By Dr. Vidit Panchal

(Or, What Becomes of a Rural Doctor?)

Who Becomes a Rural Doctor?

(Or, What Becomes of a Rural Doctor?)

Six years have passed since I decided to work in rural areas with rural health organisations. Six years that feel like sixteen, have given so much to feel, think, reflect, learn and grow and now I feel that I have moved a step ahead in life when some people are interested in knowing what I do. This includes some junior doctors, medical students, researchers and journalists who have made me feel like a ‘person with valuable insights’ in the past one and a half years. Occasionally, I do tell them something gold. But mostly, it is a leakage from the continuous reflection running inside that I convey to them. Sometimes it makes sense, sometimes its pure intellectual trash. The receivers are satisfied either way though.

One such discussion happened with a PhD fellow last month whose research question is “Why do doctors choose to work in rural areas?”. While I could tell him my own story of this decision and what succeeded it, I couldn’t help but remember all the other doctors that I have worked and interacted with and their own ideas about their work. In this huge country, the small world of health care sees a range of doctors who want things ranging from Paisa, Power and Prestige to the ones who simply are here to create something. In rural healthcare different routes exist for these motivations.

Some come with a flaming curiosity. Their intellect got stimulated by some well-articulated speech or an article by some icon of rural health and they thought of exploring the socio-political web of rural health. They contribute a lot to research, generate new knowledge, become ‘experts’ and go to conferences, do speeches, publish a lot. Their initial questions become objectives which they chase and they create learning spaces while doing so. They climb up the ladder of Prestige and sometimes meet Power on the way too. But as intellect is often afraid of confrontation, these doctors hesitate to deal with the real determinants of a community’s health like food, housing, human-rights etc and stains like caste and class despite understanding their centrality. For them, these topics belong to ‘some-things-are-beyond-our-control’ list. In their close-circle, there will hardly be a person from the community they work for. The air somehow never thins enough. Their privilege never dissolves. Their brain had pulled their unprepared heart into this new world so with time, they started playing safe. Nevertheless, these are people with admirable, sharp insights and an experience that’s educational. They keep some good virtues alive through their work and give you some good quotes to remember and re-quote. And when they retire, they shift to their urban bungalow.

Another kind of doctors come here in the welfare-mode. They think it’s a charity that they are helping with. They are amazing volunteers at times, ready to take up every task and do it ‘for the cause’. They create an image of compassion-driven professionals and generate respect for themselves in the community quickly. They pick up the singular ladder to Prestige early in the career. There is a split here though. Some run soon out of this compassion that they borrowed either from their religion or a movie and leave quietly. Some who stay longer build big infrastructures as their charm pulls many other welfare-mode donors. These doctors help many, but within the same paradigm that created the suffering. As the limitation of charity, they hardly ever challenge the structural violence in the institutions of healthcare and the community. Moreover, they become a ‘good product’ of those institutions. So, the issues remain, the need for charity remains and no significant knowledge, experience or activism is born out of them. These doctors themselves may be modest, but do not remove materialism from the healthcare they provide. So, their beneficiaries don’t do it either. They please people in individual interactions but they die a hero without actually killing the villain.

A bunch of doctors come here dragged by their rosy idea of themselves. They have a sharp brain and were involved in many social activities in their college in some student association/groups and had to always ‘keep doing the right thing’. They understand things, are often strongly opinionated right from the start and talk of their morals and untested ethics repeatedly. They get more people to join them, they stick to their older image of a good-student and mistake it for a compulsion to do good work. They post stories on Instagram, justify their actions to their group and frequently seek their validation. They claim to understand capitalism, communism and socialism because they read books on related topics. But as they move ahead in the clinical and social realms of rural health, they realise that being a rural doctor is a lifestyle choice and not an illustrious career choice. Their socialist impersonation is hit hard by the capitalist market. Their tourist phase ends soon and once they have seen all the ponds, rivers, forests and hills around the village, they start getting tired of stories of patients who live near those ponds, rivers, forests and hills. It ‘drains’ them, they say. They do not really take up any responsibility in the organisation they are working with but speak of bringing a revolution inside and outside of it. They leave, often very soon in the name of ‘pursuing higher degrees’ and never return. But they do carry this tag of being a rural doctor everywhere and start their speeches with “once when I worked in that village…”. They mimic others’ wisdom and cover it with their knowledge. They want to climb the Power ladder but softly. Perhaps, it’s power that they were seeking all along.  

Then there is this distinct lot, that is so much pained and broken by the events of life that they first come to rural health organisations to seek a ‘safe space’. It is true that these organizations harbour high human values and the ‘vibe’ is usually respectful, considerate and loving. So, these doctors feel better for a while. As they are already primed with suffering, they try to connect their pain with the pain of people they treat and seek asylum in that interaction. They do speak to the people with a genuine sensitivity. They do welcome others in their circle once they start feeling a little better as they find some meaning in their work which also aids their healing journey. Some tread a spiritual path as they move ahead and they become respected within the organisation for their presence. Then one day, their blues are back. They realise that this work wasn’t a cure for their pain because they did not take it up for the people in the first place. They did it for themselves to have that ‘safe isolated space’. So once their own emptiness hits them and the void of ideologies, goals and vision is revealed, they find themselves incapable of expanding their learnings and insights to their surroundings. They have the risk of being this irritable person who knows the fundamental problems of a patient but is grossly helpless against them. Their work doesn’t go beyond themselves. They would know that an unfair employment policy caused a particular disease, but they would be clueless and reluctant to fight for it. But these doctors create and live amazing stories of patient care, as their sensitivity is honest in its expression. They rarely climb the ladder to power or prestige. At least not by themselves. They take a walk in their flowery garden with boundaries.

The rarest of the rural doctors come here as a traveller and not a tourist. They become students when they interact with a community and are willing to read people before they read a book. But they do read books to strengthen their will and appreciate the beauty of emotions. Even in their naivety, they had realised that their work is about social justice of which they and the community are equal beneficiaries. So, they challenge the power structure and unsettle the society because it is a part of the treatment. They attract and encourage art. They take immense pleasure in creating something with the community as an expert participant, not as a guide. Their incentive is the joy of creativity itself, not the outcome. But their community often loves the outcome, so they protect it with a quiet commitment. They may not always be articulate; may not publish regularly and may not get invited to conferences. These were never the milestones in the journey they opted to have. But from an action as simple as taking a pulse, they reflect all the knowledge, experience, values and ideals they have kept moist for years in their life. These doctors stress on staying with the community rather than revolutionising it, despite harbouring a revolution inside themselves for decades. But despite the loving aura they have, they annoy their families. Sometimes, they project their commitment onto others and often can’t explain the need of their work while the world around is ‘ok’ and they could be ‘ok’ too as others often tell them. This breaks some of them, scars them at times. And if their inspiration and respect for their own story is not strong enough, they live for the myth of revolution. Nevertheless, they never leave the work and these are the ones people accept and adore the most. They never really pick up a ladder to power and prestige, they create a home where these pursuits are meaningless.

While these are observations over not a very long period of time, I believe that this distinction I presented is the distinction of predominant traits, not a compartmentalisation. Many doctors often exhibit more than one type and this can also vary according to their age. They also have an overlapping set of values which makes them interact. But this observation is something I personally would like to enrich as my own time in rural health will move forward. Tonight, I will sleep with the question “what mix of the above doctors am I?” If YOU as a reader want to share your observations about me, please do.  It will help. (But don’t write it in comments please, share it personally)

To clarify, my intent was not to assert one’s superiority over the other. Those people doing PhDs can do it. For everyone, it is ultimately a personal journey started because of factors they had little control on but made them take a rebellious decision. They just protect their decisions in their own way. Rural healthcare amusingly has space for all of these doctors, unless someone wants to pick up the ladder to Paisa. That ladder never existed.

At last, if YOU are a doctor who has interacted or worked with me and tried to find yourself in this article, I hope to read/listen to your reflections about the work that you do.