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Undervalued And Overburdened: Doctors In India Deserve Better

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This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.
They are forced to work long hours in poor and stressful work environments. Representational image.

The other day I’d gone to the supermarket wearing a mask. Five minutes in, it felt like I was trapped with no air to breathe. I wonder just how difficult wearing PPE for hours at a stretch would be. Sitting at home, most of us underestimate the potential of the virus. Sitting within the four walls we call home, we feel secure enough to believe that the outside world wouldn’t be any different.

With the “unlock” in place, our Instagram homepages are filled with stories of people going about their lives as if COVID-19 was an instance from the past. The tally keeps increasing every day, but what may seem like numbers to us is the reality for all our healthcare workers every day. The same healthcare workers who are working 16-hour shifts in low-quality PPE, medical interns who haven’t hugged their parents in three months, nurses who have been asked by their society members to vacate their homes, resident doctors who’re afraid that they are carriers of the virus, and doctors who are being hit and abused for putting in their blood, sweat, and tears.

Most of the time, violence against doctors is only consciously perceived by doctors, medical students, and their family members.

It has been estimated that healthcare workers are four times likely to be injured and require time away from work due to workplace violence than all other workers combined.

The violence at Gandhi Medical College, Hyderabad is not a wake-up call; the same alarm has been ringing for decades, and we just choose to keep hitting the snooze.

Statistics show that,  over 75% of doctors across the country have faced at least some form of violence and that 68.33% of the violence was committed by the patient attenders/escorts.

But these numbers are an underestimation as all cases of violence are not reported. Doctors often acknowledge the situation of the patient attenders who are in distress and do not report such cases. Mostly, those cases are reported where the doctor feels a serious threat to life.

The violence includes verbal abuse, telephonic threats, physical assault, murder, and arson.

The effects of such violent episodes extend longer than the experience itself, where most doctors report to have faced insomnia, depression, anxiety, and an inability to see their patients without any fear of violence.

Most news agencies have painted a tarnished image of doctors as money-making machines who prescribe unnecessary tests. A news headline saying “Negligent and inconsiderate doctors” would sell more than one saying “Over-worked and exhausted doctors”.

The major reasons for workplace violence are long waiting hours for patients in the public sector, dissatisfaction with the behaviour of nursing staff, delayed medical provision, overcrowded hospitals, shortage of medicines, and poor working conditions of doctors. Who exactly is to blame for such occurrences?

There is one doctor for every 1456 people in the country which is less than the WHO recommendation of 1 doctor for every 1000 people. To meet this goal India would need 5 lakh more doctors.

The majority of our doctors (9 lakh) are involved in private hospitals as opposed to just 1 lakh doctors employed in the government hospitals. Because of these factors, our hospitals are severely understaffed with our healthcare workers overburdened. They are forced to work long hours in poor and stressful work environments. This primarily makes them predisposed to unintentional mistakes and prone to violence. These hospitals also depend heavily on medical students who are also required to score well in their examinations.

Our hospitals have a huge dearth of medical facilities including beds and ventilators, and are functioning in nearly collapsed buildings.

Moreover, our hospitals have a huge dearth of medical facilities including beds and ventilators, and are functioning in nearly collapsed buildings. This can be confirmed by our healthcare budget which was just 1.29% of our GDP in 2019-2020 and the fact that India ranks 145th among 195 countries in healthcare access and quality. There is also a scarcity of medicines including those listed on the national list of essential medicines offered for free in public sector hospitals which compels doctors to ask patients to buy them from outside.

Violence against doctors in private hospitals isn’t unheard of, which often stems from unrealistic expectation that paying more money should save one’s life even in case of risky procedures. Apart from looking up to doctors for advice and assistance, more often than not, miracles are expected. While doctors might just get 20% of the total expenses, common people are led to believe that they are involved in transactions with laboratories.

But the patient attenders cannot be blamed entirely. In times of distress and because of the implicit low health literacy, most relatives do not comprehend the gravity of the illness and are disheartened by their unmet expectations. At times, this might also occur due to improper explanation by the doctor-in-charge due to a lack of proper training or exhaustion.

Along with the loss of a family member, financial restraints also add to their grief and anger. Only about 37.2% of the total population of India was covered under any health insurance in the year 2017-18, and as high as 82% of the urban population were not covered under any scheme of health expenditure support. Due to this poor insurance penetration, the family is forced to put in their earnings. In some cases, even mob mentality and politicians are known to trigger violence leading to frequent mob attacks at hospitals with almost no security cover.

The medical protection act outlaws attacks against physicians and damage to their property. However, this is not a central act and is enacted only state-wise as healthcare is a state subject, and only states have the power to frame laws regarding it.

The enforcement of this act is also poor because it is not tagged to the Indian Penal Code (IPC) and the Code of Criminal Procedure (CrPC). This makes it difficult for victims to file a complaint as well as the police to register their complaint because of the difficulty in recognizing which section to file the case under.

Another bill named Prohibition of Violence and Damage to Property Bill, 2019 was drafted by the Health Ministry in 2019. But the Home Ministry dismissed the need for a separate law to check violence against a specific profession. After the numerous cases of violence during the pandemic, the government introduced the Epidemic Disease Ordinance, which amends the Epidemic Disease Act to include the protection of healthcare professionals.

However, this ordinance needs to get ratified by both the houses of the parliament to get passed as an act, something that is yet to be done. This ordinance also trivializes violence against doctors by assuming this issue to be prevalent only during pandemics, such as COVID-19, disregarding the fact that such violence is prevalent across nations and times.

Banging thaalis, clapping, and showering petals on our healthcare workers might have falsely led us to believe that we have done enough for them. But in the backdrop, the reality has always remained grim with our doctors being pelted with stones, being hit with stools, or even being denied the basic right of dignity after death. The truth is that our doctors have always been fighting, may it be their struggle to secure a medical seat or their endeavour to treat patients despite the needless violence against them.

In a country where doctors are considered gods and every parent wishes that their child becomes a part of the medical fraternity, I think it’s time for all of us to make sure that our doctors don’t regret their years of diligence only to have come into a profession that is not valued enough.

The article was first published here and here.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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