Where are our doctors?

Photo: David Leahy

Why in his right mind would a doctor, well-bred and educated, want to spend a single minute away from this wondrous megacity of ours, and that too, to treat those who have no money in the villages? Doctors from our country do not and will not spend time in any village for their noble profession. The air outside the city limits is much too clean for money to be floating around, ripe for plucking.
Our honourable premier has been, is, and will continue urging the doctors to stand by the impoverished rural population of Bangladesh. The media coverage of these events is intense as the proposed punishments are thrown about in the air awaiting implementation, if the doctors do not act in accordance to their Hippocratic Oath to treat all who need help. Now the pertinent question is, have these threats ever work ,or will they ever? Not very likely
Unfortunately, it appears as if ideology, ethics and integrity have been running perilously low in recent times among many of our finest professionals, while those who may actually possess such attributes are all but marginalised. Where the culture and the mindset of no holds barred, when it comes to personal gains, prevails, and those who do dare to attempt such practices are ridiculed and termed stiff or daft, how, in our right mind, could we expect the doctors to give up the abundance of comforts in the city or deny the lure of easy money to listen to the prime minister to ensure healthcare for the marginalised? Our experience would tell us otherwise. An anecdote from a leading heart surgeon recently mentioned in passing that he had lost Tk. 80 lac in the last stock market debacle. It, however, didn't put a dent in his wallet as there was plenty more where that came from.
All the denizens of our country would vouch that good treatment is only available in Dhaka. A visiting prime minister, after inspecting the Square Hospital, commended Bangladesh's healthcare system, and said that our neighbours should learn from us. Reality check, is good care really available for the general population, leaving aside the top echelon of the society who can actually afford care in the likes of Square Hospital? Most likely not. In fact these money hoarding tendencies have reached such frenzied heights that it is common for doctors to suggest "Caesarean" instead of normal delivery for expecting mothers. A check-up by ophthalmologist would entail waiting in a line before the doctor pokes around in your eyes for roughly 30 seconds before he moves on to the next patient while his assistant writes down the prescription. After all, getting Tk. 500 per patient, what rational doctor wouldn't want to maximise his patient load?
Repetitive conditioning has encouraged this behaviour by our valiant doctors. Money over ethics has been thoroughly ingrained into their psyche. Toothless threats and soft words do not pose enough of an encouragement to make our doctors think otherwise. Au contraire, it is possible. But there need to be those among the elites who wear the same clothes and have the same degrees with the boldness and integrity to make it happen. After all, who among us does not realise what's best for him.
These doctors spend so much time and energy, not to mention money, to become doctors. Why should they go to remote villages? What is there for them? Public health organisations and their like-minded have been trying for years to implement a system where trainee doctors would spend some time in remote villages providing treatment before receiving their licenses. But people in the Bangladesh Medical Board have been vehemently opposing such initiatives. After all, it is their children who are the potential candidates for such initiatives. It seems humanity and humility have been grossly trampled by capitalism. Children, when they wrote about "The Aim of my Life" during their school exams, emotional and ideological words of helping the sick may have come up for them. The issue of whether the sick have money most likely didn't cross their thoughts.
Madam prime minister, you probably have an idea that the doctors we are talking about are used to flouting humanity and humility. Your words of caution only will not help. The doctors we speak of have no choice. They have been hypnotised by the potential of the businesses set up around them by the numerous diagnostic centres, medicine companies and so forth, all for the big pay-off. Ethics has left the building, along with accountability. It is not a rare that many doctors accidently lose patients due to their constraints of time or attention. Even those with money sometimes have to wait for 2 months before they get a chance to secure an appointment, not to mention warrant enough attention.
A system needs to be developed whereby our doctors feel encouraged to treat the ill, not just the rich. We need to be able to sit down with experts and urge them to come up with solutions. Common issues such as lack of facilities (either education for children and adults, comfortable living conditions, entertainment), proper equipment for treatment, lack of security, loss of potentially foregone income, etc., have to be kept in mind. At this stage, anything beyond a baseline MBBS is not possible outside the city limits. And once in the city, as we have seen over and over, it is not possible to go back, such is the lure.
We want to be proud of our doctors. They are, after all, our brothers, sisters, and children. The fact that we, the general population, are so bitter about these issues must be well known to the doctors. We cannot expect these problems to go away overnight, but something must be urgently done.

The writers are researchers at a research organisation.
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