No country for doctors

Doctors all over the country supported the Indian Medical Association’s nationwide protest on Monday, against the attacks on doctors in West Bengal. However, we kept emergency services open; because that is what we are supposed to do as doctors – save lives.

I remember reading a quote by Kate Gilmore, UNHRC’s deputy high commissioner for human rights. According to her, healthcare workers are part of the “machinery of human rights defence”, yet are increasingly being targeted for doing their jobs. This is not only unconscionable, but also “against international humanitarian law”.

I agree with her in labelling attacks on doctors “wrong, unfair and unjust”.

Doctors are in a special position in regard to human rights. Every hospital is like a war zone. There’s anxiety, time pressure, threat of loss of life. No matter how capable and committed, a doctor can’t always save lives.

There is tremendous pressure on doctors to routinely relay bad news to families on the brink of losing a loved one. This makes every healthcare worker vulnerable. There is no workplace in the world that deals with life and death situations as much as a hospital does. Here’s a question: if relatives of patients  start attacking the doctors, then who will admit emergencies?  It is a sad reality that three out of every four doctors and healthcare workers admit to some form of verbal or physical abuse.

Public hospitals in India have massive workloads. These doctors work continuously for more than 24 hours, oftentimes without any food or rest. They see patients 4-5 times more in number than elsewhere in the world. Commiserating with relatives over the demise of a patient is something every doctor would like to do. But the circumstances may not allow it, because there is another life that needs to be saved.

Junior doctors in public hospitals, in addition to living in almost sub-human conditions (two doctors crammed into a room with filthy toilet and other poor facilities), also frequently contract serious communicable illnesses including meningitis, encephalitis, bird flu and multi-resistant tuberculosis. These public healthcare champions succumb to illnesses and are never acknowledged.

Many of us will remember the March 2017 incident, when the absence of an on-duty neurosurgeon led to the beating up of Dr Rohan Mhamunkar at the Dhule civil hospital. Dr Mhamunkar now suffers from blurring of vision in one eye. He had gone on record to say he wishes he had become an engineer instead.

Or the case of Sion Hospital resident doctor Rohit Tated, himself a polio patient, who had clocked in 36 hours of duty – only to be attacked by relatives of a 60 year old patient with kidney failure. And it’s not just Maharashtra or Bengal. In September 2015, in a shocking instance of lawlessness in Uttar Pradesh a doctor was beaten up in Sitapur, because the hospital ambulance failed to reach the patient on time.

Nurses and other hospital staff also often face the ire of upset relatives. Other factors associated with violence in hospitals are long wait times, psychiatric patients, patients who have a history of violence and patients under the influence of drugs or alcohol, according to a study published in Journal of Emergency Medicine.

I applaud health minister Dr Harsh Vardhan’s response, asking law enforcement agencies to ensure that doctors and clinical establishments discharge their duties professionally without any fear of violence. Doctors cannot do their jobs in constant fear of assault.

The Centre’s inter-ministerial committee set up in 2015 to review doctor protection, had suggested that the health ministry initiate the process to bring a central act on the issue of assaulting healthcare workers being a non-bailable offence. It needs to be enacted into law immediately.

Since 2007, 18 Indian states have passed laws protecting doctors and healthcare workers from attacks. But enforcement is questionable. I think we need to move in that direction quickly and save India’s doctors for the patients who genuinely need them.

As acts of violence occur with increasing frequency, imagine a scenario where doctors refuse to treat patients, fearing abuse. This is a cultural issue as well; and often, as is seen with cultural issues, there has to be a legal support system for reform. It is a crime to assault a cop, a public servant; and so it must be a crime to assault a nurse or a doctor as well.

As for the case of Kolkata’s Dr Paribaha Mukhopadhyay, who is now being treated for a skull fracture after being assaulted by relatives of a  patient with bricks, please remember that India’s brightest students will not choose medicine anymore if this trend continues. In that case, where are you going to produce good quality doctors?

A few misguided Indian citizens, who are attacking doctors today, are clearly not able to see the bigger picture. In a country where access to healthcare is already so poor, where will the needy patients go? Is a doctor risking his own safety, every time he takes up an emergency case? We need to bring back basic democratic ideals to healthcare in India, and protect our doctors from a few rogue citizens who are jeopardising the lives of millions.

DISCLAIMER : Views expressed above are the author’s own.

AUTHOR

Ramakanta Panda

The writer is a cardiac surgeon and heads the Asian Heart Institute, Mumbai

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TOP COMMENT (2)

1. I agree with views expressed in this article. 2. Political parties have to take the entire blame for the current state of affairs as far as violence against doctors is concerned. Patientsâ anger can be understood but to appease voters, politicians often make doctors and other staff targets of their criticism as did West Bengal Chief Minister. 3. I am reminded of a violent incident in Thane near Mumbai, in which the hospital property was burn and a good hospital facility was wiped out by violent mob. But it is politiciansâ response to such incidents which is important. If I am correct, no one was ever held responsible for destruction of hospital property, as that was convenient to rulers. 4. Violence against doctors and other healthcare staff cannot be ended by enactment of laws. Improving quality and infrastructure of (a) our government hospitals and (b) other public healthcare facilities, especially through revamp of government hospitals and primary health care centres, needs to be given top priority. NARENDRA M. APTE

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