Medical Officer Diaries

“Can’t you stay back in Dhaka?” An old patient asked me during my Ophthalmology rotation when I was in medical school. I politely answered, “I have so much work to do in my country.” While sitting on a chair in my two-bedded room in Dhaka, I had always dreamt about working in Nepal and making a difference for my people. Ever since my arrival in April, I have been trying to make that dream come true. It is very easy to give other people advice or write about how one can make a difference but it is indeed very challenging to implement your values and principles.

We, humans, are subject to greed, comfort and leisure and that pushes us back at a time when we have to make radical decisions in life. When one wants to jump into a road never taken before, one has to think about a whole lot of things, and usually, one comes to a conclusion that life is better when you have loved ones around you. Why leave the comfort zone?

The work is the exact directory of what we were taught in medical school but it comes with politeness and behavior. It requires you to show your dedication on a daily basis and it rewards you accordingly. The shortage of Medical officers is a new uncharted topic that most people never touch upon. It is hard to find people who decide to work after completing their medical school. It is a huge commitment plan that doctors make on the basis of various statistical data and family pressure. Earning a degree and not working is considered worthless in the eyes of the society. A medical officer learns how to follow a consultant and how to stay in a boundary. There comes a point within a month and year when a medical officer starts rejecting the peers of being the third in line to treat a patient.

How can a hospital tap a medical officers potential? Well it depends on the institute they work for. Medical college hospitals try  as much to utilize the capability of their medical officers whereas private hospitals just make them their mediators between patients and consultants. Education wise you need a specialization to survive and avoid any insecurity about what and how you can make a difference.

Competitive examinations carried out in Nepal are not sufficient for the larger majorities of graduates. With just hundred seats in IOM and five thousand applicants it is less likely you will be hitting the jackpot with insufficient studying capacity. The learning curve studied in com med class is not helpful at all as it keeps reminding you to learn at a tender age before its too late or is it? When my senior suggested that he worked as a MO for four years before he tapped a major examination is worth reconsidering. Writing has always pushed me to become a better person and yet this is might push me achieve the dream that I evolved over five years.

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Typical Medical Student In Dhaka

I am just speaking out for all the medical students who come to Bangladesh to accomplish their dreams of becoming a doctor. It’s my final year and I know how things work here, through and through. So here’s a list of things that you will end up doing, especially when you study in the capital city.

  • You will spend a lot of money on food. You will either spend most of it on fast food chains or you will end it on junk food for your “while you study” regimen.
  • Dhaka is no place for partying or drinking. Alcohol is prohibited and the only alcohol that you smell is at the airport lobby before the final immigration hassle. So forget about how much you enjoy you Gin and Tonic and try adjusting to “Tang Juice “and “Prawn mango “drinks.
  • You need a serious wardrobe change up, no low cut vests and you can say good bye to your shorts and skirts. Because here, people like to see girls all dressed up from head to toe, despite the scorching sun and heat. It actually depends on how you handle the wardrobe change in your life, I have seen girls dressed in the usual clothes that we wear in Kathmandu and they do get the blunt stares but somehow they dare to manage it without much fuss. For me, I personally like to dress in “Salwar Kameez” when I go out or I wear the “Kurtes” the rest of the time. You should be comfortable in what you wear and thats my fashion statement.
  • Trying to adjust with the fact that most of the books that you just bought are photocopied versions of the original and move on with it. I think the fake ones are better than the original ones and money-wise it saves me half the amount that most med’s have to pay in other parts of the world.
  • You need to learn “Bangla” fast, like within a week or two because most of the stuff happens in this very language, its mostly like Nepali but the old Sanskrit version of it. It’s easy to understand but you need time to work on replying back. No matter how much one glorifies a college, most medical schools teach in Bangla at the very starting and end of the lectures. But no harms done when you can understand what they say.
  • It depends on which college that you go to. Mine, well literally forces the balls/guts out the students to study so basically when I am bored to death and wish I was not a medical student, I still would be studying or giving an exam. There is no way out of this mess of items, card finals, ward ending exams, block finals. So, you repeatedly get beaten up, mentally of course to study all your life, as long as you are in Dhaka. You life becomes a mess when you can’t balance the pressure and fun.
  • Coming to the part, “Fun”. What’s the fun part about being a medical student here? Well, none, besides that fact that we spend half our times obsessing about how our fellow med students in Nepal are having all the fun that we did not get. And the rest half of the time goes into studying excessive theory, seriously, like as if we are giving the PG exams the next very day and we stay focused, because there are no distractions, except when you fall in love, but that’s rare.
  • Is Dhaka the right place for you? Yes, if you can learn to cope up with new changes in your life, starting off with eating, living and defining fun, all together, if you need some seriously studying to be done with less distraction for the rest of the five years and six months then this is the best place for you. Once you make a group with a bunch of people that you like hanging out, you will always find ways to have fun and satisfaction in life in ways that you could not have imagined.

Which Patient Are You?

 I am back to the comfortable zone of writing a blog post after a while. Do not expect me to be regular when the boards are coming, (it’s this January).

The other day when I was attending to an old lady, this is somewhere in Naxal, in a small clinic for patients who seek medical attention for free. I was taking her history as usual. Later on, when a board certified doctor examined her and gave her medications for the illness, she left the clinic as usual but I was curious to know about how she felt about the interaction with the doctor.

So in the next subsequent minutes, I exchanged a few words of reassurance to her and she just smiled and gave me blessing to become a better doctor in the future. The story ends there but then I started to realize that reassuring a patient is very essential from the treatment perspective.

So in the next few hours, I reassured the next ten patients who were in the list to get diagnosed and even when the senior doctor already gave them a quick reassurance, they liked the way I tried to explain the same fact again, this time taking more of their time and mine to do so. In my quest to find the solution between the endless distance between doctors and patients, I have come to analyze patients as well. The classification is as follows:

The “Grumpy kind”: These people don’t publicly share their dislike for the way the doctor’s handled them. They go home, complain about how the doctor handled his/her case. These people are opportunistic when it comes to expressing their dislike towards doctors.

The” Violent kind”: Now, we have had heard stories about doctors getting beaten by patients. But let’s take a look at what I have to say about this: Doctor’s are responsible citizens who aim to protect and care for the sick and needy. Mistakes are not preventable. There are ways of handling situations where mistakes are unacceptable but violence is not one of them. I will have to say that patients like these are idiotic in nature. Either they don’t know terms like ” sue ” and ” law” or its the natural spontaneity of these people to act in the way that they just did.

The “I don’t believe in doctor’s kind”: These people believe in supernatural power of healing and have absolute no intention of visiting the doctor at any cost.  Either coming to the doctor is the last resort or things seem unfavorable in the supernatural department.

If you are a patient and if you want satisfaction during a visit to the doctors clinic, write to healthnepal11(dot)gmail. Share us your stories and help us make better doctors for the future. Health Nepal Foundation is keen to decrease the gap between the patients and doctors and we want to improve the health care system in Nepal.

The Day : Good Bye Nepal!

I am like a material which gets parceled in and out of my country. It does not make a difference, to the wide majority of people, if I was here to increase the population of Nepal for several days. Everyone is busy with whatever daily activities that they are doing. I come at a time when friends and family are so engaged in what they do, that it breaks my heart to ask them to stop doing that routine to spend some time with me. I don’t complain. I love the silence, the self satisfaction of doing something so peacefully that it makes me reach another dimension of life.

Life of a TCK is very simple. Your country seems to be a vacation spot. It’s my appearance most probably, the side bag that I always carry around my hips, gives a false illusion. The shopkeepers ask me if I want stones and I have actually been successful in making everyone believe that I am a tourist in my own country. I carry that side bag for three reasons, a) to keep my belongings b) to have enough space for something that I like to buy and c) to make the false illusion. I actually like the extra attention that people give. I have always been receiving it since I was a kid in different areas of the world.

My last day is mixed with emotions of guilt, anticipation and my appetite suddenly increases to a certain extent. The reason for the later is the fact that my self- conscious mind makes a good point; I can’t enjoy this food from tomorrow so let’s gulp as much food as possible. My weight always invariably increases over the vacation.

Garden of Dreams was the last stop in my map. Who says that this place is solely used for snuggling? Yeah sure, it is actually a hub for couples and if you are one of them, there is a private spot for you guys, you just need to climb several steps to reach there. Dragging my mat and elbow rester, I reached the center. The natural beauty that beholds you is amazing, add the music of the birds and water flowing nearby, it does make you wander is this heaven after all? I had to drag myself from there, it was not easy to say goodbye.

Summarizing my stay in Nepal in one sentence, I would have to say, extremely peaceful and self sedating. Starting from the Health Camps that I stayed in and the catching up with old DAV friends to the time when I went to My Republica to attend the chit chat session. Each and every memory gets stored in the fun side of the brain; making memories like theses which gets automatically stored up without any memorizations are the ones that last longer.

I am very much addicted to my country, my people and my family. I will miss the people, the variety of faces, the variety of dialogues and their unending battle to survive in one of the poorest countries in the world. I will miss the occasional fights by couples in the local bus or the time when I had to travel in a microbus with more than 30 people. I will miss the patients, that described their symptoms in pure Nepali, I will miss the way I tried to counsel them for a diseases, It’s a new experience overall. I will even miss the stuffy smell in the roads that throw unconditional house waste, It’s my country, it’s my pride and no matter how anyone try to undermine it by calling the roads, or the garbage management poor , I will always appreciate the good’s and the worst of my country without any bias.

[You Can Check Out the picture of Garden of Dreams in my FB page.]

V day in Nepal and Dharara:

The Nepalese people have decided to make Valentine’s Day their official day of love. Despite its Christian origin, it has served to spread love among Hindus mostly. The Hustle and Bustle in the shopping malls and the parallel investments by businessmen on this day has made it the second largest event after Dashain and Tihar.

In my quest to make this day memorable, I decided t climb Dharara. Dharara is a tall historical architecture/tower which is located in the city centre. It has successfully captivated many foreigners over the years.

It served three purposes during an era:

a) It acted as an information centre; people around the valley were informed about any happenings.  It probably acted as a loud speaker at the time, when Kathmandu had few houses only, it’s quite convenient to convey something when people at that time, did not have televisions or radios that could distract them and they hardly had any motor vehicles that brought noise pollution.

b) It was used to check the general population’s buildings. The Rana dynasty apparently made a rule at that time; the commoners were prohibited from building houses greater than theirs.

c) It is also said that the government kept an eye on the overall socioeconomic condition of the people by checking the smokes that came from the chimneys. People who failed to produce smoke indicated that they were going through a financial difficulty and food was not available. They then enquired about the difficulty.

d) It was used as a sightseeing tower, must say the view from Dharara is extra ordinary. You can actually visualize the valley from a 360 degree angle.   I don’t see why most of the Nepalese people take this monument for granted. Most of the people do not  want to make time to visit it once in their life time.

Kathmandu city was filled with couples; the love was in the air. Women were dressed in Red and few men dared to wear the color of love as well.  Nepal readily accepts any culture and despite the fact that we have a very low GDP, it seems that we are rich in the Gross National Happiness.

Someone asked me why girls blush when they get a red rose on V- day? The possible explanation: it’s the increase in estrogen that dilates the superficial blood vessels in her face. Doctors will always encourage love but they advise safe sexual practices and responsibility. Recently, the UK Health Protection Agency launched its week long awareness campaign on sexually transmitted infections. If awareness campaigns for STD were coincided with the month of love, it’s actually makes sense and the emerging couples have a very good reason to listen to these message and it make the event worthwhile as well.

Dharara gives you breathlessness for about 3-5 minutes, which is later followed by this extreme excitement to view Kathmandu. It also makes you want to visit that place again and scream as loud as you can to check if it serves the purpose of information centre.

I am quoting a tweet by WHO, please take a time to ponder on what it has to say: “Valentine’s Day is not only for “young” people! Anyone can celebrate it with their parents and grandparents.”

Kina Jane Bir Hospital? Nursing Home Ma Gaya Hunacha ni?

This has been my first ever visit to the oldest Hospital in Nepal,Bir Hospital, established in 1889 after the name of one of  the Rana Prime Minister of Nepal, Bir Shumsher. I wanted to know more about this hospital and services it is offering to people. For that, it would be unfair on my part if I discussed about Bir Hospital without visiting the place.
Bir Hospital is the largest referral hospital in Nepal with a bed capacity of 535 patients. The Rana dynasty successfully launched it in 1889 with a dream of providing the basic health care in Nepal.
Located near a busy road in the city centre, it offers free diagnosis to the ailing Nepalese people.  A sign board says “No Horn Please “, and I find it as “ Yes Horn Please “ all around the hospital with repeated blare of car horns.
India  has on several occasions, supported this hospital by providing funds for the extension. Recently, they have successfully constructed a new segment of the hospital.
“Kina jane Bir Hospital? Nursing home ma gaya hunacha ni?” (Why are you going to Bir Hospital? Nursing homes are better? ) :  A typical response from many people. Those that have enough money do not even consider this hospital fit for regular check up. They have reduced this hospital for the poor.
The other criticism that Bir Hospital gets from the average common people is that it is dirty and unclean. People have this unexplainable fear that they will get any disease if they visit this hospital.
This is what I have to say about Bir Hospital:
  • As a medical student, I found Bir hospital to be an epitome for clinical knowledge. Patients from different classes come here with a variety of problems and it has a wide range of departments. One of those that caught my eyes was the Hemophilia centre (It’s a blood coagulation disorder). I just glared at the luck of those doctors who have so wide clinical exposure. Why is there criticism for doctors from there, when they have so much exposure and practice?
  • The second criticism that most people complain is about the tidiness and well-being of the environment of the hospital. When you go to a hospital, do you want your surroundings to be full of flowers and something that pleases your olfactory senses? Or you want your diagnosis to be right and accurate and so that you get treatment early? I don’t see why people go for external features of the hospital when the main attraction of a hospital is made the doctors that are present there. I actually found Bir Hospital to be clean and tidy and fit for patients to come and get there diagnosis done.
  • There is no proper line system in Bir Hospital. Once people get there History/ registration book, they are referred by the people who stay in the counter booth to the respective Out Patient Departments. I was referred to the ENT Department.  I got dazzled there as patients coordinated their own line and it was a matter of shifting seats to the door next to the doctors. Many people get away early. You have to manage your own queue in the hospital.
  • Many people take things for granted. The services that Bir Hospital gives, for instance getting your diagnosis done for free of charge is a big thing. Can you expect an engineer to diagnose your illness if you don’t consider the value of the time of the doctor?
  • There are different religious groups active in the hospital that help the poor to afford for medical investigations. They have subsided the rates of some of the investigations.
  • The central library in Bir Hospital provides the latest medical books and journals. I found  several computer stations for one to stay updated on the latest meds. Med students registered under NMA are only allowed to enter the library
  • Bir Hospital does not have an official web page. But the one that appears on the google search page is the one that is run by senior residents for the interns. Also the site has some useful advices about the FAQ of the test entrance and also it offers some few useful links on different subjects.

I don’t know why Nepalese Media only makes time to focus on the negative happenings about any hospital in Nepal. Focusing on how Bir Hospital has expanded over the years and how It has grown as a hospital for the general people to the hospital for the poor only.

Bir hospital will never fail to attract people from different segments of Nepal; people will be referred to get  treatment done there.  We are a poor nation, we are an emerging nation, people should utilize the facilities without shame and creating unnecessary scene in the hospital just because someone gets a preconceived notions about any disease. As a citizen of an emerging nation, I do not expect a five star health care institute , I am content with what Bir Hospital has to offer,  are you as well?

Will You Accept A Female Version Of Sanjay Gupta In Nepal ?

I have been watching too much CNN ever since I was a kid. It was a compulsory channel. My dad forced us to watch it, he watched the current news and we sat there waiting for the news to end. This routine got me interested into the current affairs. No offence,BBC is equally good but I have a special reason to favor CNN.

Dr Sanjay Gupta! I think, he was the first person that I followed in twitter. He has been such an inspiration for me who  has always kept an keen interest in journalism, which got overlooked when my mother got ill and again resurfaced after I joined med school.

Dr. Sanjay Gupta is a registered neurosurgeon, academic and journalist. He is the senior medical correspondent of CNN and you have seen his work during the Iraq war, Haiti incidence etc. He is an American citizen, married with 3 children to an attorney. He has written two books and he also got the award for the sexiest man in the world for the year 2003 by the Peoples Magazine. Besides that he has got some more notable awards.

What does one have to do to become the next Sanjay Gupta? You have to get  yourself into med school, get an MD degree and you must need the charisma which he has. Nepal needs a Sanjay Gupta who can actually bring the factual details to the public through the eyes of the doctor.

What is the criticism for the next Sanjay Gupta? When doctors decide to do something other than the normal duties like going to the hospital and treating patients there is heavy criticism from everyone. People just assume that he/she is not competent enough to treat. What about those doctors who believe in preventive med rather than the treatment? I bet, I have already got criticized by just writing blog posts, but please keep the criticism coming, because it actually encourages my motives.

Sanjay Gupta is a pioneer and he has ignited hopes and dreams of many med students like me who think that mass media and public health education /awareness is equally as important as treating patients.

What are your views, will you accept a female version of Sanjay Gupta in Nepal ?