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.
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.