Why does it matter to me, to delay post graduation by 7 years after MBBS?

The rains has just stopped here at Sittilngi, a tribal village in Tamilnadu. The crickets are singing constantly, the water is dripping from the roof and I had to walk through a pool of water in darkness, since power is gone. My musings are chaotic but are held together by a sane experience of rural life, that has almost become a part of my identity. Looking back, life does seem like a roller coaster ride, yet in a slow pace, that made me realise who I am, to myself. This journey had it's own bumps and humps, struggles and turbulence but whose life doesn't have it anyways? What matters is what I have right now and that is Peace. 

Being brought up in a town and then shifting my base to a medical college in a city, I had no clue of what a village life means, leave alone a tribal village. To start with, it was never about, 'Rural Service' as people would call it. It was essentially an escape route away from the post graduation entrance preparation. 

During college, medicine was done in bits and pieces, health was restricted to community medicine lectures, learning from the poor was a norm when we were clear that we wouldn't being our loved ones to the same, prestigious institutions we are learning from. Along with it was the life of friends, in hostel, making studies more like a forced routine to get a degree. Fun, laughter, loudness, friendships took the center stage and through the initial four years, I somehow forgot about the fact that, 'I am going to be a Doctor'. Well, it was true for many of us, but I felt like the reality slapped me during internship. Though the clinical experience was great then, I felt lost in the ocean of departments, procedures and duties. A mere emptiness filled me when poverty, accessibility, trust and social fabric started reveaing itself. But as interns, all we did was searching for organs and organ systems. After a long OPD, I was happy to see a patient coming with headache to be referred to medicine, cancelling his entire journey of how he has missed his one day coolie to seek help. It felt like, all we were taught about was to handle just ourself to sail through internship. Certain questions of mine, used to be countered with, 'Why do you want to know? Anyways you will do post graduation' or 'Dont think too much, they are poor. This is how it is'. All this made me understand one thing very well, the Dr. before my name is only two alphabets which didn't carry any meaning. I just became a medical technician and it questioned my competency and meaningfulness. I was very clear to not to enter PG without realising who I am and what it means to be a Doctor. It felt like, learning what it means to be a Doctor in a place where it is not a tertiary care hospital would really nurture me. Out of sheer luck I met Dr Regi George (called as 'G') at a close friend's house. I heard his story of a rural hospital in a remote tribal area, started by him and his wife Dr Lalitha (called as Tha). Somehow it felt like, I should go there and really see what it is. When I discussed this with one of my Post Graduates back then, he shut me off saying 'Urupudama poga vazhi paakura' (you have found a way to waste your life). But nothing changed my mind. My family also accepted to support me.

Sittilingi is in a bird shaped valley of 16 villages between Kalrayan and Sitheri Hills of Tamilnadu. The place is predominantly a tribal area with more than 95% of tribals.

I visited here with my parents and joined here as a junior doctor in 2015, few months after internship.

After that each day was treat to mind and body. Scenic sunsets, star gazing, privilge of inhaling unpolluted air, being around an abundance of bamboos and farm lands in a place far from the tentacles of an urban life. Soon I got acclimatised to silence and slowness in life. Time took a different perspective where, I was not in a rush to prove myself academically or socially. Medicine was tailored to the community and people would greet you with a genuine, concerning smile. The organisation, Tribal health initiative was 22 years old then, with a full fledged 25 bedded hospital (it became 40 bedded by the end of my six months here) and had rooted in other so called, 'Determinants of health' through organic farming, education and livelihood intiatives. It felt like, doctors don't have to just talk about what makes health but can actually work on improving health of people.

A journey through 15-20 kilometres of forest on either sides is essential to reach the hamlet here. A life without any urban inputs awaited me. I had to wash clothes by my hand every Sunday, travel 15 kilomteres to access ATM, no way of eating in hotels, internet was just 2G which could barely manage whatsapp and what not! Powercuts, continuous rains, humid summers were also part of the package. But it was thrilling and fun and I never felt bored or alone here.

Clincal knowledge was tremendous to learn. Even now in 2022, this is the only hospital with emergency theater and ventilators for more than 50 kilometer radius. Here everything is 'Uncollege'. We call everyone by their names, there is no prefix of a doctor or a nurse. Every patient had to be called by the name they have, not case diagnosis. 'Where the patients come from' always matters as much as thier signs and symptoms. Cost is to be thought about for every extra investigation we write. It was indeed a busy clinical work, juggling between outpatients, deliveries, surgeries and medical patients. Once a lady, from a village 60 km away came to us with Tuberculosis. She had woken up at 3 AM in the morning, cooked food at home, took the first bus at 5 AM, and changed another two buses, to reach Sittlingi and waited for another two hours to see a doctor, as she can no longer function like before. The disease had pushed her limits and she couldn't push anymore to have a normal daily life. A friend of mine diagnosed and treated her and told me at the end of the day, ''She has struggled so much to see me. 'Me', a person who is 'just a MBBS doctor' in the outside world. She didn't question my credibility or lack of specialisation and all she needed was a doctor to listen to her and help her. I feel more and less at the same time". This became an every day story of different layers of social fabric discussed and acknowledged inside the walls of the hospital. We were taught and shown that medicine can be done in an empathetic way for the underprivileged which gives satisfaction to both patients and us.

What was more significant was, I was opened upto a new Avenue of, 'Social Medicine'. Where society and medicine are at constant interplay with each other, deciding each other's fate all the time. With other intiatives arround, I eventually imbibed the fact of how to be humane rather than just being a doctor. 

I learnt so much from our senior nurses here, who can still conduct a breech delivery by themselves. Seeing the tribal women, being trained at a remote village to become nurses for their own community was itself a huge blow to the education system we believe in. If we can educate people and they take ownership of their own community, isn't that what health is actually about?

Even after three years of being here, living a village life, it felt like it was not enough. My doctor friends usually go for post graduation after two years of work and get through NEET. I thought I was ready to do the usual ritual of coaching classes and Multiple Choice Questions. My mentors G, Tha, Anu, Krishna, Ravi and Prema told me not to get into a comfort zone without seeing other places in life. So I quit job here and put myself in a coaching center. It was a different world altogether! It somehow didn't make sense to know about glycogen storage disorders and metabolic syndromes, when the real issues are more about poverty, accessibility, lack of human and other resources and other tangled cruelty in the society. I had to give up the preparation after a year and started back packing, to realise what it means to be a doctor in this country and not just at sittilngi.

Travel welcomed me with a truckload of wisdom and obstacles. I jumped NGOs in between rural Odisha, Chattisgarh and Jharkand. I made many travel - visits to other states as well, in search of solidarity and friendships. It gave the bigger picture of the country itself, making me realise how foolish I was to think only about Sittilingi. I saw babies being delivered at a village, cut off completely during monsoons due to fierce streams. It taught me liberation, uncertainties and how to tackle helplessness. Every terrain, village, tribe and hamlet was echoing exclusive stories about themselves. Nowhere I was left to feel terrible, since people from organisations and communities welcomed me with open hands. To be fair, they helped me to realise what it means to them, to have, 'a Doctor' around. 

I gave my worst CPR ever to a 17 year old pregnant mother when we lost her and her unborn baby to cerebral malaria. I have vivid memory of her husband who cried so much, unable to believe that everything was alright two days earlier. A pregnant mother with hand prolapse, came to hospital after 16 hours, since it took to so long to reach a hospital with caesarean facility. She had to carry her dead baby, in search of a surgeon to just take the baby out. People were breathing silicosis in Rajasthan, battling sickle cell disease in odisha, TB was an every day story in almost all parts of the country that I visited. Mining had exploited their daily life where villages and looked jet black near coal mines around Dhanbad, Jharkand and had reddish hue because of iron near Dalli Rajhra, Chattisgarh. In Nilgiris, tribals were just working out ways to live around elephants. Farming was no where a part of their daily routine, struggling through poverty, drought, helplessnes and diseases! I saw adults in 30s and 40s with BMI around 15. There has been patients who walked into OPD for lethargy with hemoglobin 2 and 3. 

Yet I was welcome everywhere. All those NGOs had been working on some way to help people and themselves. No where I felt alone and unsafe. I found so many doctors of my generation who I could relate to, living in villages scattered over the entire country. There were a significant number of friends from non doctor community like activists, writers, teachers, health professionals who gave a 'non medical, non rat race' perspective of life. More than just the clincal team welcoming, I cherish how the communities took care of me, for the human inside me. During a rough monsoon, when communication was cutoff in Kerpai village in Karlaput wildlife sanctuary, the team I was a part of realised my sudden fear of the unknown. They collected mushrooms from the forest and made mushroom gravy for me to wake up to. The words spoken were, 'Didi' from their side and a teary eyed, 'Thanks' from mine but it was an intense of communication of togetherness! There are endless humane stories almost everywhere.  After a point, it gave me a huge hope that, 'I am not just not alone but I am also taken care of'.

A place in Jharkhand called Jan Chetna Manch became my epitome of what health means. Run by midwives, their health center does allopathy in the most non medical way possible. They are not under any doctor, since it was started by a sociologist and midwife Lindsay Barnes, just to meet the needs of the place. She is accredited as a honorary member of RCOG (Royal college of obstetrics and gynaecology, UK) for her work in the field of obstetrics in rural India. Their center made me wither down the identity of a doctor itself, and how it just matters to be a human being to address what another person needs! Even now it feels like, every other doctor should go visit their place to understand health and unlearn bio-medical model of our education.

I had so many downfall as well, amidst all this. I went through depression, insomnia, clustered thoughts and helplessness. Yet I could sail through. People made me sail through. Be it family or friends, everyone reassured me with love, time and care to make sure I get healed, along with nature in all these places, that un binded me from within. Even when I was going through the lot, this huge support always made me feel that, 'I will come out of this phase soon'.

I had to stop travelling because of COVID. I joined back at sittilngi to meet the needs during pandemic, for myself and the hospital. But I had evolved as a person and was still in denial to do post graduation and was not ready for it. Pandemic pulled me through one and a half years of hectic work, till last year when I came to terms with a lot of things in life - that I want to be a doctor, a clinician in a secondary care hospital that is rooted to the community. I wanted to navigate through the urban and rural worlds with self confidence in medicine and to have a job security. So after six and a half years of MBBS, I finally told myself, 'I will do PG'.

No, all this doesn't mean NEET was easy to prepare for. In fact it was not easy at all. I went through what every PG aspirant goes through. Hopelessness, self doubt, un awareness of today's competition, everything put me down. But again people helped. My family became a huge support and made me realise from time to time, about how proud they feel about me and my PG does not matter for them, since they have already been overwhelmed and happy with all the experiences I learntt hrough the my rural journey. My friends and mentors kept me sane. Above all these, some one from sittilngi, be it patient or team members would ring up almost every weak, to just enquire about my well being and no medical doubts were a part of conversations!

Also, most of the MCQs (multiple choice questions) had a strong story to connect to. They were the patients and people with their faces staring at me. Their smile and despair which made me feel responsible, kept coming back from time to time. NEET is more about science than social fabric but I could understand how science is a key to unlock specialisation level of medicine, which will add value to my knowledge and also help people. Days were difficult to only study, switching of all other sensory inputs, but what is inside me, my personal stories replayed again and again and again and again. I didn't pass exam with double or triple digit rank but I could crack this national level entrance with a decent rank to get the post graduation I desire. That's all I need for myself.

Now I am back at Sittilngi, waiting for my counseling. I am just here to be here and nothing else, reminiscing my few years of life. I feel like any other human being in this valley now, trying to figure out my own life further. I no longer carry the tag of a Doctor in a super-human level, since many humans have taught me that everyone is equal and has something to learn from.

I am still over whelmed with the love of people here, a home that I built myself over years, a network of friends to nurture me and a community acknowledging me for who I am. 

As mentioned earlier, I am at peace. Nothing else can trade this experience of human emotions that I have encountered. Age and doing things late don't matter anymore, since my timeline only means to me and no one else. I am no longer thankful for the choices and people I met through this journey but I already feel a part of larger alternate world of rural India, medicine and health itself.

And that is exactly why it matters a lot to me, to delay post graduation after seven years of MBBS!!