The emergency room is 15 meters x 10 meters perhaps. Every available space is taken up, mostly by patient beds, leaving very little space for corridor or work space for physicians. It is always in action. There are sick people: very sick most of the times. We have a lot of communicable diseases. Many of these patients get diagnosed with tuberculosis and other types of transmissible illnesses. In this enclosed space, few ceiling fans and exhaust fans on top of the windows make feeble attempt to circulate the air. The air is muggy. It smells of disease, body odor, and feels warm. There is a deafening cacophony of patients in distress, families in panic, crying children, doctors in conversation, nurses in action.
There are certain standards for healthy work space, but you need to know of none to get an idea that this is not a healthy work environment. It is not just the emergency room, our wards, outpatient clinics, intensive care units are all the same.
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In these clinical care environments, you will see young doctors scurrying around in their white coats. These are residents and interns. They spend a large amount of their time in this suffocating environment. They are the workhorses in health care. Cheap labor is what health economists call these people in North America. They are paid minimally (rather they are made to pay hefty sums sometimes in Nepal). They work very long hours. The ground work of patient care is in their hands. They talk to the patients first, whenever there is a change in patient's condition they are the ones who are called first and they are the ones available to manage acute crises in patient's health. If anyone in the patient care team knows the patients best, it is the interns and residents.
You will see several of these doctors sniffling. Respiratory illnesses is very common among our interns and residents and is not difficult to attribute it to the work environment. We hardly have any set up to practice basic hygiene. Crowded small call rooms are shared by several residents. Do they feel exhausted sometimes? I am sure they do. But if they were to express it, my guess is, they will be told everyone goes through this stage, this is the time to learn and not complain. They undergo all this hardship in the name of training. Traditionally, this hardship has been accepted in the medical communities. It took death of an 18 year old Libby Zion in New York after an error by overworked residents and her influential newspaper columnist father to bring into attention the risks of overworked residents. Now, the US enforces strict duty hour rules for trainees. We do not have any such rules. Furthermore, our residents and interns work in a risky environment for themselves and the patients they care for. We are better off if we start talking about these issues now than later.
There are certain standards for healthy work space, but you need to know of none to get an idea that this is not a healthy work environment. It is not just the emergency room, our wards, outpatient clinics, intensive care units are all the same.
.JPG)
In these clinical care environments, you will see young doctors scurrying around in their white coats. These are residents and interns. They spend a large amount of their time in this suffocating environment. They are the workhorses in health care. Cheap labor is what health economists call these people in North America. They are paid minimally (rather they are made to pay hefty sums sometimes in Nepal). They work very long hours. The ground work of patient care is in their hands. They talk to the patients first, whenever there is a change in patient's condition they are the ones who are called first and they are the ones available to manage acute crises in patient's health. If anyone in the patient care team knows the patients best, it is the interns and residents.
You will see several of these doctors sniffling. Respiratory illnesses is very common among our interns and residents and is not difficult to attribute it to the work environment. We hardly have any set up to practice basic hygiene. Crowded small call rooms are shared by several residents. Do they feel exhausted sometimes? I am sure they do. But if they were to express it, my guess is, they will be told everyone goes through this stage, this is the time to learn and not complain. They undergo all this hardship in the name of training. Traditionally, this hardship has been accepted in the medical communities. It took death of an 18 year old Libby Zion in New York after an error by overworked residents and her influential newspaper columnist father to bring into attention the risks of overworked residents. Now, the US enforces strict duty hour rules for trainees. We do not have any such rules. Furthermore, our residents and interns work in a risky environment for themselves and the patients they care for. We are better off if we start talking about these issues now than later.
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