on June 16, 2019
Dr Paribaha Mukhopadhyay’s Facebook entry on 17th February 2019 reads thus:
“Finally, Dr. Paribaha Mukherjee it is!
After fighting for 4.5 years, finally achieved something that I can adore for the rest of my life.”
In less than four months, on the night of 10th June this young doctor was rushed to the ICU with life-threatening injuries, after being hit on the head. Dr Paribaha was interning at the NRS Hospital in Kolkata on that fateful day when a skirmish broke out between the relatives of a dead patient and the hospital staff after allegations that the patient had died due to medical negligence. In the ensuing melee, a brick hit Dr Paribaha in the head with such force that his skull caved in and he had to be rushed into emergency surgery. Four days later, Dr Paribaha is said to be stable but not yet out of danger, and uncertainty looms large about his ability to practice medicine even after his recovery.
Let us begin at the beginning. India is a third world country with third world statistics on everything including healthcare. According to the Medical Council of India, there are a total of 10,41,395 lakh allopathic doctors registered with the state medical councils or Medical Council of India. This means, there is less than one doctor for every thousand patients.
The same sources mention that there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. A visit to the Out Patient Department in any government healthcare facility presents serpentine queues of people with various ailments coming from as far as 40 kilometres away and a handful of harassed doctors managing everything from regular coughs and colds and seasonal illnesses to serious road accident casualties. A doctor friend who graduated a year ago, when asked about her work said, “I stitch wounds, I prescribe cough medications, I deliver babies and I fight with authorities just to see that there are enough syringes and bandages and antiseptic lotion.”
While the World Health Organization prescribes a basic requirement of at least one doctor for every 1000 people, allopathic doctors in India are expected to treat at least 10 times more number of people on an average. It is this lack of doctors that has placed Indian healthcare at a shameful global ranking of 112, even below countries like Iraq and Venezuela. The lack of doctors and other healthcare professionals when combined with a lack of resources and political commitment (the budgetary allocation this year, as per the interim budget announced in February 2019 stands at a mere Rs 63,298.12 crore as against 431010.79 for defence 93.847.64 crore for education and 140763.97 for agriculture) paints a dismal picture of the healthcare system in India, where even the basic healthcare is inaccessible, unaffordable and mostly unreliable.
Over the last couple of decades, this ever-escalating demand for affordable healthcare has seen a new player in the form of the Corporate Health Care System. Corporate healthcare, like all things corporate creates a ‘caste system’ in the otherwise simple process of keeping a population healthy and disease free. Now, the ‘moneyed caste’ have access to a system where they can get the best healthcare their money can buy, often in a comfortable and sometimes in a luxurious setting. Complementing this are the healthcare providers who work in these corporate hospitals who are well paid, get to see a predetermined number of patients per day — often educated enough to understand and follow the given instructions, aiding their rapid recovery. For these doctors, the success rates are higher, the accolades are more, they get more referrals and often end up having a thriving private practice where their appointment diaries are sometimes booked weeks in advance.
Corporate healthcare has also spawned a whole new industry in the form of diagnostics. Doctors are not averse to prescribing tests, which have to be done only at certain laboratories and diagnostic centers, from which they are known to receive commissions. It is not usual to find doctors who are arrogant, conceited and positively hostile towards patients who dare to question the legitimacy of this practice. The situation is so bad that anybody who has had anything to do with a private doctor ever has at least one story about the superciliousness of the doctor and the condescension of the healthcare system.
On the other side of the divide are doctors who work in government hospitals or smaller primary health centers, some of them in far-flung, inaccessible areas. It is a system where there is less than 0.06 doctor per 1000 patients, where, when medicine is prescribed, patients don’t have the money to buy them, and in situations where patients may be able to procure medicines free of cost or buy them with some difficulty, they may not be able to afford the nutritional support required to make that medicine effective. This is a place where a whole legion of healthcare professions fights a losing battle against simple illnesses like diarrhoea, malaria, and typhoid day after day, every single day. It is a system, which is geared at dehumanizing the doctor as much as it is geared at stripping away the dignity of the patient.
The ongoing crisis of the doctors vs. the state, the allegations and counter allegations, the strikes, the threats, the defiance of the striking doctors and the perceived lack of support from the community has to be seen in the context of the above-mentioned scenario.
What makes this strike different?
Let us face it. This is not the first time that a patient has died due to medical negligence in a hospital in India. It is also not the first time that doctors have been assaulted in the course of their work. A study by the Indian Medical Association in 2017 had admitted that over 75% of doctors in India have faced violence at work. Sometimes the violence is so extreme, that doctors end up losing their lives. A few years ago, the husband of a pregnant woman, who was admitted to the hospital in a serious condition, killed a woman doctor. The patient had been referred to another facility, but died before she could be shifted. The distraught husband entered the consultation room armed with a sword and killed the doctor. There have also been cases of vandalism, burning down of hospitals, harassing the families of the doctors by families and relatives of patients who believe that they have been victims of medical negligence and callousness. So what is it about this instance that makes it different?
The Silence of the IMA
The first thing that stands out is the silence of the Indian Medical Association in other cases, where the doctors have been victimized. Even as I write this piece Dr Onkar, a post graduate medical student from Karnataka studying at the Pandit Bhagwat Dayal Sharma University of Health Sciences (PGIMS), in Rohtak, Haryana, has committed suicide due to alleged harassment from his seniors. The deafening silence of the IMA in the case of senior doctors like Dr Binayak Sen, or more recently, Dr Kafeel, who were victims of state repression or turning a blind eye to incidents like the suicide of Dr Payal Tadvi raises questions about the prompt action of the IMA in this one case.
The Political Angle
The General Elections are just over in India and Mamata Banerjee is being touted as the last bastion standing against the takeover by the Hindu Right. Discrediting Mamata Banerjee politically is, naturally, high on the rightwing agenda. On the other hand, the ham-handedness with which the West Bengal Chief Minister has handled the situation has nearly brought the state to the brink of disaster. The order asking the doctors on strike to return to work by 2 pm on 14th June was not only defied by the protesting doctors, but going a step forward, doctors all over the country organized token strikes in solidarity with the junior doctors of NRS Hospital, causing immense discomfort to thousands of poor patients dependent on the government healthcare system. This has ended up portraying the doctors in poor light, while giving credibility to doubts that these strikes are not a spontaneous expression of solidarity, but politically engineered actions, aimed at discrediting the West Bengal government.
Though the demands of the striking doctors – criminal proceedings to those responsible for the violent attack and assurance of a safe working atmosphere in government and private hospitals – are well within reason, the charges and counter charges of who led the attack on the doctors in NRS Hospital has complicated the situation, with both the BJP and the TMC charging each other with brining a truckload of goons to the hospital following the death of the patient.
Where does the solution lie?
The first step would be for the striking doctors to realize that the ones who are most affected by their strike are the very people who they claim to serve, sometimes at the cost of their own well-being.
The poor and the disempowered that completely depend on the crumbling government healthcare systems are the ones who bear the brunt of any kind of disruption in medical services. In many cases, patients are forced to approach private healthcare providers, which they do at the cost of their life’s savings, often bringing themselves and their families to the brink of bankruptcy. This ends up alienating them further and they lash out at the most visible symbol of a system that let them down when they needed it most – the doctor.
A strike like the one we are seeing today turns both the doctors and the patients into victims of a system, which has already made quality healthcare the prerogative of a few ‘fortunate people’.
Healthcare is a basic human right. Every human being has a non-negotiable right to a life free of pain and ill-health. In a civilized society, healthcare should be easily accessible and completely affordable. The sooner the doctors and the patients realize this, the easier it would be to sort out this mess and prevent such problems in future.