Between thoughts and words

We were conducting a workshop on ethics and professionalism among community health workers. There was a case study which we discussed in the workshop. A community health worker (CHW) is posted in a village which has many members belonging to a nomadic tribal community. The CHW provided care for a woman who had just delivered her fourth child, a healthy boy. She instilled an intrauterine contraceptive device in this woman without informing her, immediately after the delivery, even when she was still drowsy from the labour. We were discussing the ethics of instilling an intrauterine device in the tribal woman without informing or obtaining consent from her.  "People belonging to that tribal community never practice contraception. They have many children. They have frequent childbirths without any spacing. It is impossible to convince them to have an intrauterine device. If we do not instill the device now, we will miss the opportunity and she will get pregnant soon. It will be harmf...

Someone I know was going through a tough time. They were venting to me about their situation. Their supervisor at their work was giving them a hard time. "They treat me like a child. They speak down to me and give me instructions and lessons for everything", this person was complaining about their supervisor. When we were discussing this, one thing that came up was how my friend felt a sense of obligation towards this supervisor because this supervisor was the one who got them the job. This led to several important questions -  1. Is the help we do transactional?  2. What is gratitude?  3. Is gratitude accompanied by indebtedness? I am writing my thoughts on these questions in this blog with an intention to share with my friend as a follow up to our conversation that day.  Is help transactional? The word 'help' means doing something for others to make something easier for them or to be useful to them. Therefore there is a difference between doing a work for someone a...

Last week we conducted a training for community health workers on ethics and professionalism. We were discussing the principle of autonomy and the right of every individual to decide what treatments they will take and refuse. We used a case vignette which describes a community health worker inserting an intrauterine device to prevent pregnancy in a young woman belonging to a marginalised tribal community without informing her, immediately after delivery even before she could recover from the dizziness and fatigue of the labour pains. It was no surprise to us that most of the participants argued that what she did was right. They had the following arguments: 1. The young girl is from a poor, marginalised tribal community. She is uneducated. She will not understand what is birth spacing, contraception or intrauterine devices. It is difficult to explain to her.  2. Even if we explain, it will only make her afraid and she will refuse.  3. If she refuses now, we will not be able to ...

"The psychiatrist listens to everything I say patiently. His treatment helps me a lot. I am feeling better now. But still I don't feel like I have poured my heart out till I sit with you and speak to you..." said a 45 year old woman in one of my clinics. She lost her son in a road traffic crash 3 years ago. She is suffering from a severe extended grief and the past 3 years have been very stormy. Recently, a psychiatrist has started visiting our clinic two days a month. This lady consulted him last month and since that visit, she has had a dramatic improvement in her symptoms and her mood. I ascribed her feeling of satisfaction when she had a conversation with me to our long stating clinician-patient relationship and the trust that has built over the years. Yesterday, I realized there could be more to it than that. An elderly man who came to the clinic yesterday for his diabetic foot ulcer dressing, commented to our nurse on his way out of the clinic, "there is someth...

Recently we received a generous philanthropic contribution at our rural clinic and are in the process of setting up a basic laboratory service. One of the greatest challenges has been recruiting a laboratory technician. There are many young boys and girls in the local villages who have completed their diploma in medical laboratory technology, but they are not choosing medical laboratory work. While the market rate of salary for a fresh medical laboratory technology graduate is about 7 to 8 thousand rupees a month, they would get double the salary if they went for job as labourers in local manufacturing and textile export companies.  Among the few applications that we received, many of them had no practical exposure in laboratories, because they had gone away for work in these factories. We decided to take any young enthusiastic person interested in the work, train them for this purpose and gradually create a sustainable model of laboratory services. But we have been having a minor ...

While discussing with an erstwhile student this morning, the discussion rapidly morphed into an argument. The student said, "while I am grateful for the fact that you engaged in this discussion, what you are saying does not make sense to me and does not really matter to me". My initial reaction to it was anger and hurt. But then I slowly realised that there is a 20+ years age gap and a huge generation gap between us, which is the reason for such a predicament. When I brought it up, the young man pointed out to me that I am unnecessarily invoking a generation gap to cover up my inability to convince him. I had to end the conversation there, because things were getting uncomfortable. Here are some of the things which I told him, which did not make sense to him and thus led to the rapid south-bound spiral of the discussion.  1. "Self care is over-emphasised. It comes from an unnecessary heightened sense of importance for the self." Self preservation and caring for the ...

I stumbled upon an article in one of my social media feeds this morning during my travel to the clinic. Nora Fatehi is getting flack for her comments on feminism. In a recent podcast she is quoted to have said that "I dont need anybody" kind of feminism has destroyed the social fabric and women must play a role as nurturers. She has subsequently defended her statement that she only referred to toxic and radical feminism in this manner and is not opposed to the feminist ideology. Some commentators have asked, "have we become over-sensitive"? Are we overdoing activism, by raising voice against everything? This article got me thinking and several important events in my life that transpired over the past couple of months flashed across my mind.  Last week we had a research team meeting. We were discussing our job responsibilities for the week. There was a major temple festival ongoing in the nearby town. The main festival day, Saturday, was declared as a local holiday. ...