As someone who is one year away from being a qualified doctor, and is completing an internship in a government hospital, the recent spate of attacks on doctors is unnerving.
In the past month, resident doctors have been attacked by irate relatives of patients in at least three separate occasions. Resident doctors are postgraduate students who work in government hospitals. They are qualified doctors specializing in the many branches of medicine, and are the main healthcare providers in the hospitals they work in. Security was noticeably absent in these situations, and the relatives were allowed a free hand in injuring the doctors.
In response to the lack of support and governmental apathy, close to 4,000 resident doctors have abstained from work as a mark of protest, demanding more from the government, in the form of greater security at hospitals, and strengthening laws that protect health-care providers from such attacks. This is in view of the fact that there have been no convictions in cases of such attacks, and even after repeated assurances security has not been provided. The trigger to these protests was the reporting of new cases of violence over the past week, in the Civil Hospital in Dhule, Lokmanya Tilak Municipal hospital (Sion hospital) in Mumbai, and the Civil hospital in Aurangabad.
The problem of this violence against doctors is not a new one. As many as 45 cases have been reported under the Doctor’s’ Protection Act 2010 over the last 3 years, as stated by Dr. Yash Kabra, President of the Central Maharashtra Association of Resident Doctors (MARD). The Act criminalises attacks on doctors with a punishment of a three-year prison sentence. However, protesters believe that the Act will only be effective if implemented better and if the period of imprisonment is increased to a minimum of seven years.
These strikes have attracted public scrutiny, with a public interest litigation filed by Mr. Afak Mandiya, who complained that frequent strikes across the state of Maharashtra have adversely affected the condition of health services. After serving notices to at least 1200 resident doctors from KEM Hospital, JJ Hospital and Sion Hospital, the Bombay High Court on 23rd March 2017 ordered all resident doctors in the state to end their strike immediately and resume work, stating that “medical emergencies are critical and are unlike any other emergency, which can wait”, as reported by the DNA.
In what appears to be some form of respite, the Maharashtra Government has promised that more than 1,000 armed guards will be deployed at civic and government hospitals across the state. However, the residents in Maharashtra have not yet decided to return to work, stating that they want written confirmation from the concerned authorities that court directives will be implemented, not verbal assurances. It is also pertinent to note, that although elective procedures and consultations aren't taking place as part of the protest, emergency departments are still functioning.
Whilst the issue is unfolding, with many opinions from all sections of society, it raises some pertinent questions with respect to governmental frameworks, infrastructure and budgetary allocation. As a society, it is important to remember that it should not be a situation of Doctors Vs. Patients, since both are essentially on the same side. The side that wants a healthier and more productive population.
When one inspects the reasons for this violence against doctors, the obvious answer stems from the fact that relatives of patients are likely to attack doctors in situations where they think the patient has not received the care he deserves. Sadly this is a common occurrence in Government hospitals, not because of the doctors, who are working against all odds, but because of a hospital infrastructure that is in shambles. When patients come to hospitals looking for care, and are greeted with less ICU beds, no essential drugs and overworked doctors, it is no surprise that violence unfolds.
It is abundantly clear that such a grim situation has come to pass because of the lack of government initiative in the healthcare sector. The root problem does not lie with doctors or patients. We live in a country with the second largest population in the world and also with the lowest government expenditure on healthcare. India spends only 1.3% of the GDP on health as opposed to the WHO recommendation of 5%. It is more appalling that these numbers have clearly not been remedied by the National Health Policy of 2017, which was prepared with the aim of revamping healthcare and moving towards a ‘robust healthcare industry’.
The Policy is ambiguously drafted and is ambitious only in language, but not in spirit. It sets out various aims and objectives to ensure a reduction in ‘catastrophic expenditure’ on the public’s part, but is completely silent on the framework to achieve such goals. It provides no details on the definitive direction that needs to be taken to ensure a better healthcare system in India.
Another problematic aspect of the Policy is that it calls for Public Private Partnerships in the field of healthcare financing citing reasons of ‘critical gaps’ that need to be plugged. What the Policy consequentially ends up doing, however, is that it allows the Government to escape responsibility when it comes to allocating higher amounts of money for the healthcare sector. Moreover, the Policy conveniently forgets the various disadvantages of a PPP arrangement, such as negligible accountability owing to weak monitoring, and inadequacy of relevant information in the public domain.
The discontentment among the resident-doctor workforce is an automatic result of weak policy construction, which fails to cater to basic, practical needs. What this leads to is an overworked doctor workforce, a shambolic health infrastructure, and average care being given to patients. Individual doctors cannot be held accountable for this inadequacy of care to patients, it is merely a consequence of an apathetic Government which is shunning its responsibility towards society.