have a stock in the store. But how a prescribing doctor knows about availability of certain medicines without having a working logistics management information system (LMIS).
Question needs to be asked first that if hospital after hospital is not up to the mark, then the problem may not lie inside the hospital but in the health system. If no MS is performing then the first question we all need to ask is: how are they being appointed, what is the criterion for appointments and who is appointing them? The second question we need to ask is: what professional training is being provided to them once we select them for administrative positions?
Readers will be surprised to know that in most instances there is absolutely no training before an appointment. Most government departments, including civil services, where starting grade is 17, like health department, gets extensive preboarding training while health system does not offer any type of preboarding training. Other departments of government normally have required administrative trainings for promotions to the next grade, but health system does not offer until very late in the career and that too is not given much importance. Many are given ad hoc positions instead of permanent positions just to keep them under the thumb. Tenure security is just a fancy word, and you could be moved on the whims of someone. This automatically translates into suboptimal performance.
I am also dismayed at our public hospitals and want them to be improved. To make this happen first we need to: decrease the sick people needing hospitals by population management; provide clean drinking water to reduce 70% of disease burden on hospitals; transparently and fairly hire medical superintendents; provide them needed professional training; empower them administratively and financially to run public hospitals. Only then could we make them accountable. The current practice will only demotivate the whole department and result in the remaining good officers exiting from the public health system. Arresting doctors will not help but understanding their problems and working with them will improve the health services.
