Tag: doctors attacked

Watch | COVID-19 Daily Updates: After Attacks on Medics Rise, Ordinance Passed

Attacks on doctors and health workers will now be seen as a non-bailable offence.

Union minister Prakash Javadekar told the media on Wednesday that the Central government has amended the Epidemic Disease Act of 1897 under which attacks on doctors and health workers will be seen as a non-bailable offence. The accused, if found guilty, be awarded a jail term of three months to five years with a fine of Rs 50,000 to Rs 2 lakh. In cases of severe injury to workers, the jail term will be increased to six months to seven years with a fine of Rs 1 lakh to Rs 5 lakh.

This development has come amid an increase in the number of attacks on healthcare workers. The latest case was the attack on the family and friends of a doctor who died of COVID-19 while they tried to bury him in Chennai. Locals falsely believed that the doctor’s burial in the vicinity will ‘contaminate’ the area.

On Tuesday, The Indian Medical Association called for a candlelight vigil and the observance of a ‘Black Day’ to protest against violence and discrimination faced by medical practitioners treating COVID-19 patients.

Following this, home minister Amit Shah interacted with doctors from via video-conference. After their meeting with the home minister, the association called off their protest.

Note: The total number of active cases, deaths and the number of patients cured mentioned in the video are as of Wednesday morning. According to the latest figures updated by the health ministry, the number of coronavirus cases in India stands at 20,471, including 3,959 recoveries and 652 deaths.

The Antidote to the Crisis is in Cooperation, not Segregation

The trick, as the ancient Taoist saying goes, is to fight the monster without becoming one.

In early March, the Director-General of the World Health Organization had commented that stigma, “to be honest, is more dangerous than the virus itself.”

His statement was made when reports of racism towards the East Asian communities had started growing across the Western world.

Over the next many weeks, the story played out just as he cautioned, and India has been no exception. Our society, ridden with cracks across many lines, is now confronted with heightened fear, paranoia, vigilantism, ostracism, invasion of privacy, discrimination and stigmatisation. Not just positive cases, but even those ‘suspected’ are facing social resistance.

So are the doctors, social workers and many others on the front-line treating those with COVID-19. The answer, on how best to address these issues, lies to some extent in understanding how similar issues were handled around previous pandemics. In the Indian context, an analysis of our overall socio-economic conditions and how this virus and the consequential and somewhat inevitable ‘lockdown’ has amplified the class divide will be helpful. 

Historically, in 1853 when United States was gripped with the yellow fever epidemic, European immigrants, who were perceived as vulnerable to the disease were stigmatised.

People with their belongings are seen at a vegetable market early morning where the entry of outsiders is restricted during a nationwide lockdown imposed in the wake of coronavirus pandemic, in Ghaziabad, Monday, April 20, 2020. Photo: PTI

In more recent times, the East Asians were attacked during the SARS epidemic and Africans post the Ebola outbreak in 2014. As professor, Abhik Roy, points out, “Although the causes of pandemics and their effects may be different, history shows that the demonisation of certain minority groups is an all too familiar scenario when a nation struggles with a viral pandemic.”

It is stated that, through many decades and across many centuries, people of ‘other cultural backgrounds’ – the outsiders – have been made scapegoats for being carriers of contagious diseases. But as Roy explains, and it may sound overtly simplistic, what the history of pandemics has taught us is that our instinctive desire to scapegoat some members of a community inevitably creates wildfire of conspiracy theories.

What history also tells us is that the only solution is to break the cycle and stop engaging in dissemination of misinformation. But unlike ever in the past, as a society, we are addicted to social media and therefore need to exercise even greater caution and resist the urge to ‘forward’ that unconfirmed news alert which we receive. Our government has, therefore, done well to announce it will penalise the spread of fake news and maintain a strict vigil on how its directives are implemented. 

Confronted with an unprecedented crisis, the Indian government’s call to enforce a lockdown and adopt measures related to ‘social distancing’ was really a choice between economic loss or loss of life.

Also read: The COVID-19 Crisis Tells Us Democracy Needs Expertise as Much as it Does Elections

Our government valiantly chose human life and despite its good intention, it couldn’t have imagined that the solution would create a new societal epidemic – a disease that deepens India’s class distinction. While disciplining ourselves to keep a safe distance, the age old practice of untouchability is re-emerging, where we are treating each one as an impure ‘other.’ It is perceived that only the secluded will emerge victorious. 

Not all have the luxury to isolate.

To keep the system going, essential service providers, those kirana shops that we had passed upon for the bargains at the big retailers, are functioning. As also are many others starting from bureaucrats and police personnel to municipal sanitary workers, vegetable vendors, milk men, garbage collectors, chemists, delivery boys and a host of others. Needless to say, no amount of caution is enough.

Children feed birds. Photo: PTI

But aren’t we taking it a bit far by collecting bags through sticks or have vegetables left at gates so as to avoid contact, or give instructions through balconies from where we drop our money only to square-up later. Till date, there has been no shortage of supplies, for which we are all relieved. But we don’t want these ‘outsiders’ who fulfil our daily needs to come too close for they may be the spreader and after all we must at all times remain safe.

Enough has been written about the plight of migrant workers, but let us once again acknowledge the multitude of hapless ‘others’ who for absolutely no fault of theirs, have overnight been thrown out of everything — jobs, wages, shelters, source of income. As someone commented ‘passport wala virus laya aur ration card wala suffer kar raha hai’.

Like all of us, they too wanted to be locked down in ‘their homes.’ They really don’t deserve any blame and definitely not our heartless neglect. If not now, then when ever will there be a need for humanity to extend empathy and show compassion towards them. 

Another societal ill that’s emerged is the stigmatisation surrounding COVID-19. What else explains the numerous suicides that one is reading about daily. Or the constant assault on the entire Muslim community for the gross irresponsibility of the Tablighi Jamaat.

Also read: In Assam, Syed Abdul Malik’s Ode to Composite Culture Is Being Vilified on Social Media

Doctors who spend 16 hours in those PPE suits return home only to be confronted by belligerent landlords who fear that they will bring home the virus. With a disease that yet has no cure, but which still has an over 80% rate of recovery, even recovered patients are being victimised.

It was numbing to read about the man from Shivpuri, Madhya Pradesh, who, upon his recovery and return from hospital was forced to put his house on sale, because his presence was no longer ‘socially acceptable.’ Equally distressing was the story of the nurse in northeast Delhi who had fully recovered and yet was treated by those in lockdown as though he was a criminal coming out of a lock-up and polluting their surroundings.

And it’s painful to even talk about the doctor in Chennai, who succumbed to the virus, transmitted to him while caring for a patient, but whose family wasn’t even allowed to give him a respectful burial.

From all that one is reading, it appears the virus isn’t going away anytime soon. At a time like this, rather than becoming strangers in an increasingly estranged world, we need to turn closer towards our fellow human beings. Let us therefore treat this collective human ordeal as a call for solidarity.

We must collectively work to shed the stigma surrounding the virus and get people to tell the truth about their travel history and not hide medical conditions for the fear of being quarantined. Not everyone needs a ventilator and there are more happy stories than sad ones and that’s what we must focus on. 

As our Prime Minister stated in his recent message, this virus does not distinguish between race, religion, caste, colour and borders and humanity’s response to this common challenge should be based on unity and brotherhood. We must therefore remind ourselves that viruses don’t discriminate, but society does.

Rats and a crows share food left by people on a roadside during the nationwide lockdown to curb the spread of coronavirus, in New Delhi, Wednesday, April 22, 2020. Photo: PTI

We need to move beyond societal structures of casteism, classism, elitism, and patriarchy as though only a certain section of society is vulnerable. It’s time to realise that this pandemic is an equaliser in that it endangers the entire human species.

Empathy, shared responsibility, and collective understanding stand complementary to the bio-medical measures that interrupt transmission. Both are essential to overcome this pandemic. 

We have to defeat the virus medically, but also with wisdom, compassion and humanity. The effectiveness of the fight against the virus will be determined on the level of social solidarity, and the degree to which we’re willing to look out for each other. God forbid, if tomorrow someone in our own home gets tested positive, we won’t abandon them.

Then why must be any less compassionate to our neighbours or even that stranger whose story we hear? Let’s remind ourselves, unlike some other viruses, patients of COVID-19 have little to no control on how they may contract the virus.

We must therefore remember that the real antidote to the pandemic is not segregation, but rather cooperation. This sense of humanity must be viral in every house, street, city, and country.

The trick, as the ancient Taoist saying goes, is to fight the monster without becoming one!

Satvik Varma is an advocate based in New Delhi. A graduate of Harvard Law School, he’s licensed to practice both in India and New York.

Uttar Pradesh Doctor Who Treated COVID-19 Patients Dies of Same Disease

Thirty-five-year-old Nizamuddin was the head of a community healthcare centre.

New Delhi: A doctor who had been involved in the treatment of COVID-19 patients died after having contracted the disease, at Moradabad on Monday.

The doctor has been identified by local news reports as 35-year-old Nizamuddin. PTI has reported that he headed the government-run Tajpur community healthcare centre.

Nizamuddin, who reports have said was an Ayurveda doctor, had been undergoing treatment at the quarantine centre in the Teerthanker Mahaveer University Hospital in the district.

He had reportedly been associated with the National Child Health Programme.

The Hindu has reported that the doctor had also been part of the team that visited the “area where attendees of a religious congregation in Delhi were found.”

The hospital’s quarantine centre in-charge Virendra Singh told PTI that Nizamuddin had been treating coronavirus patients and got the disease from them. “He was admitted to the hospital on April 13,” Singh is quoted by PTI as having said.

Moradabad Chief Medical Officer M.C. Garg, however, told The Hindu that Nizamuddin was admitted to TMU on April 10 when he tested positive. “On April 11, when his condition deteriorated, he was shifted to the ICU. On Sunday night, he suffered a heart attack and died during treatment on Monday morning. Five members of his family have been quarantined.”

On Monday, the state health department’s principal secretary, Amit Mohan Prasad had said 19% of patients in the state were in the age group of 0-20 years, 48% between 21-40 years, 24% between 41 and 60 years, and 8.50% are above 60.

Uttar Pradesh has reported a total of 1,294 COVID-19 cases, out of which 1,134 are active, Prasad said in his daily briefing on Tuesday.

Nizamuddin’s death comes hours after that of a Chennai doctor, Simon Hercules, who it is being suspected also may have contracted the disease from patients. Hercules’ burial made news after it was was met with stiff opposition from locals.

While the Delhi government of Arvind Kejriwal has announced Rs 1 crore for the families of healthcare and sanitation workers who die in the line of duty, Odisha chief minister Naveen Patnaik has announced Rs 50 lakh’s assistance for their families.

COVID-19: Structural Changes Are Needed to Address Violence Against Health Workers

Rather than only limiting responses to punishment and harsher penalties, policymakers must address the underlying structural factors that lead to violence against healthcare professionals.

As Indian healthcare professionals battle the raging COVID-19 pandemic, several media agencies have reported disturbing incidents of violence against healthcare professionals. In Indore, stones were pelted at healthcare workers trying to screen for the coronavirus, while in Hyderabad, a junior doctor was assaulted by relatives of a deceased patient. Similar incidents have been reported in other parts of the country as well.

While the COVID-19 pandemic is admittedly unprecedented, these incidents of violence are themselves not new and are part of a larger pattern that has received widespread media coverage in recent years. The Vidhi Centre for Legal Policy’s research on violence against healthcare professionals analysed 56 such reported incidents of violence between January 2018 to September 2019. In a number of such instances, the death of the patient was an immediate trigger for violence, while aggressive relatives prompted violence in other situations.

A review of Indian studies and academic writing on the issue revealed the crippling lack of infrastructure and personnel to deal with growing numbers of patients, poor quality or complete lack of primary care, leading to overburdening of secondary and tertiary care facilities, and overall poor communication skills as distinct causal factors of violence.

Also Read: India Needs an Urgent Law to Protect All Health Workers From Violence

Turning a crisis into an opportunity for bigger reforms

An immediate response to violence against healthcare professionals is usually prosecution under harsh laws and calls for new laws to deter similar conduct in the future. This response is based on the theory of deterrence which assumes that offenders make rational choices and avoid indulging in certain conduct due to the high costs associated with the consequences.

Deterrence-based reasoning, however, works better when laws are accompanied by efficient enforcement and criminal conduct is premeditated rather than the result of sudden and violent emotions. In India, violence against healthcare professionals occurs in specific contexts and situations and is hardly ever premeditated. Further, the well-acknowledged slow pace of the criminal justice system questions the efficacy of only using criminal laws to address violence in healthcare settings.

In light of COVID-19, the policy-makers are focusing their attention on meeting the immediate needs of healthcare professionals such as supplying adequate personal protective equipment (PPEs) and ramping up infrastructure by increasing isolation facilities and ventilators. However, the crisis presents an additional opportunity to take a long, hard look at Indian healthcare and address many of the systemic issues which have led to violence.

Therefore, rather than only limiting responses to punishment and harsher penalties, policymakers must address the underlying structural factors that lead to violence against healthcare professionals.

Members of Resident Doctors Association of AIIMS wearing bandages on their heads protest to show solidarity with their counterparts in West Bengal. Photo: PTI)

Need for structural changes

While global best practices suggest that several steps can be taken by the healthcare establishments themselves to prevent violence and to provide redress to their employees, hardly any steps are taken in India at the organisational level to prevent and address such violence in healthcare establishments. The World Health Organisation (WHO) recommends that specific obligations should be imposed on healthcare establishments to prevent violence like the elimination of risks of violence, routine assessment of the incidence of violence and its causes, developing policies, plans and monitoring mechanisms to combat violence, setting up adequate mechanisms for reporting.

Post-incident interventions should also be undertaken by healthcare establishments like providing medical treatment, counselling, management support, representation and legal aid, rehabilitation etc. Additionally, having proper grievance redressal mechanisms in healthcare establishments for patients can prevent them from getting triggered.

Further, as healthcare professionals in India are not protected by labour laws, having an occupational health and safety framework in the health sector in India, similar to the US, can go a long way in addressing the issue of violence. In the US, employers including healthcare establishments are liable to provide their employees with a workplace free from recognised hazards likely to cause death or serious physical harm. In addition to violence, this kind of framework will also impose greater accountability on healthcare establishments towards ensuring the safety of healthcare workers in a pandemic when they are exposed to higher risks.

Also Read: At AIIMS, Confusion as Healthcare Workers Asked to Reuse N-95 Masks

As poor communication skills in healthcare professionals have been identified as one of the factors linked to the rise in violence against them, the Indian medical curriculum needs to be reformed to make medical graduates equipped with effective and empathetic communication skills. The medical training curricula should focus on techniques to deal with the grief of the patient’s attendants, socio-political reasons underlying the flareups involving patients and their relatives, and the ability to deal with vulnerable groups such as the victims of sexual abuse and the LGBTQ+ community. Addressing these issues will contribute to preventing the triggering of violence due to the lack of communication skills in doctors. In the context of the current crisis, where doctors may be overburdened even accessible public communication about the pandemic could go a long way in addressing misconceptions.

Another factor that has contributed to violence in recent incidents and has come in the limelight in the current COVID-19 crisis is the breakdown of trust between the healthcare system and the patient population. For instance, COVID-19 has highlighted concerns regarding access to ventilators and prohibitive costs in private hospitals. These correspond to identified reasons which include high cost of procedures, medication, and hospital stay; inconsistent quality of treatment based on patient’s ability to pay; perceived corruption of the doctor-pharmaceutical company nexus, among others. This highlights the urgency of rehauling the regulation and governance of healthcare in India to ensure accessibility and greater accountability on the part of healthcare establishments, both public and private.

Turning our attention towards these structural issues in the long term will not only address the problem of violence in healthcare settings but will also help build trust in doctor-patient relationships. The COVID-19 pandemic is an opportunity to think deeply about these issues.

Akshat Agarwal and Shreya Shrivastava are research fellows at the Vidhi Centre for Legal Policy. Views expressed are personal.

India Needs an Urgent Law to Protect All Health Workers From Violence

As the world battles a pandemic, who will protect the protectors?

The world is going through an emergency. We are at war, albeit not with a combatant nation. We are at war with a pandemic, which has subsumed more than 50,000 lives worldwide. The cavalry on the frontlines is not our regular militia but our healthcare professionals. It is the doctors, the nurses and the hospital support staff that are leading the offence against the pandemic.

The grim reality, however, is that our healthcare professionals are neither adequately appreciated nor protected. News reports tell us that there is not enough PPE (personal protection equipment) for our doctors and nurses. That they are misbehaved with. That they are pelted stones at and spat on by unruly people who were defiant from the very beginning. If this doesn’t enrage the conscience of the nation, nothing probably will.

What are the legal indemnities available against such actions? Why do we not have a separate law criminalising assaults on doctors and healthcare professionals?

Last year, the Ministry of Health, government of India proposed the passing of the ‘Health Services Personnel and Clinical Establishments (Prohibition of Violence and Damage of Property) Bill’, which had contemplated imprisonment of up to 10 years and the imposition of a fine of as much as Rs 10 lakh on those who assault healthcare personnel. It had even attributed a fairly wide definition to healthcare personnel which included, doctors, dentists, nurses and paramedical staff, medical students, diagnostic service providers in a health facility and even ambulance drivers.

This legislation was due to be introduced in parliament in its Winter Session of 2019. However, the Ministry of Home Affairs gave its thumbs down to this proposed legislation, reasoning that there could be no separate law to protect doctors.

However, in Delhi, we do have the ‘Delhi Medicare Service Personnel and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2008′, which is an Act to “prohibit violence against medicare service personnel and damage to property in medicare service institutions in the National Capital Territory of Delhi…”

Also read: Calcutta HC Slams Detention of Doctor Who Tweeted on Insufficient Protective Gear

Section 3 of this Act prohibits any act of violence against medicare service personnel or damage to property in a medicare service institution. Section 2(d) provides an inclusive definition of a ‘medicare service personnel’ which includes inter alia registered medical practitioners, nurses, nursing aids, midwives, paramedical workers, ambulance service providers etc. Section 2(f) defines ‘violence’ to mean ‘activities of causing any harm or injury or endangering life, or intimidation, obstruction or hindrance to any medicare service personnel in discharge of duty in the medicare service institution or damage to property in such institution’.

In terms of Section 4 of this Act, acts of violence under Section 3 are punishable with imprisonment up to three years or with fine of Rs 10,000, or both. The offence under Section 3 is also cognisable and non-bailable. However, it seems that for want of knowledge about this enactment, its provisions are seldom invoked by the Delhi Police.

On May 3, 2017, a division bench of the Delhi high court, alarmed by the increasing incidents of violence on doctors, took suo-motu cognisance of a news article in the Times of India titled ‘AIIMS doctors to get self-defence training’. The news report suggested that one in two doctors in public hospitals face violence. As a sequitur, notices were issued to the Union of India and the Delhi government, however it appears that there has been no progress in the writ petition since.

Therefore, insofar as Delhi is concerned, while we do have a substantive piece of legislation criminalising such assaults, it appears that there is little awareness about its existence. This is inferred from the order dated May 19, 2017, where the Delhi high court asked the government to consider giving wide publicity to the provisions of the enactments.

Also read: The Wire Impact: Thane Hospital Doctors Finally Get Protective Gear

A similar enactment may or may not be present in other states in the country. Therefore, in the absence of a Central legislation on the subject, attention necessarily would have to be made to the Indian Penal Code to punish such violators.

The provisions of the IPC, which would cover assaults on public servant, would be the following:

  • Section 186 : Obstructing public servant in discharge of public functions.—Whoever voluntarily obstructs any public servant in the discharge of his public functions, shall be punished with imprisonment of either description for a term which may extend to three months, or with fine which may extend to five hundred rupees, or with both.
  • Section 332 : Voluntarily causing hurt to deter public servant from his duty.—Whoever voluntarily causes hurt to any person being a public servant in the discharge of his duty as such public serv­ant, or with intent to prevent or deter that person or any other public servant from discharging his duty as such public servant, or in consequence of anything done or attempted to be done by that person in the lawful discharge of his duty as such public servant, shall be punished with imprisonment of either descrip­tion for a term which may extend to three years, or with fine, or with both.
  • Section 353 : Assault or criminal force to deter public servant from discharge of his duty.—Whoever assaults or uses criminal force to any person being a public servant in the execution of his duty as such public servant, or with intent to prevent or deter that person from discharging his duty as such public servant, or in consequence of anything done or attempted to be done by such person in the lawful discharge of his duty as such public serv­ant, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

However, the common denominator in all of the above provisions is the supposition that victim is a ‘public servant’ as defined under Section 21 of the Penal Code. While this might be true for employees of public hospitals, the same may not hold true for doctors and healthcare staff who are in the employment of private hospitals. For them therefore, the provisions of simple assault and hurt may apply, which carry significantly less stringent punishments.

In the United Kingdom also, even though there are no separate offence for assaulting a public servant, assaults that are committed on public servants are treated seriously. Paragraph 4.12 (c) of the Code for Crown Prosecutors states: “… A prosecution is also more likely if the offence has been committed against a victim who was at the time a person serving the public.” This is reflected in the Sentencing Council’s Definitive Guideline on Assault, in which the fact that ‘Victim was providing a public service or performing a public duty at the time of the offence’ was clearly identified as an aggravating factor.

Also read: AIIMS RDA Writes to PM Over ‘Backlash’ Against Doctors for ‘Raising Genuine Concerns’

The sentencing practice in the UK indicates that custody is the appropriate starting point for a person who assaults a public servant. Case examples are the following:

  • R v McNally 2000 1 Cr. App. R (S) 533– the appellant was attending a hospital with his son when he became involved in an argument with a doctor and assaulted him with one punch. He had no previous convictions and was charged with ABH. The Court of Appeal held that 6 months’ imprisonment was the appropriate sentence, and reiterated that such circumstances seriously aggravated the offence.
  • R v Eastwood [2002] 2 Cr. App. R. (S) 72 (at 318)– the appellant was drunk and in A&E when he assaulted a nurse during the course of an X-ray. The nurse suffered torn ligaments in her hand, and he was charged with ABH. The Court found that in such circumstances, the starting point after trial was between 21 – 24 months’ imprisonment with a sentence of 15 months’ imprisonment suitable after guilty plea.
  • R v Colin Dickson [2005] EWCA Crim 1826– having regard to the case of McNally and the judgement of Rose LJ on aggravating and mitigating factors for length of sentence, the Court of Appeal considered that the same factors will come into play when determining the appropriate sentence for assaults on police officers. Such are attacks are particularly grave and any attack on a police officer who is carrying out his duty has to be treated very seriously.
  • R v McDermott (Victor) [2006] EWCA Crim 1899– assault occasioning actual bodily harm carried out on a member of an ambulance crew. Appellant was attended to by an ambulance crew when found lying in the road and was verbally abusive to the crew who sat him on the ambulance step. He stood up and punched one of the crew in the head, causing his ear drum to rupture. Appellant was drunk at the time and had previous convictions for drink-related offences, including ABH and criminal damage. Appeal against length of the sentence was dismissed – assaults on medical staff and ambulance personnel would frequently merit a custodial term. There had been no personal reason for the assault, alcohol was an aggravating, not a mitigating feature. 15 months’ imprisonment was appropriate in all the circumstances.

However, in the UK too, there is the similar problem of distinction between professionals engaged in public healthcare and those engaged in private healthcare. While the former is clearly an aggravating factor for sentencing, the latter may not be.

This unwarranted distinction by itself is a prime reason why an umbrella legislation for the protection of all healthcare staff, be it public or private, needs to be brought in at the earliest. The draft proposed by the Ministry of Health seems to be a balanced draft and had already passed the rigours of public consultation. It is now incumbent upon the Ministry of Home Affairs to reconsider its earlier stance and usher the passing in of this key piece of legislation.

The imminent need for such a legislation would, in my opinion, justify taking the ordinance route to bring it into immediate enforcement, as well. After all, the question that stares us in the face today is, ‘Who will protect the protectors?’

Rushab Aggarwal is an advocate at the Supreme Court of India and the Delhi high court. He can be contacted via email on mail@rushabaggarwal.com.

IMA Condemns Violence Against Doctors, Nurses Who Went to Treat JNU Students

“How does it reflect on the nation, if it cannot protect its doctors and nurses reaching out to the injured?” the doctors’ association asked in a statement.

New Delhi: The Indian Medical Association has condemned the violence unleashed on doctors and nurses who went to Jawaharlal Nehru University to treat injured students.

“How does it reflect on the nation, if it cannot protect its doctors and nurses reaching out to the injured?” the doctors’ association asked in a statement. “Is this a civil war? What is the message that goes out to the nation?”

The IMA also said that the Union home ministry has been blocking a law against violence on medical professionals. “IMA reiterates that doctors and nurses have the right of way to treat the injured and everyone has the right to life and access to care,” the body said.

In the past, the IMA has been known for its silence in political situations and even criticised for bending too far for the ruling regime. In August 2019, IMA president Santanu Sen wrote to the editor of The Lancet because the journal criticised the Narendra Modi government’s actions in Kashmir. Sen alleged alleged that The Lancet had “no locus standi on the issue of Kashmir” and had “committed breach of propriety in commenting on this political issue”.

Also read: ‘They Were Banging the Door With an Iron Rack’: Students, Teachers Describe JNU Violence

Recently, however, it has made public statements questioning the use of police violence. On December 22, 2019, during the height of the anti-Citizenship (Amendment) Act protests and the government’s crackdown, the association condemned police action inside hospitals, calling it “a new low in the civic life of the nation”.

The statement also said that the police action is not entirely unexpected, referring to the “impunity” with which doctors and hospital staff are often attacked.

Watch | ‘Safed Coat Wala’: An Ode to Doctors Across India

Navaldeep Singh speaks about violence against doctors in his latest poetic performance “Safed Coat Wala”.

Poets are rebels who use their words to change the world bit by bit. Poetry is a powerful tool that is used to spread messages in the most melodious manner. It can be used as a great agent for social change. Poet Navaldeep Singh uses it as a medium to start conversations about important social matters.

He speaks about the topic of violence against doctors in his latest poetic performance ‘Safed Coat Wala‘.

The brutal attack on Paribaha Mukherjee, an intern in Nil Ratan Sarkar Medical College, Kolkata, on the night of June 10, followed by the pelting of stones at students and doctors in Burdwan Medical College, reiterates the issue of safety in the workplace for doctors. But, were hardly the first incident of the kind.

This poem is an ode to the doctors all over India, who are nothing short of saviours. Navaldeep Singh portrays the grim reality in our country, where almost 75% of our doctors have faced some form of violence during their practice.

Also read: The Stethoscope Versus the Fist: A First-Hand Account

Featured image credit: Youtube screengrab

Watch | Doctors’ Strike and the Display of Enmity Through Cricket

A discussion on how fair the doctors’ strike was, its impact on the public and how the media reported it.

On Monday, doctors across India decided to boycott work for a day in support of their colleagues in West Bengal. Two doctors were attacked and injured by a patient’s relatives in West Bengal on June 11. The doctors demanded action against the accused and security measures for the hospital staff.

The strike has left many patients in a lurch and is affecting those in critical conditions since doctors have refused to attend to them.

Urmilesh discusses how fair the doctors’ strike was, its impact on the public and how the media reported it with senior journalist Gautam Lahiri, Qurban Ali and Dr Omshankar from Benaras Hindu University.

A Doctor’s Strike Was Inevitable in West Bengal’s Broken Health System

Years of neglect of the public healthcare sector has lead to an unmanageable increase in patient load.

West Bengal’s public healthcare delivery system has virtually collapsed, as resident doctors of government medical colleges continue to protest against the state’s non-sympathetic attitude towards their security concerns. To make matters worse, a few hundred senior doctors have tendered their resignations in the last few of days to show solidarity with the striking junior doctors.

This round of agitation started after the relatives of an elderly patient, who died on Monday at a medical college in Kolkata, alleged that he died due to negligence. Things took a turn for the worse soon after as hundreds of people entered the college premises and thrashed junior doctors brutally.

It must be noted that this is not a one-off incident. Cases of vandalism and assaults on doctors in hospitals for reasons such as a patient’s death because of alleged medical negligence have become a regular phenomenon in West Bengal. The situation became so alarming a year and a half ago that the state government wanted to introduce taekwondo for self-defence for medical students in all government medical colleges.

Despite these measures, violence continues unabated in hospitals and therefore, the question arises – How did we get there?

The genesis of the crisis

There are a few inter-related issues which are responsible for the healthcare crisis in West Bengal. One, in government healthcare facilities, people vent their anger against the staff as the services are simply not up to their expectations. As a result, doctors, nurses and other staff members who directly engage with patients become the victims of the patients’ families and relatives’ ire.

Years of neglect of the public healthcare sector has greatly affected the ability of government facilities to cater to people’s medical needs. The near breakdown of the referral system has increased the patient load on the tertiary-level facilities beyond manageable limits.

Also read: What Hospitals Can Do to Curb Attacks on Resident Doctors

In this respect, the medical colleges which are located in Kolkata are the worst sufferers. Patients come not only from different localities within Kolkata but they are also being referred to from adjoining districts such as North and South 24 Parganas, Medinipur, Murshidabad and Nadia. On any given day, the patient footfall is anything between 3,500 and 4,000 in each of these medical colleges.

Faced with such overcrowding of care seekers, the system by default comes up with allocative devices such as rationing of services, including time. The doctor-patient interaction time becomes so limited that it leaves the patient and her family members utterly dissatisfied.

Many of them are forced to seek preferential access to services based on personal connections or by bribing touts. This situation has arisen due to the severe inadequacy of health infrastructure in the state, critical for the delivery of health services.

Currently, on an average, a government allopathic doctor in West Bengal serves more than ten thousand people (10,441 persons), falling far short of the WHO recommended doctor to population ratio of 1:1000 (this holds true even after the inclusion of AYUSH doctors and private physicians). In addition, as of 2018, in West Bengal, there are only 5.62 beds available in government hospitals per 10,000 population.

Unfortunately, common people cannot even fathom the larger picture as to why government hospitals are in such disarray. In fact, the government campaign is such that it provides sufficient financial resources to public facilities so that people can avail free treatment.

Further, the government keeps boasting about its initiatives of setting up of several new multi-speciality hospitals, fair priced medicine shops and diagnostic centres. Through this misleading campaign, a false impression has been created in the public consciousness about the state of government health facilities. Therefore, when the people come face to face with the harsh reality, they become frustrated and at times, resort to extrajudicial means.

Besides these supply-side issues, the current crop of doctors has also contributed to this crisis to a certain extent. Earlier, the budding doctors were more eager to learn the practical aspects of medicine and hence, they used to spend more time with the patients and, through this process, a doctor-patient bond used to develop. But the current trend among the medical students is to pay greater attention to the theoretical aspects so as to clear the entrance test for PG, which would eventually help them get a job in a corporate hospitals So, it would not be incorrect to say that today’s lot lacks a bit of empathy towards their patients.

Also read: The Notion That Doctors Are Infallible Needs to Be Broken

The ongoing agitation by the doctors has hit the poor the most. It is important to know who the consumers of government health services are. According to the 71st round of the National Sample Survey, 80% of the bottom 40% (ultra-poor) depend on the in-patient care provided by government hospitals in West Bengal.

Unsurprisingly, they do not have the means to seek treatment from private hospitals and that is why patients have been lying in front of hospitals, waiting for the doctors to attend to them. The current impasse, therefore, needs to end at the earliest. One can only hope that better sense prevails and both sides soon return to the negotiating table.

Soumitra Ghosh is Assistant Professor at the Centre for Health Policy, Planning and Management, Tata Institute of Social Sciences.

What Hospitals Can Do to Curb Attacks on Resident Doctors

In a recent survey of 193 resident doctors, 61.7% had been exposed to violence by relatives, patients and/or accompanying caregivers.

The recent attack on resident doctors following the death of a patient at the Nilratan Sarkar Medical College (NRS) in Kolkata highlights the glaring, yet often overlooked, issue of violence against foctors meted out by relatives, caregivers and patients. The World Health Organisation has estimated that between 8% and 38% of health workers will be subjected to physical abuse at some point in their career.

In a soon to be published study, conducted via online survey by the Centre for Enquiry into Health and Allied Themes, in collaboration with the King Edward Memorial Hospital and Maharashtra Association of Resident Doctors, it was found that violence against resident doctors is widespread and high. The study sought to capture the perspectives and experiences of resident doctors working in public hospitals in Maharashtra on such violence: how it affects them and their practice, and their response towards it. It also asked for doctors’ recommendations on preventing and responding to such violence.

Of the 193 respondents, 61.7% had been exposed to violence by relatives, patients and/or accompanying caregivers. Of these, 76.5% had been exposed to more than one incident of violence as a resident doctor working in a public hospital in Maharashtra.

The violence comprised several forms of abuse. Threatening (76.5%), humiliation (57.1%) and pushing/shoving (57.1%) were the most commonly reported. Assault was reported in 17.6 percent of the incidents. It was also found that it was groups (73.9%) of relatives (in 91.6% of these cases) and escorts that were largely responsible for such attacks. The presence of groups/mobs has been documented in several cases of assaults on doctors (such as the one in Kolkata last week, in the Dhule Civil Hospital in 2017, in 2018 at DY Patil Hospital in Pimpri and several other incidents).

Also read: The Notion That Doctors Are Infallible Needs to Be Broken

Residents reported violence against them even in routine medical cases (such as removal of a double-J stent and even dog bites), and not only in emergency cases. In terms of system-related factors, delay in providing care, overcrowding, long waiting time for patients and relatives, and lack of equipment and drugs were opined to contribute to such incidents. These were accompanied by the lack of effective systems in place such as a gate pass system, restriction of entry of relatives to certain areas of the hospital, etc.

Such violence affected residents personally and professionally. Residents reported avoiding giving proactive advice to relatives and patients (39.5% reported this), losing motivation at work (34.5%), developing anxiety about coming to work (35.3%), becoming fearful (36.1%), having repeated memories about the incident (20.2%) and even participating in related protests (31.9%).

When asked about their immediate response, it was disconcerting that calling seniors/hospital administration was not what they often did. The absence of a senior doctor is an issue that warrants immediate attention. Leaving the residents to deal with emergency care has been highlighted as a matter of concern by several stakeholders.

Post-incident, a total of 44 respondents (37%) reported having taken no formal action. The reasons for not taking any action were: it was of no use to report such an incident (56.8%); there were no procedures available in the hospital to formally report such violence (29.5%); or did not know about procedures to report such violence (27.3%). Only 13.4% of residents in the present survey said that hospital administration encouraged them to report violence.

It is also important to note that 58% of the residents have reported that the hospital administration took no action in the context of the incident and several residents even reported being blamed for the incident. Merely 30% recorded a medicolegal case, which is at least some documentation of an incident of violence. Hospitals routinely register cases such as patients falling off the bed as a medicolegal case, and so it can only be apathy that assault on a doctor in hospital premises is not recorded as one.

The study points to a critical gap: the absence of formal mechanisms, protocols and policies to prevent and address violence against residents. The role of the hospital administration and the state is critical in addressing this.

Security measures such as guards, CCTV cameras, emergency alarms, etc., are very important to put in place. However, in isolation, these measures will not be effective in prevention and may even prove counter-productive. They should be a part of comprehensive strategies and policies to deal with violence in the heath sector, and be accompanied with relevant training and response protocols.

Watch: Understanding the Doctors’ Strike in Bengal and Its Political Context

It is the responsibility of the hospital administration to implement strategies to prevent overcrowding, such as a gate pass system and restricted patient entry. Senior doctors should be present at critical and sensitive times such as at the time of declaration of death or times of critical communication with patients and relatives. The study found that a majority of incidents had occurred during night duty. The availability of seniors at this hour is therefore pertinent.

The hospital administration should encourage to residents to report violence and ensure that every resident is provided support and each incident of violence reported by them is investigated. There should be a move towards filing an institutional FIR in such incidents and not left to the individual doctor.
Residents should be able to have a safe and conducive workplace. Incidents of violence against resident doctors need to be prevented, better responded to and their impact mitigated. And towards this the hospital administration needs to be firm and proactive and the institutional environment towards the issue of violence against residents needs to change and made more supportive.

Tejal Barai-Jaitly is a researcher working with the Centre for Enquiry into Health and Allied Themes on the study on violence against doctors. The author would like to thank Dr Padma Deosthali for her inputs.