Where is the Hippocratic Oath?

In my quest to understand as many dimensions of the Indian public health system as possible, I accompanied my colleague to a government health center to help set up a new neonatal care unit (NCU) and observe/assess delivery and newborn care practices. Six months ago, the state government passed a health policy mandating that 100 CHCs (out of 270 in Rajasthan) establish a separate room designated specifically for neonatal care. This center was one of the lucky – or so I thought – hospitals chosen to receive 1.25 lakh ($125,000 USD) to purchase necessary
equipment and drugs.

Originally, I was confused by our mission to “set-up” the unit, since I assumed that that would fall under the purview of the hospital staff. Nope. My colleague explained that three radiant warmers (to regulate temperature) and one phototherapy device (to treat jaundice) had been sitting unused in a storage room for the past six months, and that without support from my NGO and him being physically present to oversee the process, nothing would happen. So, we wheeled a line of four pink and white machines from the storage room to the NCU.

The journey took a total of five minutes.
IMG_8467
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(Old devices that were no longer in operation)

My colleague couldn’t hide his elation; he smiled ear to ear and repeatedly thanked the obstetrician for his support and cooperation, after which the doctor graciously and rightfully acknowledged my colleague’s pivotal role in the process. This was among the first cohort of any health centers to utilize the government funding to establish an
NCU. I was incredulous that there wasn’t greater effort to utilize available funding, even if for corrupt reasons. When I asked the doctor about this, he explained that most hospitals don’t know that this money even exists, and if it wasn’t for my colleague, than they too would have remained unaware.

My colleague’s dedication to ensuring that health centers within the public system are availing eligible funds and following through with establishing NCUs is simultaneously inspirational and demoralizing. The level of hand-holding for setting up a fundamental aspect of a hospital is shocking. When I reflect on this scenario, I cannot believe that this doctor is being congratulated for improving services for newborns. Isn’t that his *!@% job?!

The doctor’s parting words, albeit facetious, captured the attitude of some officials within government health system who continue to perpetuate the millions of preventable deaths and injuries each year: “I hope you know that this new unit is going to increase my workload.” I have always interpreted the Hippocratic Oath, “Do not harm,” as a pledge not to knowingly conduct incorrect or nefarious behavior. However, I now understand to a wholly new degree that inaction is a form of action, and, as such, the destructiveness of apathy.

From another angle, this comment also reveals an aversion to taking on the risk of dealing with sick newborns. This mindset prevails among some government medical professionals, which, as the director of the women’s health-focused NGO I’m working for says, “prevails and kills the desire to bring about change.” The very essence of a doctor’s role is to take responsibility for and manage high-risk, life-altering situations — hopefully with the intention of securing, maintaining, and increasing patient wellbeing. If doctors are unwilling to do that, than they are violating the fundamental human right that they have pledged to promote: “the highest attainable standard of health (WHO),” which, in my opinion, is akin to criminal behavior.

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One thought on “Where is the Hippocratic Oath?

  1. Kyla,
    Thanks for sharing the never-ending internal conflicts arising from engaging with the system! The sin of omission is just as severe as the sin of commission, I’d say.

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