Indien: aus dem alltag im besten krankenhaus des landes

Dr. Manish De ist Anästhesist am berühmten All India Institute of Medical Sciences (AIIMS) in New Delhi. AIIMS gilt als das beste universitäre Krankenhaus des Landes, wo Behandlungsmethoden auf höchstem Niveau auch den ärmsten Patienten angeboten werden können.

Dhurjati Paul, der selbst aus Indien stammt, hat dort sein Praktisches Jahr gemacht und mit Dr. De über seine Arbeit, das Gesundheitssystem in Indien und seine persönlichen Eindrücke auf seiner Reise zum Arzt im AIIMS gesprochen.

Dr. De, for how long have you been working at AIIMS and how does an average day look like?

Dr. De: Hi, I am Dr. Manish De. I am working as an Anaesthesist in AIIMS, New Delhi for 2 years. Each day is very hectic with 8  am to 6pm of average duty hours. At the same time, I am exposed to brilliant minds, exceptional equipments and one of a kind operation theatre (OT = OP-Saal) setup in the world.

How was your experience till now working here?

Dr. De: I had a wonderful experience here till now. I met a lot of really extraordinary Anaesthesists. This is a promising place to actually apply one’s knowledge. Faculty (= Oberärzte), seniors (= erfahrene Ärzte), support staff of OT all are working in unison to maintain integrity of this world class institute.

How much does treatment cost per day at AIIMS? Does the government provide any health insurance?

Dr. De: In AIIMS, we serve both the poor and well to do. All medications, procedures and ward admission charges are free of cost for the needy having a below poverty line (BPL) certificate with income of less than 100 INR (Indian National Rupee) per day (ungefähr 1,43 Euro). A very minimal amount of 100-500 INR/day (ungefähr 1,43 - 7,14 Euro) is charged for treatment of most of our other patients. We do have private wards (= Privatstationen) with five star quality rooms and care where treatment costs around 2000-5000 INR/day (ungefähr 28,57 - 71,43 Euro). Indian Government does provide Health Insurances like Delhi Goverment Employees Health Scheme (DGEHS) for all the employees working here and Central Government Health Schemes (CGHS) for anybody willing to get themselves registered.

In average how many patients does one single doctor have to see per day?

Dr. De: In AIIMS, the doctor:patient ratio is 1:1700. On an average, one single doctor has to see almost 200-300 patients per day in out patient department (= Ambulanz, Poliklinik) from 9 am to 5 pm. In the wards, one doctor is alloted to look after 5-10 patients per day. 6-8 patients undergo surgery in each OT under supervision of 2-3 Anesthesists per day.

Was it tough to get in such an institute? Tell us something about the competition that Medical students and doctors face here.

Dr. De: Yes, I had to go through a lot of examinations before I cleared the AIIMS Post-graduate (PG) entrance examination. This examination is conducted by AIIMS every six months. Almost 100.000-150.000 candidates appear for this examination every semester for a total of 150-200 PG seats in all clinical and non-clinical branches. So, the competition is pretty tough here. We do have an All India National Eligibility cum Entrance Test (NEET) conducted every year. Around 200.000 - 250.000 doctors appear for NEET for approximately 4000-5000 PG seats.

So, in India after completing the basic Medical course, we have to clear this Post-graduate entrance exam in order to get the opportunity to become a specialist.

How is the Medical course designed in India? How long is the duration of the course? Tell us something about your journey and your background.

Dr. De: Medical curriculum in India is of 5 and a half years duration, divided into 4.5 years MBBS course (= Medizinstudium)  and 1 year internship (= Praktisches Jahr). We are taught Anatomy, Physiology and Biochemistry in 1st year; Pathology, Pharmacology, Microbiology and Forensic Medicine in 2nd year (1.5 years); Opthalmology, Otorhinolaryngology and Preventive and Social Medicine in 3rd year and Medicine, Surgery, Obstetrics and Gynecology and Pediatrics in final year. We are given ward teachings from 2nd year onwards. After completing MBBS, 1 year internship is mandatory in all clinical departments.

After MBBS, one can join any Goverment or private hospital as a MO (Medical officer). Anyone can appear for PG entrance examination. After clearing it, one can either join a Diploma or MD/MS course (= Facharztausbildung) in any clinical or non-clinical subjects depending on his/her rank in the exam. Diploma course is of 2 years and MD/MS of 3 years duration. After MD/MS, one can appear for DM/McH (= Spezialisierung mit Schwerpunkt) entrance examination for Medicine or Surgical super-specialisation branches which is of 3 years duration. In total, it takes around 12 years to be a specialist in any branch in India. But, jobs are available in between when one is studying for super-speciality. Each traning course after MBBS is stipendary.

I always wanted to study medicine from my childhood. So, I started training myself during my board exams (= Abiturprüfungen) to appear for medical entrance test (Aufnahmeprüfung für das Medizinstudium).

I cleared it in 2007. With God’s grace, I got admitted in the oldest medical college in Asia, Medical College, Kolkata. It was a wonderful journey of friendship, fellowship and fraternity from 2007 to 2012. Then, I completed 1 year internship. After that, I was House-physician for 1 year in Cardiology and CCU (= Critical care unit, Intensivstation) at my alma mater (= Universität) for 6 months each. Then, I prepared for my PG entrance examination for 1 year. Finally, I joined AIIMS as MD trainee in the Department of Anesthesiology, Pain Medicine and Critical Care in 2015.

What is the most fascinating thing that you have seen till now or who is the person that fascinated you the most in your Medical journey?

Dr. De: The most fascinating thing I saw was revival of a 24 years male patient of Hepatic Encepahalopathy due to Hepatitis A, during my internship in Medical College, Kolkata. Given the limited resources in state colleges, we tried level best to treat our patient. The patient came disoriented with a total bilirubin of 42 mg/dl and came back walking with total bilirubin of 4mg/dl. On the day of his discharge, the parents of the patient literally bowed to our feet and from that day onwards, my respect for this profession and my patients magnified a million times.

I always looked forward to hard working and knowledgable colleagues and seniors who have guided me althroughout my carrier. Special mention will be my best friends in my alma mater, Dr. Rimesh Pal, Dr. Amartya Kundu, Dr. Soumen Chakrabarty and Dr. Mainak Banerjee. I am deeply indebted to my professors, Dr. Sanjay Chatterjee and Dr. Sekhar Mukherjee who were pioneers of Medicine in Medical College, Kolkata among many more I couldn’t mention.

As an Anaesthesist how important is the knowledge about human physiology?

Dr. De: Anaesthesia is a subject standing on the pillars of Human Anatomy, Physiology and Pharmacology. If one is well verse with all of them, he can call himself a satisfied Anaesthesist. Anaesthesia starts from cardiovascular and respiratory system and continues it’s journey through cerebral and renal physiology. It is a hub of never ending knowledge. We want patients in our OT, ICU (= intensive care unit), pain clinics and emergencies to be within physioligical limits. So, if one knows the limits, he/she will be a good Anesthesist. We actually save patients from near-death situations with our continous hard work and clear knowledge of physiology.

What are your future plans regarding your career?

Dr. De: My primary aim in life is to alleviate suffering and pain of my fellow countrymen. Thus, I have plans to pursue Pain Medicine course after my training in Anesthesiology. I want to come to Germany also if possible in future to recieve training on this specialization.

How can foreign students apply for an elective training or internship at AIIMS?

Dr. De: Foreign students are welcome to do their elective training, internship or just observership at our hospital. They can apply online by writing to the Dean (= Dekan) and further information is then provided by himself.

Dr. Manish De, we thank you for this interview and wish all the very best for you and your future plans.