ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846
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Striking Out

Doctors need to go beyond demanding security to address violence against healthcare workers.

 

The attack on two doctors by a deceased patient’s relatives in a Kolkata hospital and subsequent events snowballed into a nationwide strike by doctors last week. The stir started off with the junior doctors in Nil Ratan Sircar Medical College and Hospital going on strike demanding increased security in hospitals. The inaction on the part of the Mamata Banerjee government, with the chief minister choosing to give the doctors an ultimatum instead, led to the resignation of many senior doctors in the city and protests by doctors all over the country, culminating in a nationwide strike called by the Indian Medical Association (IMA) on 17 June 2019. With all non-essential medical services, including OPD services, being affected by the strike, patients across the country were left to their own devices.

Not too long ago, in 2017 we saw a similar situation in Maharashtra, when, after a spate of attacks on doctors, the Maharashtra Association of Resident Doctors had striked for five days. Then too, their demands were regarding increase in security measures, which were acceded to by the government. In the two years since, we seem to have not learnt any lessons, with the demands of the doctors and the solutions of the government again revolving solely around the issue of security. While the demands of the doctors for more security and safety measures and a strong law are justified, these will work only as stop-gap measures.

The striking doctors in Kolkata also demanded the setting up of a grievance cell and the passing of a central law prohibiting violence against healthcare workers (HCWs). The IMA has also limited its efforts to calling for a central law and has stayed within the security discourse. While there already does exist such a law in West Bengal, as well as in many other states, that makes violence against HCWs a punishable offence, it has clearly been left unimplemented by the government. Recent studies have shown that incidents of violence faced by doctors and other medical personnel are becoming increasingly common, not only in India but globally. In fact, one of the studies has revealed that it is nurses who face the brunt of the violence, along with those working in the emergency and intensive care wards who come in direct contact with patients and their relatives, whereas another found that doctors attribute the long waiting times in hospitals as the cause of patients’ frustration and violence in most cases. Also, a 2018 study of HCWs in a tertiary hospital in India has noted that though workplace violence was found to be prevalent, the reporting of such incidents by HCWs was exceedingly low because of a high level of unawareness about the reporting mechanisms in the hospital. These observations point to a deeper malaise in the healthcare system in India.

While no form of violence can be condoned, be it that against doctors by indignant relatives of a deceased patient or that which is caused to patients as a result of strikes by doctors, an examination of the conditions in which it occurs, while not justifying it, can explain its occurrence. The problems plaguing India’s healthcare system are no secret. As the strike was going on, reports of a serious outbreak of Acute Encephalitis Syndrome in Bihar’s Muzaffarpur district that has led to the deaths of over a hundred children, and counting, were trickling in. This outbreak just goes to show the crippling incompetency of public healthcare, and in a state where the disease is known to be endemic. Reportedly, none of the public health centres in Muzaffarpur district even meet the minimum standards required. This has resulted in an outbreak that will only strain the already overtaxed healthcare infrastructure and resources further, and will only contribute to creating conditions conducive to patients becoming frustrated and desperate. In the absence of grievance redressal mechanisms and shortage of human resources to handle the situation, confrontations between HCWs and these helpless patients are likely to result in flared tempers, and violence is apt to ensue.

From dealing with inadequate medical infrastructure and resources, to being overworked in public hospitals, the workplaces of doctors have become high-pressure environments. Further, a highly corporatised system that tends more to the business of healthcare now has changed the ethos of the system. A private sector in healthcare that continues to function unregulated and unmonitored, rising costs of healthcare, inaction on medical negligence, and such incidents of violence; these have all lead to an increasing trust deficit in the doctor–patient relationship over the years. The doctor is no longer the benevolent saviour in the eyes of the patients. The “care” in healthcare has taken a backseat, where there is a lack of appropriate communication skills among doctors to be able to deal with patients in critical conditions as well as their grieving relatives.

In this context, the doctors’ demands at all such protests and strikes over the years being limited to security measures have been rather short-sighted. The real problem lies at the systemic level and issues need to be tackled at that very same level. In order to do this, the government needs to first ensure the implementation of the law on HCWs’ protection. It also needs to implement the clinical establishments act, budget for ample human and other resources, and see to it that all healthcare establishments follow the basic norms as laid out in the law. Most importantly, there is need for change from within the doctor community as it is the doctors themselves who are best placed to raise these systemic issues and demand their resolution in order to ensure that the provision of healthcare happens in a functional, efficient, and safe manner.

Updated On : 26th Jun, 2019

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