turf woes, tough wars.

The doctor had asked her, ''doc, how do you treat trichomonas vaginalis here?'' she had repressed the urge to ask him how it was treated elsewhere, jokingly she had responded that she was well above such student-like questions but at the end of her answer had placed 'flagyl'
''What, flagyl!'' he had seemed genuinely taken aback and whether it was the disbelief at the 'simplicity' of the remedy or the distrust for the respondent was not clear but he had summoned one of the senior clinicians at the facility to inquire if this was true.
''What dosage?'' now it was their turn to be pleasantly surprised.
As they had worked side by side(actually they shared a table) she had been under great duress from the laughter she had been suppressing.
This was in the comprehensive care clinic of a sub district hospital cum provincial rural training center. He was the head of the senior clinical team that came here twice weekly to review the seemingly hard boiled cases. She was a newly recruited clinical officer on her three month mentorship program.
Even during the consultation she had sneaked out time and again to go laugh at him and spread this little bit of news to anyone who cared to listen. She could not fathom how a senior medical officer could fail to know such a simple remedy.
Over lunch hour this had been the topic of discussion.
"Some conditions are rare and it's possible to forget their treatment", one clinician(let's call him Mose the defender) had asserted in defence of the doctor. This had only opened a barrage of fresh assaults on the poor doctor's competencies.
"But he works in a referral facility"
"And he is supposed to be the consultant here, he should know everything"
"It was just a simple, harmless, inquiry, why should you ridicule him for his honesty?" our good guy Mose had gone on.
"Ok no issue for forgetting but why doubt the response, does he believe 'we' are all idiots?"
"Besides we all know he's your friend so you have to defend him but he is a doctor for heaven's sake!"
"And the way he is always hard on us"
"You can't afford even a small mistake with ARVS and you know that very well", Mose had quipped.
"That's not in contention, it's just that this has to apply to all other conditions and medications"
Mose had finished with his lunch and left the others at their happy and demeaning chatter about competencies and incompetencies.

He had always been the silent conversationalist at such like cadre-staking discussions. But now he was riled by what he considered a complete senselessness that pervaded these discussions. He was a clinician himself and he knew they were not the downtrodden of medicine, but he also acknowledged the coldwars that existed between the nurses, doctors and them. This was the one discussion in which any meritorious argument always got subdued by the mudslinging that followed. The two contentious issues were the skewed working conditions and remuneration. Doctors were only on call-called only when required. All the while it was the others who sweated it out in the various departments. Of course this sentiment was not entirely true but it formed the base of the grouses that nurses and clinicians had against the doctors. Who was the real donkey here?
Nurses on the other hand regarded the clinicians as equals; they went to the same colleges and attained the same level of certificates. Did clinicians take this view? This was best played out in the health centers and dispensaries! And did doctors 'look' down clinical officers and nurses?
Mose appreciated the fact that these supremacy contests were no good and this was best seen when the care of a patient went wrong at the facility, then it was a good reason for fault finding, crocodile tearing, backstabbing, obsessive defenciveness and fixing each other.
The differences in remuneration against the services offered was the other thorny point; thorny indeed...

What infuriated Mose was the way this 'sibling' rivalry debate was going. On television and social media it was 'mudslinging, and unbridled contempt open season', the benign grudges festered. Had the various unions failed to reign in their belligerent members or at least some of them? But did the unions effectively execute their core mandates? There had to be a doctor, a nurse and a clinician. In his college training he remembered how much he had learnt from nurses and doctors. Why did genuine grievances have strains of bitterness against the other cadres? This did not apply to only them but the others as well, the unions had slept on their job but this was no license for the decline in the mutual respect amongst the three that perhaps shared the closest clinical kinship..

mother knows..

The sun was well up, this he verified by pinching aside his bedroom curtains and sneaking a quick peep outside. This was to him a daily ritual, for nothing filled him up with sprightly gusto like a bright sunny morning or even just the prospect of one. This was his gauge, his unconventional indicator that the day would turn out just fine. So as he went about a task here and there in preparation for the day, he whistled a tune, actually it that old bobby mc ferrein`s song, `don`t worry be happy`. He had it somewhere in his collection but could not locate it then. Today he would be handling the MCH and as that was one sure drainer, he `stuffed` himself proper, this he began at the house with a glass of cold mango juice and a couple of some cakes, he ended it at the hospital food canteen with hot chapati and beans laced with beef soup. Now he was set and well barricaded against the hunger pangs that would assail him later.
The morning presented to him nothing new that he had not yet encountered before; common respiratory infections, malnutrition and dehydration in their many forms, treatment defaulters and failures are all cases that he dealt with on a daily basis.
The mid morning was usually the heaviest period of the day but a conversation between a subordinate staff and a colleague of his caught his ears and was enough to distract him. It was about the sub`s ineligibility for some vacancies in the department because she was HIV negative. His heart sunk. One week earlier as he had labored to get an IV access on a very sick, he had some how misplaced the first canular he had used. This was compounded by the fact that the safety box had been taken away during the cleaning exercise and had not been returned. A replacement had taken long in coming and as this could not `delay work`, he`d carefully displayed all the sharps on a clean paper in one corner, later he`d dispose them off in the safety box. But this particular one had missed him. This particular subordinate had come to remove the bed sheets which had been soiled by another child and had she not borrowed cotton from him he would have missed the injury she had sustained from the sharp. On further inquiry he had found out it was the missing sharp. Matter of factly he had instructed her to go for post exposure prophylaxis to which she coyly laughed.
He had been newly deployed to the department at the time and had believed she was already infected because she was a peer educator. He had gone about his duties and this event had somehow escaped his attention. Earlier the following week he had remembered and when he`d inquired how she was doing with her medication she had laughed saying she did not take the drugs, this he took it as confirmation she was already infected.
Now here he was learning that she no peer educator and that she was HIV negative or purported to be so...and about two weeks after the incident..
As he lost himself in thoughts and thoughts a day old boy was brought in, not sick but that she had been discovered in a disused pit latrine. On examination he was found to be as sound as is probably possible and this was surprising. The rescuer mother never ceased for a moment to thank God for the wonderful gift of a son(she only had girls) Already she had grand plans for the boy and even had christened him, Blessing. The child had however to be admitted just as a precautionary measure and later she had to go through a lengthy adoption procedure before she `took the son home`. Nothing dampened her cheerfulness. This spectacle had nearly brought activities to a halt in the department as everyone wanted to have a good look at the baby, after which they would curse the real mother..
As matters settled down leaving only a heavy scent of the disgust in the air a lady in her late pregnancy was brought to him. The nurse rapidly explained why she had brought her to him. She had tested HIV positive but had declined any form of intervention to protect the baby from infection. She was a high school teacher and this was her second visit to the clinic. She was due in about three weeks time and what had actually brought her today was a urinary tract infection.
He had spent with her close to half an hour going through all the aspects of her status but she had been adamant she knew what she was doing. She was actually still angry with the husband for having infected her and this she said informed her decision. Could he call this stupid obstinacy? He did not quite place it or did it matter? The point remained what was he to do? The more he tried to convince the more candid she actually got and he knew if this could be equated to a contest then he had been outwitted...a certain irritation crept upon him and he politely asked her to leave but give serious consideration to what they`d discussed. She was reluctant to leave, may be she was on the verge of tears but she showed no trace of it.
`God bless the child` he muttered under his breath as she walked out through the door and as he went back to the rest of his patients a distant sadness descended over him; for those things he could influence but failed to and those courses he could not influence but which he strove to have a hand in.