District MO : You go district to relax..?

I am tired.

The first imagination when I was going to sent to a district hospital is purely an imagination. Listening from other senior who went to a district hospital before me, they said, it is time to relax in District.

Not so many patient. Woke up late, go to hospital at what time whenever you like. Go drink coffee at 10.00 am recess time. They have recess time?

Can go fishing. Farming. Went for vacation often. Have a lot of money to save. No need to buy groceries because people will bring groceries to you. Everything sound very nice and tempting.

Thus, I went to a dsitrict hospital. To my surprise, what I heard from other people are wrong.

As a district MO, you are left in a situation where there are limited resources available. You have a few colleague with you and not all of them are perfect. That is human nature. Everyone get tired and when you are tired, you tend to do everything within 50% of your reach.

Oncalls are frequent. More than what I get when i was a house officer. Thinking of doing vacation? You are oncall 3 weekend per month thus when will be your vacation time? Trying to apply for leave but your colleague is going for a course, or your colleague applied leave earlier than you...? You are basically stuck in district not going anywhere for the whole month. When you do have a weekend to go to a big city then you look like a monkey just able to get out from it cage.

Patient.... not few like I imagine. Everyday, I see 60-70 patients in clinic, see 20 plus patient in ward and in bad day can reach up to 30 patients. I thought I can have coffee time at 10.00 am.

Oncall can be bad..not everyday bad...but bad enough to make you feel exhausted by the end of oncall day. And you are oncall again that day..and the weekend after that day.

Escort is another thing. Escort a patient, spend 6 hours.. 2 hours journey to the city, 1 hour pass over, 3 hours going back to district ( when you go back, you can't turn on the ambulance siren to clear the traffic). After escort, you still have to think about the remaining patient.

Like my colleague said to me a few months ago when he joined my hospital..he said when he was a house officer, after work, there is nothing to think about, you just went home or go enjoy with friends somewhere, you work is basically finish for that day. When you are a medical officer, in district, after work, you still have to settle your patient because there will be no next house officer or medical officer to take over that patient for you. You left the patient in the evening, and tomorrow morning you will not expect oncall will settle everything for you. You still have to settle whatever that are not settle the day before. Its a responsibility given to you.

You have no specialist to help you, yes everyone will said, a specialist is just a phone call away but..he is a phone call away. Stabilize patient before transfer..thats the order from a specialist but your patient keeps going down under. Sometime you want to call specialist and say..."please help me" and cry out loud.

I live in hospital quarters with my family and my wife is also my colleague here in my district. I believe we don't spend enough time with our daughter. We are living in hospital quarters which is just  few hundred metres away and we still don't spend enough time with our daughter!

The sad thing, is when MO in big hospital start acting weird towards district MO. My colleague once said to me that his case was rejected because there is no bed in referral hospital. He insist to transfer that patient because he think that patient is sepsis..and the blood cns came out as Melliodosis. He was scolded because he didn't know how to manage sepsis.

That patient (luckily) got transferred that day after a numerous discussion with medical team. From what i heard, that patient admitted to ICU the next day and spend more than a week in ICU. He was right to transfer that patient.

Here in district, not that we do not know how to treat patient, but we know which patient that can stay and which one need specialist intervention. I believe we have been to state mortality meeting enough to be blamed that we did not transfer patient early enough to specialist centre. We don't do thing because we don't know how to do it.

I can say a lot more but you will not understand until you experienced the life as a district MO. The good thing is, this experienced tend to teach us to become better.

I will not regret to be here as a distirct MO.


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