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While dealing with a corrupt bureaucracy, insensitive to the needs of
doctors, both by way of manpower and equipment support may be a reason for
the reluctance of doctors to work in centres which have suffered years of
neglect and degradation, one must not overlook the fact that access to
education for their young families is a critical factor which dissuades
doctors from taking up jobs where there are no schools and roads and
transport make travel impractical.
A simple thing like Laparoscopic Female sterilization, which is
perhaps the most common procedure which is done in a lot of rural centres,
has been incentivised by the Govt and even though it has ensured that it
continues to get done, a lot of centres in the Bimaru states as they are
called, dont follow the Standards at all. They do huge numbers in a day,
dont follow infection control guidelines (about the number of people who
should be in theatre, the solutions which should be used for disinfection)
and as a result, deaths in these camps are not infrequent. The mortality
and morbidity from these procedures had instigated a public interest
litigation in the Supreme Court, which had in turn brought about the
publication of the Standards of Male and Female Sterilization, which have
been disseminated to the states.
The state of affairs is a result of general apathy, poor leadership
and management, corrupt transfer policies and top down approach of
bureaucrats, who often have no idea about healthcare.
No competing interests
20 February 2010
Staff Grade Obs&Gynae
James Paget University Hospital NHS Foundation Trust NR31 6LA