Motherhood South-East Asia

I recently had my twenty four hour work shift, it went well, if you asked. The very idea of nurses calling me up in the middle of the night several times was quite annoying to a certain extent but then I knew this was the price of getting into MBBS.

I had the opportunity of being the keen observer of the hospital, starting off with various wards, which I have not been posted, yet. The very striking ward was the antenatal ward, where most pregnant women, who are close to their due dates, were getting admitted. The ward is over loaded with women and it seems that Bangladesh is a baby producing factory.

As I was being an intern and checking the vitals (that basically sums up my work), I came across a lady, she was in her early forties and she was happy to be pregnant, when enquired about her choice to conceive a baby at such an old age, she gleefully said that it was “Allah” given. Similarly, I attended a patient who will be receiving chemotherapy for cervical cancer, (she has seven children), and she gives a very similar answer.

There is no control of birth; unmet need for family planning has made things worse for those that want to keep the maternal health status high up. The maternal health condition in Bangladesh is well versed than in Nepal even though things like birth spacing and use of contraceptives when husband is away are easily missed by women.

Most women are not familiar with the term of antenatal check up. Although, WHO has made it mandatory for pregnant women to take at least minimum 3 check ups, women are still not aware of such polices, instead, they seek medical attention when their due date arrives. What is the reason for policy making when health education is in limbo?

The process of pregnancy is a very important decision that equally both partners have a say in, but most women that I have encountered were either pressurized by their family or the husband himself or the hypocritical silent society that we are a part of.  Educating pregnant women about the birth process or informing her about how her body will change as pregnancy advances are keynote targets to save the extra patient load that most government institutions clearly fail to show interest.

Healthcare policy making is just a tool for the government to show that it abides by WHO, there are still patients who never get any antennal check up done, even if they did claim to get checked, its by a quack, when asked if she has done the basic investigations, she declines and even further she cannot even recall taking any iron pills!

This is the situation in hand, we live in the 21st century where neighboring countries are becoming super-giants in arms and ammunition and yet a primary care general physician has to face “Death of the patient- severe blood loss (Post-partum hemorrhage)!”


Who monopolies the world of Vaginas?

It was 5:30 hrs in the morning, you know the anticipation that you get before traveling to another country? I almost felt that. The special preparation that I did for my departure was a clean apron that I washed the night before. I love to be punctual, so I was half an hour early and was all ready to enter into the world of vaginas or aka the GYN and OBS department.

Working in Ramadan is fun to a certain extent; you get extra hours of sleep and well, if you get lucky you can get some free ifftari as well and It does seem extremely rude to go out for tea breaks deliberately announcing that you are a Non-Muslim, so, according to my plan, I snuck out before entering the GYN department. People who know me also know that I am very punctual with my meals as well!

Who monopolies the world of Vagians? The entire time, when my senior was asking me to make discharge papers, I was wondering why the most successful Gynecologists in Nepal and Bangladesh were Men? Men come to Men doctors when they want to get checked and vice versa but people who can afford, especially those who want to get checked according to rankings, will always prefer male gynecologists.

Where is the feminism? Where is the “we trust female gynecologist act”? Sorry sister, a male doctor’s opinion is worth a thousand then a female one! Then they ask the ultimate question like, when you get pregnant, which doctor would you prefer? You need to pause and think, marriage, babies, that road is far off, let’s just avoid that question. If I were to answer that question, hypothetically, I would always choose a doctor who would understand me, who could bear my personality, who I can trust professionally to do the job, knows when to pull the alert button. “Doctor, you sound diplomatic!” becomes a common response when people ask me stuff. Then I think, gens, why must you show off like that?

Patients are smart these days, with Google, WebMD, the online rankings for doctors, practicing must be a different experience in Western countries but in South East Asia, still patients suffer from minor problems of obtaining medications or being educated about a disease. Among all these difficulties that most of the majorities of the people suffer choosing a doctor for child birth is not a leisure that they enjoy.  The question of who gets to be their future child’s doctor is a futile question that people who enjoy better healthcare can fiddle about.


Confessions About Marriage:

181230_539610816081319_1709117519_n“My whole life has been about studying, passing the exam and getting gratitude out of it. I am satisfied and comfortable with the way life is going through. I don’t want to complicate things and take the burden of relations on my tinny shoulder. I need to grow and in the way of life, if I find the perfect or close to the perfect match I shall consider marriage as an option. ”

“Are you kidding me? Marriage is for the 30’s and 40’s. I need to grow as a doctor, earn enough dignity and money to choose a wife. And oh! I don’t like a smartass hammering me every second on the road.”

“I am excited to get married very soon, I have been dreaming about it all my life and soon will be an appropriate time as you know the biological clock stops ticking after a certain age.”

“The last time you asked me a question about marriage, I was perplexed and I gave a very unrealistic answer but as the years have passed and I have been heartbroken and have come to the realization that a profession can make a big difference in what a person wants in the future. I want to marry someone who can guide me through my career. One seeks for professional gain through personal!”

“Being ambitious and running around being a free soul is what most women doctors in South East Asia seek but they get tied with social stigma and they are redeemed marriage unfit by the society if they seek to finish post graduation. If you want to be a success story in South East Asia, marriage is a must!”

“A perfect body, gushes of estrogen flowing through your arteries makes you an ideal woman for marriage, irrespective of any profession and degree. I am not one of those whinny girls who end up with fainting spells every time they attend the OR. So, if I get married it has to be someone who can specifically delete excessive drama and let one do what one wants! ”




Relationships and screw ups

I have been unfair to the people who  have actually enjoyed reading my blog posts over the years. I have this great equilibrium between the amount of extra reading that I do (non-medical) and the amount of blog posts that I write. This blog post comes after I finished reading a book by Erich Segal entitled “Doctors “.
“Doctors are wounded healers” says the book. The story is gripping and you can identify to the characters of the book. I particularly noticed that the book projects doctors to eventually have a screwed love life or a broken family relationship. Maybe the writer could not have started the book if he had only projected about the normal life. But then again, makes me ponder, are we normal?
What makes a successful doctor? Is it the lady behind the man or was it the damn fortune that he was destined to have? What about Female doctors, who should be held for their success? The man behind her (I meant husband or boyfriend) or the fact that she is cold blooded or there is no success for female doctors at all?
Look at the proportions of hypes that men get all the time. Even today, men are considered far better than women for doctors! Why is that? Is it because the female race has to subsequently bow down to the realities to life, like having baby, taking the home responsibilities and well, what not that comes with commitment.
It’s difficult, to actually see this happen. I disagree to bow down to subtle realities as far as I can. I mean, it almost took me ages to finish a degree, will take another decade to be well know (if people find me equivalent to the male counter parts) but I will never settle for comments like please avoid a duty because you are a female.
It’s not only a crime to be ambitious; it also makes you an outcast in this field. And deciding to settle for the least of it is the toughest thing that one has to do. Each and every character of Erich Segal’s book reminds you of the fact that life is going to be bumpy either ways, so get prepared for both and move on with your life and keep reminding yourselves that life is never going to be normal for us!

Doctor and Patient Relationship

This is in response to the article that came out in My Repubilca Daily yesterday; junior doctors see patients referred by seniors. 

It is said that the ailing patients, who travel from different parts of Nepal are completely ignored by specialized doctors and henceforth the junior doctors are treating them. Here’s what I think:

First of all, let’s talk about the junior doctors. Most of the doctors that handle such patients are “specialized to be” individuals and they are under the guidance of specialized doctors. If they follow the treatment protocol of the senior doctors and proceed accordingly, I do not see why people would judge their credibility?

Secondly, why is there a shortage of treatment modalities outside Kathmandu? a)  Lack of coordination of the tertiary hospitals with the central hospitals, b) Patients decision: as most patients think that getting treated in the capital city will cure their aliment.  c) Lack of the healthcare to plan initiatives, the system should have assessed the quantity of doctors that are required in both rural and urban areas and have generated medical students accordingly, d) Failure of the government to meet the desired needs of the population.

Thirdly, why do doctors miss their clinic duties to work in the Nursing homes? Just giving an instance here, if you offer a child chocolate over vegetable, he is smart enough to choose chocolates.  What has the public sector done to attract doctors to their side? If Nursing homes provide security, where doctors are not beaten up randomly as they have done recently in the past few months, then why wouldn’t a sane normal human being discontinue or show displeasure over his government sector job?

Fourthly, Patients do create some unnecessary drama, some get satisfied with just few visits by specialized doctors and some expect their super busy doctor who probably handles fifty cases a day to be doing the normal vital parameter check up for them.

Fifth, I don’t think a doctor will prescribe the same drugs over and over again unless and until if the treatment protocol says so. Unless it was to correct a defect of some sort, which would mean that repeated intake of the drug is a must.

Sixth, it’s about time the healthcare sector was given to the private sector. Examples like these will keep on rising unless a permanent solution is brought.  What good has the public sector done so far? It has successfully driven of all doctors from the country till now.

Doctors and Patient relationship is very fragile which needs constant nurture from both the sides, if patients start contradicting the knowledge of doctors then, may god save them!

Should Doctors Ask Their Children To Be Doctors?

There is a general predisposition for children who have doctors as their parents to be doctors. So why does this happen? 

Children mimic their parents from early childhood.  As they see their parents put their blood and sweat into their work they gradually get accustomed to the daily medical life.  What is a medical life?  

Medical life is not much of an extra-ordinary life; it’s a normal life that a med and future doctor lives. A life, which involves periodic night duties and endless clinical hour time. It requires grading examination every now and then. This life is an endless hurdle of examinations and re examinations. It’s likely that one cannot make much time for child care.

 When both parents are reputed doctors in their own fields, there is likely chance that their children may experience attention deficit problems. Do you give enough time to your children?  People who develop their childhood under such circumstances can comprehend their lifestyle in a similar manner since they have been accustomed to it since early childhood, that’s why they decide to get into med school but there are exceptions.  

A surgeon’s child seems to know more details about a particular topic because he viewed that  procedure when he was just 10 years old and still does when he is with his father. Do doctor’s children have better clinical eye? Early exposure of books and med terms in the house will definitely help them edge further in this field. But eventually it’s the practice and practical work that makes a doctor reputed rather than the hereditary genes.

 Question of asking your child to be a doctor is a very unusual question, because at first it’s about what the child wants and not what we want.  Many meds want their children to be doctors. When asked why they would present that option to them, some said that they wanted their children to face to same experiences and difficulties that they felt over the years and will do in the future.

At first, a child’s first right is education, what he/she chooses is their option. What we can do is explain the details of the struggle that one has to do from med school to the actual job work. The path is very long and tedious; one needs to make many sacrifices. If a child understands the implications of this profession then it’s their choice.

I see why parents who are doctors force their children to be doctors, it’s partly because they want their dynasties to grow. It’s a profession of immense pride and hard work, the respect that you earn over the years makes it even more attractive and it does make the subject more lucrative from a child’s point of view.

What would you do?

In conversation with a Drunk Doctor:

 Thank you Dr. B for letting me take your interview. (He was drunk at this phase.)

Dr. B: Anything for you MISS  Sarina and your Blog Medical Mind.

How much did you drink? (Just to make sure that he can stay stable for the rest of the interview)

Dr. B : Not much, few shots of vodka  and few sips of tequila.

I must say you have a very good taste in alcohol. (Both of these drinks has maximum concentration of alcohol. )

Dr. B : It’s a gradual progression… MISS Sarina. It started from few beers in med school.

Do you call yourself as an alcoholic?

Dr. B :No, I would not (all alcoholics say this). I only drink after I finish my duties and I do everything at home and hidden from the world. But MISS Sarina, I am giving this interview just for your Blog Medical Mind.

Why do you drink alcohol on a regular basis?

 Dr. B : I do this because I suffer from a chronic pain which is immune to analgesics. I see so much suffering around me in the hospital. I hardly can do much for the poor people. For several months, I gave my monthly salary to help those people on a regular basis and after a point I realized that it was not enough. If 20 more doctors gave their annual salary to these poor people ,then, they can afforded the treatments.

Why did you stop giving your salary to the people?

 Dr. B :After a certain point, I started getting the typical depression symptoms. I could not focus on my job and I started to drift away. Then one day I met my med school buddy who visited my village. He brought a bottle of vodka. The rest of the story is pretty clear.

Don’t you get the hangover effect the next day?

 Dr. B :I do, but I try to overcome that with two mugs of coffee the next day. I am not that much punctual, the patients have to wait minimum two hours to get checked in the morning. But what can I say, I do this to decrease my suffering, I can’t see my patients suffer.  It’s a chain MISS Sarina. They abide by that.

Are you in a relationship?

Dr. B :Very much single and ready to mingle but the last girl just ditched me in a very unusual manner. She gave up our relationship just because I was posted in a remote village. I can’t believe that I dated her for 3 years! Love is Shit MISS Sarnia!  I will definitely marry someone some day. I am still young and some male doctors even get married in their 40’s.

Won’t you raise your voice against this injustice that is happening in you village? Don’t you want to ask the government to subside the treatment opportunities or provide other treatment options?

 Dr. B :MISS Sarnia, you are very much young. Are you in a relationship? (Not relevant to the question, he drifts from the question)… I tried to raise my VOICE, but the only thing that I am really good at is to raise a glass full of VODKA! Cheers!

(I like a section in the New Yorker called Shouts and Murmurs; I got inspired to write this from Mr.Ian  Frazier.)  

(Dr. B does not exist in real life and  any resemblance to anyone is purely coincidental)