Emergency care in the rural area: Can doctors be ethical and survive?

Dr Himmatrao Bawaskar, a general physician from Mahad, Maharashtra has raised a question in a paper published in Indian Journal of Medical Ethics. Pointing a finger at the current scenario of medical facilities in rural areas, he has put forth the question whether doctors can be ethical and survive, while providing emergency medical care

HL: Emergency care in the rural area: Can doctors be ethical and survive?

Dr Himmatrao Bawaskar is a well-known name in the medical fraternity of the country. He is a renowned general physician, who has been instrumental in providing medical care to the victims of scorpion bites in the rural areas. Over the past 40 years, he has been working relentlessly for the benefit of the people living in rural areas.

But, bringing to light the medical facilities available in the rural areas, in case of emergencies like poisonous stings, accidents, heart attacks and other acute health conditions he has put forth a question, ‘Can doctors be ethical and survive, while providing the emergency care in the rural areas?’ Dr Bawaskar has raised this question in Indian Journal of Medical Ethics.

While speaking to My Medical Mantra, Dr Himmatrao Bawaskar says, “Both the ethics and law demands, that payment should not be asked upfront from the patient in emergency cases. Yet, patient and their families fail to pay for months or even years. In this case, a doctor in small communities is easy prey.  In these conditions can one be true to ethical principles and ensure one’s own survival?”

Through this paper, Dr Bawaskar has tried to highlight the hardships and the mental agony the doctor had to face while providing the medical care in the rural areas. There is enormous pressure under which the doctor from a small hospital works and the financial and mental stress he has to face.

Dr Bawaskar further says, “There is an urgent need for improvement in terms of qualified staff, specialists and modern investigation facilities like Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI), etc., at the primary health centre level. Due to the non-availability of these facilities patient visit the private hospitals. Owing to which, the pressure on the private hospital increases.”

He further adds, “There has been no improvement in rural government hospitals for the last 30 years. In a life-threatening medical emergency, poor patients have no alternative but to approach private hospitals. Unless the government uplifts the PHC’s the people staying in the rural areas will not get good medical facilities.”

In the Indian Journal of Medical Ethics Dr Bawaskar writes:

  • The patients invariably compare rural facilities unfavourably with those of tertiary care hospitals in the big cities.
  • Besides providing treatment, we have to update the relatives on the patient’s health and investigations.
  • Sometimes, relatives who may not be properly informed or have come from a city, have difficulty understanding the constraints under which rural doctors provide treatment.
  • In addition, doctors today suffer great stress because of the hanging sword of the Consumer Protection Act and the aggressive responses of patients’ relatives to an adverse result.

Dr Bawaskar adds, “The government must finance the widest possible health insurance coverage of the poor. The present government has planned a health insurance scheme for vulnerable families of up to Rs 5 lakhs per family per year for secondary and tertiary hospital care, which we hope will work successfully. However, a majority of the poor are from rural areas and can only visit the primary health centre and primary private peripheral hospitals, which, unfortunately, are not covered by this insurance. This scheme may result in unnecessary referrals to secondary and tertiary care hospitals.”

In the paper Dr Bawaskar concludes saying, “These may be some of the reasons why so many doctors want to leave India or why doctor parents do not want their children to become doctors.”