The Kafkaesk Bureaucracy
How to get permission to work as a guest physician at the Government Hospital of Leh, Ladakh, India.

On the 12/7/05, let us say day one, I presented myself to the Medical Superintendant of the SNM Government Hospital of Leh with the request to work as a guest physician. He did not accept my request with halfhearted reasons such as there is no place and I do not have a permit.
Our landlords in the guesthouse suggestet I should ask at the Mahabodhi Hospital in Choglamsar in the next Town.

On day two, I spoke to  Dr. Norbu, the surgeon at the Mahabodhi Hospital. He said however, the "case load" is too low and so I would not learn very much. I should try at the Government Hospital and ask the surgeon Dr. Tashi Mortup during his private consulting hours. Dr. Norbu was pleased about a small donation of surgical sutures I  brought allong with me.

Day three. The private clinic of the only surgeon of the SNM Governemt Hospital in Leh takes place in the first storey of a small house built of cement. You climb up wobbly  iron stairs and arrive on a narrow Veranda, squeezing past the pharmacy, mainly selling to Dr. Tashis patients. Now standing in a small queue on the mentioned Varanda. Two further tourists and I am waiting along with Ladakhis, Tibeten and Kashmiris.
Its "clinik" is perhaps 16 sqare meters large, about half of it is a meager waiting area with several plastic chairs you might use as garden furniture. A nurse does not exist.
Most patients are squeezed up in front of the consulting room door and listen to what is spoken inside. So the next in the line already can hear when it is going to be his turn.
When my turn comes, I find myself in a small booth, no larger than two times three meters! In the "corner" is a desk with Dr. T Mortup Kyser sitting at it. He showed me a stool to his left for me to take place on. He was measuring a patient's blood pressure and pulse sitting at the short side of the table; noted something and disappeared out of the door to come back with some medicine from the afore mentioned pharmacy.
In the meantime a further patient had emerged from a curtain behind me, behind which was an examination couch. Four people in a 6 qm large consulting room.
Now Dr. Taschen turned to me. After stating my request, he seemed to be pleased: "At the Government Hospital we have a very high work load". Already several foreigners had worked at the SNM in recent years. However I would need a permission of the Chief Medical Officer in the city. I should go there tomorrow. We would see each other by the latest the day after tomorrow. I thanked him.

Day four After I had found the "Office Of The Chief Medical Officer Leh (Ladakh)" I noted taht the dear gentleman did not want to be disturbed before 11:00 AM.
At the given time I presented my request. He nodded, pressed a button and the electronic sound of a bell sounded outside. A secretary in classical Ladakhi dress appeared. A long dark-brown dress or coat of solid rough material, around her hips a purple broad belt, her black hair tied in a knot and fastened on her head.
The Chief murmured a few words in Ladakhi or Hindi to her and told me that I could collect my permit tomorrow.
I thanked him, followed the woman and discussed the matter with her, because she needed copies of my license to practise medicine, passport and visa data.

Day five As discussed with the secretary I came at 11 o'clock to collect my papers  just to note that the letter was adressed to "The Deputy Commissioner/Chief Executive Officer, LAHDC, Leh" asking him to give me permission to work at the SNM Hospital.
And I should present myself in person. So I walked right across town in a  nice sunny 30 degree celcius to find this guy.
The two storied building with a green tin roof seems to be the city hall or something the like that. Many Lhadakis were studiing long lists on the outer walls. Inside in the cool and dark it was very busy.
No sign-posting showing where to find what. I followed the flow and discovered "The Office of the Deputy Commissioner". Messengers were going to and fro and persuaded me to enter. The Deputy was sitting in a large, bright, nearly empty area on a raised chair behind an enormous, heavy, extremely tidy desk. He was holding several papers in his hands, signing the one or other that was passed to him by his secretary standing beside him. At the same time he was discussing with five simple people sitting in a row of chairs before him in Ladakhi or Hindi an affair apparently about a "Homestay" with "Night sleeping".
When one of the places became free, I  took my place and handed the letter of the Chief Medical Officers to the Deputy. After having read the letter he scribbled some note, signed with his green pen and called one of the messengers with a bell sounding like "I wish you A merry Christmas".
I followed my letter into the office opposite and received a further signature. A simpler melody carried me with a further messenger down to the ground floor, into the world of the "division Officers" and I finally landed in an office without an officer.
After half an hour I decided to go to find out what was going on and found the "Chief Divisions Officer". He greeted me and offered me milk tea with nan (Indian bread). After some small talk he told me that the Divisions Officer concerned was at a funeral and no one could to this work and the officer should be back towards 2:30PM.
When I inquired again at 14:30 o'clock, he had not appeared yet. I was to come again in one hour or better tomorrow.
The messengers went their ways carrying highly important documents to even more important places wooed by melodious bell tones.
After one hour the dear Sub- Divisions-Officer was at his place and had even taken notice of my letter. My documents were being prepared and he indicated a stack of documents, which had risen to an astounding 500 pages. Everything appropriate was initiated and submitted to the Chief Officer for signature. I should come past tomorrow, or no, better on Monday starting from 10:30 AM.

Day six and seven: I needed the weekend to recuperate from the kafkaesken Odysee in this trial and my "Indian Belly".

Day eight: 10:30 AM, Divisions Officer: "There is the question whether you are a surgeon, we need the CMO to claryfy!"
Despite the fact that I explained that I was in further training to become a surgeon and was not a specialist yet. That was not sufficient for him. I should come back at 2 pm again.
Slowly I had had enough, so I went without permission to the SNM Government hospital. (see there).
At 2 pm I then revceived a letter addressed to the Chief Medical Officer in order to clarify whether my "degree is duly (!) recognised by the Medical Council of India". Hereby I went to the CMO and only found the secretary. I should come tomorrow...

Day nine: After I was allowed to go before the CMO and in a few words stated my problem, he wrote a couple of lines under the letter of the Divisions Officer and told me I should personally show up to the DC (District Magistrate).
Again through town under a crystal-blue sky and light brown dust under my feet.
The private secretary submitted my letter to the DC. After the respective waiting period, he noted something in the way I may work, but that no medicines are to be prescibed.
I followed the Messenger carrying the letter to the Office of the Headquater Assistant just opposite, who countersigned and then again in the ground floor to my Divisions Officer, Mr. Amin again. He said after reading it carefully:"O.K., you will come back tomorrow ".

Day ten: Mr. Amin sent me straight to Mr. Tashi, the Headquaters Assistant. He had received a hand-written preliminary version of my permission from Mr. Tashi. He read and countersigned it. The messenger brought the sheet to the chief typist in the typing office, who assigned one of her eight sub-typists to type it on the computer. While I was waiting Tea was served. The chief typist cheked hand written original and copy word for word, countersigned and a messenger brought the thick document back to Mr. Tashi. Only he was not to be found despite a long waiting period.
I came back in the afternoon and found Mr. Tashi straight away, because he still had to sign the permission. He had already done this, only the document was not to be found. It had travelled back again to the chief typist.
Mr. Tashi presented the long desired document to me after this long struggle.

Elias, Leh, 23/7/2005

Dr. Tashi's Private Clinic on the first storey on the verranda behind the pharmacy.

Letter of the Chief Medical Officer

My file

The chief secretary

The long desired document