when I saw front page News in Mumbai Mirror about " Ward boys doing Doctors work in a Hospital in Mumbai", I was more amused than surprised.Because thats an Age Old Practice in India. When I was medical Student in K.E.M. Hospital Mumbai, C.L.W. Suturing was done by wardboys in Casualty. to my knowledge practice is still continuing in all the hospitals. Most probably it started off during World Wars when such wounds were sutured in battlefields by Medical Staff.

C.L.W. is "Contused Lacerated Wound". One gets it when there is any accident,fall while playing,a brawl or any form of injury. One on Scalp are most common, they are difficult to detect as hairs hide them and easiest to suture. You have seen Stallone " Self Suturing" a CLW in Rambo I-First Blood. Next to 'taking out Bullet with Pocket/Kitchen knife', its most common method to show Masochism in movies.

In Casualty, once its established that there is no other serious underlying injury like Fracture or Bleeding, CLW suturing is done and person is sent home. CLW suturing is done to stop bleeding and wound heals in week's time with thin scar. If suturing is not done than wound may bleed and healing takes longer and may leave ugly scar. Suturing is very easy and is more like Sewing done at home. only difference is that one uses Sterilized,Surgical thread with Surgical (Trocar Pointed) straight or Curved needle. Suturing with Curved Needle requires training and skill. With straight needle- most common - it's very easy. Thats why No one wants to do it, and it ends up with Lowermost person who cant say NO. Thats wardboys in Casualty.

In surgery its most basic thing and every one starts off with it. If in casualty Intern is posted or better, if students doing Surgical posting are there then they are given this job as favour. Wardboys are asked to 'Assist' them( Nursing staff wont bother to assist such a simple operation!) with warning for CLW on Scalp that " Take Care and dont push the Bloody needle in the brain". with merriment all around as soon as Students back is turned. Procedure is done with all the surgical care and observing most of the surgical principles. hands are washed, Gloves are put on, Wound is properly cleaned, towels are used to isolate the wound and sterile Technique is used while suturing. In short everything is done as if this is a proper, major surgical procedure. only problem is that Suturing requires no great Skill, hence for busy,overworked Casualty officer, its a burden and irritant which he wants to pass off to someone.

As the procedure is simple and done by person not using skill, result is 'ugly scar". In the case of Head wound, hairs can hide the ugly scar but if its on face or other prominent visible place than scar looks hideous and may require plastic surgery in future. So any wound on face, arms, Legs are referred to Plastic Surgeon. In Public Hospital this means wasting 3-4 hrs as Plastic Surgeons are overworked and they take pretty long time to suture the scar. But they will hide it. In private Set up this is costly affair and may set you back by 10-15K + service charge! Only you will know where the scar ( proof) of abusive,violent husband is and can show him to end all future arguments and fights!

Diplomas from CPS.

Last week a PIL was filed by Dr.Arun Date against College Of Physicians and Surgeons in Parel. Lawyer representing the Petitioner claimed that CPS established in 1913 has been handing out Fellowship like FCPS and Diplomas like DGO,DFP,DOMS,DORL,DVD etc. It is alleged that CPS doesn't have Hospital,faculty or Infrastucture. petitioner have asked Court to direct Govt. to withdraw recognition to CPS.

I have failed to understand the purpose of this Petition. All the Universities for MD/MS and Diplomas,,National Board of Examination Delhi for DNB also have no Hospital of their own. they have Faculty and Infrastuctue. same is the case with CPS. For Post Graduate Degrees and Diplomas all the state Universities, National Board have CET, then Students have to apply for Post Graduate course and according to Merit List they are assigned Degree or Diploma in a Subject as per their preference ,a Teacher and Hospital where they have to do Resident Doctors post for 3 years for Diploma and 4 years for Degree. They have to write Theses under the Guidence of the Teacher and finally take the Exam. pass it to get either Diploma or Degree.

As far as I know CPS follows the same pattern. With One Teacher one Student policy adopted about decade ago, number of Post Graduate Teachers/students for Degree course of state universities and national Board has gone down. One has to have 'Teaching Expirience' to be teacher for Degree and Univ.Diploma. That is the Teacher has done Post Graduate Training(resident Posts) in Teaching Hospital like KEM,Nair etc. If one has done Registrars Post of 2 years in Cooper or Bhabha,Nanavaty,Lilavaty Hospital in Mumbai then one do not have 'Teaching Expirience' and he/she can not become post Graduate Teacher.!!.No teaching is involved as such.

CPS recognises these Doctors as their Teacher for Diploma Course and assign students to these Teachers and are posted in Hospital like Cooper Hospital,Bhabha Hospital in Bandra,Rajawadi in Ghatkopar,Bhagwati in Borivali etc etc.

Normally there are no takers for these Hoseman/Registrar posts in Peripheral Hospitals if they are not recognised for any Degree or Diploma. Resident posts of these hospitals go vacant and few that are filled are by those who are in transit or by Doctors who want a place to live in Mumbai. (All Resident posts are 24x7 with Resident qarters.) More often than not in all these peripheral hospitals patients are looked after by AMO's. and Patients care suffers. But if these posts are Recognised for Diploma by even CPS then Resident doctors doing Post Gradute courses are available,Honarary Doctors take Classes, arrange for Seminars on one Sunday in a month, and teaching for student is provided. Hospitals like Nanavaty, Lilavati,Somaiya, etc get resident Doctors because their posts are recognised for DNB and Diplomas of CPS.

If the undisclosed reason for this PIL is well known secret that all these posts are sold than this is wrong approach. unfortunatelly all the Post Graduate Degree and Diploma courses in Medicine,dental are allegedly for Sale and at present, price varies from 30 Laks to astonishing 90 Lakhs for Opthalmology and Radiology degree course. There is even 2 year Advance Booking of the Seat !!

If the Court,acting on this PIL withdraws recognition of CPS,many hospitals in Maharastra will loose resident Doctors and finally patients will suffer. Its ironic that there is News item in newspaper that panel has recommended recognition to Coaching Classes on par with College for undergraduate degree.---PK