The Dilemma In Healthcare
Chetana Rajesh
A labyrinth of inequalities,
A web of overlooked subtleties,
Mistakes that glare,
Points out a dilemma in healthcare.
A voice that remains unheard,
A lesson that remind unregistered,
These mistakes that glare,
Constantly pointing out a dilemma in healthcare.
And although once in a while,
In a world that is mostly hostile,
Some voices emerge resilient,
Awaiting some sort of fulfillment.
The inequalities in healthcare are forever discussed but never really acted upon.
One of the communities that perhaps bears the brunt of this inequality is the LGBTQIA+ community.
In a society that is constantly battling gender stereotypes and taboo since time immemorial, the concept that both gender and sexuality are a spectrum has low acceptance.
A recent interaction with Anindita Kundu (she/they), a trauma therapist identifying as demisexual and non-binary, pointed these stereotypes beautifully. When asked about when she first became aware of her gender, she cited an incident from her childhood where she was pulled up by her teacher for the length of her skirt. She went on to point out that that’s what frames our perception of gender.
The clothes we wear, the way we speak, and not how we feel on the inside or what we want that frames society’s perspective of gender. Sexuality is perceived in a similar way within the confines of heteronormativity. Now those reading this article must be wondering why the discussion on gender and sexuality is important or even relevant in healthcare. Well, to put it in the words of perhaps one of the loudest voices of the transgender community, Dr. Trinetra Haldar Gummaraju, says “When I got into med school five years ago, I was a confused queer kid. I called myself a different name, used different pronouns and I had this idea of Medicine being a noble, magical profession. Today, one dramatic socio-medico-legal transition, several failed friendships and relationships later, several dramatic twists and turns in my career later, I’m at a weird precipice again. I don’t know what my future will look like. I don’t know if I’ll make a successful doctor. I can’t name a single transgender doctor in India in the same position that I am – for reference, for comfort – to tell me it’s going to be okay.”
If a transgender doctor does not perceive healthcare as a safe space for the LGBTQIA+ community, it serves as evidence of a lacuna in healthcare. One that is far from filled.
Even in the midst of a pandemic, Dr. Aqsa Shaikh, the first transgender woman to head a COVID vaccination center echoes Trinetra’s concern, by throwing light upon the issues faced by the transgender community. She says: “When it comes to access to healthcare services, it is anyway difficult for the transgender community during usual times and to imagine how they might have accessed these services during the pandemic!
Even if it meant a checkup for something as simple as fever, which was difficult. A lot of hospitals were converted into Covid dedicated centers and therefore even the number of facilities available for them decreased. During any such crisis, the stigmatization and discrimination increases especially against the marginalised communities and the same happened with the transgender community. So the opportunity to go for dignified and affordable healthcare services was drastically reduced. We saw how the transgender community found it extremely difficult to access testing services, Covid isolation facilities divided into the binaries of males and females.
We also saw how they were left lagging behind in the first few phases of vaccination — from booking slots to IDs with respect to use of name and genders, which is why the vaccination rate in the trans community has been four times lesser than the cisgender community.” If these statements aren’t a reflection on why we need to foster a better more inclusive environment in healthcare or simply put a safe space , there is really nothing to be said. But the take home point is not really the reflections of people from the community. It is not the onus of the LGBTQIA+ community to educate us , to do lives and interviews for us to learn during pride month.
The responsibility falls on us. We have to learn , we have to educate ourselves, we have to open our minds to the spectrum of gender , to the spectrum of sexuality and if we are lucky enough to have someone from the community share their experience with us, it is important to draw upon their shared experience to work towards fostering a safer space in healthcare. That and not changing logos to represent rainbows, requesting the inputs from the community during pride month is a true celebration of pride.
LET’S EDUCATE OURSELVES TO FOSTER A SAFER SPACE!
“Doctors who specialise in not specialising are the future of Medicine”
Dr. Suranjana Basak
What begins as a competition in school ends up as an insane rat race for the rest of your life. It is stressful not just in medical career but in other professions as well. However, it is important that such an approach is not seen in medical students as they will be handling human lives in future and not machines or documents.
An error in judgement or or intention can cost someone their life. With the growing insecurity among the general public towards the medical fraternity, it is critical that we prepare ourselves to embrace the positive and the negative of the society and reinstate the faith in medicine. Often MBBS graduates are puzzled as to whether to study further and if so, then in which branch and how?
Considering the growing gap between UG and PG seats in India, we have been losing almost 35% of Indian Medical Graduates to US and UK for Residency and future. Let’s take a step back and understand whether we really need to specialize further. Here is why you shouldn’t:
1.India has a population of 1,32,60,947 (as of 2020) and 12.6 lakh allopathy doctors (including super specialists) and 5.6 lakh AYUSH doctors, which makes it 1 doctor for every 1854 people. What that means is: It could be 1 ENT for 1854 people or 1 neurosurgeon for 1854 people or 1 general physician for 1854 people but JUST ONE of them and not 1 each. Who would you resort to for vomiting? Who would treat you for malaria? Who would deliver your baby? Who would treat you for Tuberculosis? (Naming some of the most prevalent diseases in the country) You’d want that doctor to be your PHYSICIAN, right?
2. With a constant rise in the lifestyle diseases such as Diabetes Mellitus, Hypertension, PCOD, Hypothyroidism, Acute Coronary Syndrome, Dyslipidemia, Cerebrovascular Accidents, a patient needs to head to multiple specialists. But you still head to a phy-sician for your day-to-day ailments. Someone who understands your system and your illness. Someone who knows your 20-year medical and social history and who has connected you with the right specialist at the right time. An Orchestra is led by a con-ductor who directs the performance with movements of the hands and arms, often made easier for the musicians to see by use of a conductor’s baton. The conductor unifies the orchestra, sets the tempo and shapes the sound of the ensemble. That is precisely what the primary PHYSICIAN does.
3. You start early as a PHYSICIAN. Post MBBS/ Post Internal Medicine you walk into practice, research, teaching and education which paves the path for the future of med-icine. This is actually a three-year lead at least as compared to super specialists who study for three more years, attain further training and work experience, then walk into practice which is extremely pin hole since they only cater to one area of expertise which may set a prejudice to the other existing parameters.
Lastly, the Covid-19 pandemic has been an eye opener enough towards to the true he-roes of the era – Doctors and more so, Physicians. Note: ‘Physicians’ in this article are not solely referred to Indian GP/ AYUSH doctors but also, MBBS, Family Physicians, General Medicine Postgraduates.
