Not to speak of the poor patient who will go through hell during this period. Many of them will suffer in silence or die in obscurity as five-star health care services are woefully out of their reach.

This will be the fourth strike by the Maharashtra Association of Resident Doctors (MARD) in the lasttwenty years. Their demands have essentially remained the same. They want a reasonable pay scale, which should match the salaries drawn by the residents of other states and an improvement in working conditions. Considering the sub-human conditions they work in and the mere pittance they draw for the services they put in, this is not asking for too much.

Presently, junior and senior resident doctors in Maharashtra draw Rs 4,500 and Rs 5,100 per month; as against their counterparts in Delhi who draw Rs 15,000 and Rs 18,000 respectively. The fee paid by these post-graduate students in Delhi is Rs 1,280 per term (six months); as against that our resident doctors pay Rs 6,000 in government medical colleges and Rs 13,000 in municipal ones.

The resident doctors work in pathetic conditions, to say the least. There are as many as five or six doctors staying in one small dingy room. It is common to see one doctor sleeping on the cot and one sleeping below. In one teaching hospital in Mumbai, residents are housed inmortuary barrack, where they share their room with scores of rats. The number of bathrooms, latrines, waterfilters, etc. are woefully inadequate.

Mess services are either insufficient or totally absent. Doctors have been demanding subsidised meals during duty hours for almost two decades now only a handful of hospitals have been able to do so. There is no regulation of workload. Due to decrease in number of postgraduate teachers, there is a proportionate decrease in the number of resident doctors. This has resulted in an enormous workload on every working resident. It is not uncommon to find residents working for forty-eight hours continuously without a break. They do not have a weekly off, a night duty does not necessarily mean that they will rest for the next twelve hours.

The truth is that the resident doctors form the backbone of the public health delivery system, without them no hospital can function even for a day. Full-time senior doctors, honorary doctors and lecturers work for only a limitednumber of hours -- they cannot maintain even twenty-five per cent of the services provided by a hospital.

In recent times, even physical threats and assaults have come to haunt the resident doctor. Add to this the risk he runs of contracting deadly diseases like AIDS, Hepatitis-B, tuberculosis, etc; and his cup of woes starts overflowing.

Exploitation is the name of the game. The authorities know that the resident doctor is also a postgraduate student, who can be easily threatened or victimised. Moreover, this being a floating group, it is very difficult to unite them or to keep them united. Being a vulnerable group, they are also amenable to political manipulations. One controversy which raises its head every time MARD goes on strike is whether resident doctors are students or employees; whether they receive stipend or salary. This is a typical ``chick first or egg'' story. The fact is that they are fully qualified M.B.B.S.

doctors, who are registered with the Maharashtra Medical Council. It is purelyincidental that they are also doing their postgraduation. Student or employee, stipend or salary, can any hospital run without their services?The issue of whether doctors should ever strike work is contentious. Some consider it unethical, some a legitimate form of protest in a democratic setup. Suffice it to say, a very meagre salary coupled with abysmal working conditions can only make it impossible for them to work efficiently and live with dignity. Basically no resident doctor likes to strike work, it is only when the situation reaches breaking point that he reluctantly exercises his right to protest or agitate.

How, then, can this imbroglio be solved permanently? The solution is simple the resident doctor should get what is due to him. His salary should be commensurate with his basic minimum needs. In one of his judgements, Justice Ranganath Mishra of the Supreme Court directed all the states of India to implement the Model Residency Scheme. The Fifth Pay Commission recommended handsome pay scales forresident doctors, which are already being implemented in Delhi and other North Indian states. Nearer home, in 1991, the Sapatnekar Committee appointed by the then chief minister Sudhakarrao Naik recommended a substantial rise in pay scales for resident doctors. In short, there is a widespread recognition that the residents deserve a better pay packet and decent working conditions. What, then, prevents the present-day government from meeting a justified cause?

Reports of bankruptcy of the state government may be true, but certainly it is not so poor that it cannot meet the just demands of only four thousand residents. How does one, otherwise, explain the Diwali bonus of Rs 8,500 per worker paid to four lakh municipal employees, Rs 25 lakh spent to buy a limousine for the governor or Rs one crore per month per minister being spent on the jumbo-ministry or Rs 390 crore as bonus-largesse to government employees.

A doctor once asked me in disgust, ``Why can't we ask our politicians to go to hell?'' My replywas, ``Because they are busy creating one in India.'' We are about to witness one such hell, starting November 22.

Dr Arshad Gulam Moh'd is president of the Indian Medical Association's Bombay West branch