COLLATERAL DAMAGE: Critical patients who go to government teaching hospitals for treatment are bearing the brunt of the cease-work by junior doctors.

Specialised treatments like cancer care, cardiology and neurology in the government healthcare sector are available only at medical college hospitals, and the cease-work by junior doctors has affected these services, health secretary Narayan Swaroop Nigam said on Friday. He renewed an appeal to the protesters to resume work.

The junior doctors said on Friday evening they would continue their cease-work, called in the aftermath of the rape and murder of a postgraduate trainee at RG Kar Medical College and Hospital on August 9.

“As we said earlier, our primary demand is the arrest of all the culprits involved.... We have no clarity about the investigation; the CBI should come clean on this,” a junior doctor said.

Junior doctors, many of them postgraduate trainees, work only in the medical college hospitals.

Nigam has called a meeting on Saturday afternoon with representatives ofjunior as well as senior doctors to find a solution. The meeting will include theJoint Doctors Forum, Indian Medical Association, Bengal, and junior doctors’ associations.

“The strike has affected patient services in various tertiary and secondary care hospitals across the state. Specialised care like cancercare, cardiology and neurological care are available only in medical colleges. In theabsence of resident (junior) doctors, these services are getting affected badly,” Nigam said.

“Poor patients, who are dependent on government hospitals, are especially affected. Resident doctors have joined work in other states, including AIIMS Delhi, and in AIIMS Kalyani in our state.

“We once again appeal to our resident doctors (to) return to their services. The government upholds the dignity of our medical professionals in the highest order. Normalcy in patient services must be restored immediately.”

Nigam said Bengal had between 8,000 and 10,000 resident doctors.

“There are 2,000 resident doctors for every year. So, (taking) three years together, there are 6,000 doctors. Also, we have a three-year bond with them. That makes the number between 8,000 and 10,000,” he said.

The health secretary’s public acknowledgment that patient services have been affected runs counter to the protesting doctors’ claim that services are normal. Nigam’s comments also indicate that the impact of the cease-work is being felt far beyond emergency care.

Many senior doctors said they were only treating patients with emergency medical conditions at government hospitals.

A professor of neurosurgery at a medical college told The Telegraph that more than 100 planned surgeries had been deferred in the past two weeks at his hospital as it was impossible to perform them without assistance from junior doctors.

Faculty members at medical colleges said junior doctors perform crucial roles such as preparing a patient for surgery, assisting the senior surgeon in the operation theatre, and monitoring patients’ health from evening till the next morning.

Post-operative care or investigations like endoscopy are also handled by junior doctors.

A senior doctor at a government medical college said he and his colleagues, all aged above 60, were doing night shifts now.

“Many such senior doctors are admitting only a few patients as it is not physically possible for them to look after a large number of patients, particularly at night,” the doctor said.

“We are having to draw blood samples from patients, a task usually performed by junior doctors.”

At SSKM Hospital, the combined number of patients at the gastroenterology, hepatology and gastrointestinal surgery OPDs used to be about 1,200 a day. The number has fallen to between 250 and 300, said an official.

One reason for the lower OPD numbers is a reduced arrival of patients, who have read and watched the news about patients beingturned back. Another is the curtailed issuance of OPD tickets by the hospitals, sources said.

SSKM would earlier conduct about 100 endoscopies a day, a number that has dropped to around 20. Colonoscopy, a procedure that allows the doctor to look inside the colon, has fallen from about 40 a day to less than 10, the SSKM official said.

“Many patients are being asked to come to the hospital after a few weeks,” a doctor at SSKM said.

At the cardiology department of a government hospital, a doctor said angioplasties were being performed only on those who had suffered myocardial infarction (a heart attack). Those with chronic stable angina, a condition in which the heart needs more oxygen, are being asked to be on medication.

“Procedures like angioplasty will be done for them only when the (hospital) conditions become normal,” a cardiologist said.

A neurosurgery professor at a medical college said junior doctors were involved in the pre-operative stage, during the surgery, and also in post-operative care.

“A patient must be made fit for surgery. During the pre-operative stage, they (junior doctors) give medicines and arrange the investigations to ensure that a patient is fit for the surgery. The visiting senior faculty depends on their feedback,” the neurosurgeon said.

“When a surgery is being done, the surgeon is supplied with stitch materials by the junior doctor. Suppose a surgery is being done on a tissue. The senior will use the scalpel but the junior will hold the tissue and make it easier for the surgeon to perform.”

In the post-operative stage, a patient may have convulsions at night. Whether to put the patient on ventilation or give oxygen is immediately decided by the junior doctor.

“Patients at a hospital are under the care of junior doctors between evening and morning,” the neurosurgeon said.

Jayesh Kumar Jha, head of surgical oncology at SSKM Hospital, said the absence of junior doctors had forced the department to delay some of the surgeries that need “round-the-clock” post-operative care.

“I am delaying these surgeries because the post-operative care may not be as good as required. But there are many other surgeries that we are doing,” he said.

“I must add that there are resident doctors who are still giving patient services and taking part in the strike. They do understand that without their support, patient care is not possible at a government hospital.”

Another surgeon at a state-run medical college hospital said surgery also involved departments like anaesthesiology. If junior doctors of the anaesthesiology department are on strike, the waiting time for patients already admitted to a hospital for surgery gets longer.

A health department official said the OPD footfall at government medical college hospitals had plunged more than 50 per cent since the cease-work began a fortnight ago.

“The number of admissions has gone down by more than 40 per cent and diagnostic tests have fallen by more than 50 per cent,” the official said.