Synopsis: The death of Mohammed Sayeed, a 75-year-old patient at the NRS Medical College and Hospital, Kolkata, West Bengal, led to a scuffle with duty doctors, who refused to discharge the body in retaliation. A mob injured a doctor. The medicos struck work. Doctors and medical associations nationwide have voiced unanimous support and called for protective legislation against the violence of the public (BMJ 1, 2).
The Telegraph carried three accounts: duty doctors’, relatives’, and police. The differences in perspective are striking, as are the ‘facts’ of the case. As the English historian EH Carr once said, facts are fish that swim around in the ocean, especially in such a rapidly politicizing situation. The fish you catch determine the story you tell.
The wise doctor’s dilemma should be to decide on the correct story to tell and the appropriate step to take. But for some reason, there is only thoughtless conviction.
The Indian census, civil registration and sampling exercises, despite imperfections, are useful; especially so is the Sample Registration System statistical report, which, using large sample sizes, estimates (adequately for current purposes) vital statistics across the country. The last section shows distribution of deaths between public and private hospitals, external medical supervision, unqualified supervision and other situations.
West Bengal statistics:
- Population: 90 million in the 2011 Census. (higher today).
- Estimated Crude Death Rate (SRS Report 2016, Statement 40, p 122): 5.8 per 1000 population. The Civil Registry in 2016 shows 544,197 estimated deaths of which 82% are actually registered (CRS Report, Statement 2 p 2).
- Nearly 33% of these deaths occur in government hospitals (SRS Report, Statement 57, p 180) –approximately 180,000.
Now remember that most of these 180,000 deaths were mourned by family, friends and community. So, even if say 200 violent confrontations have occurred the past year before the current incident, 179,800 deaths occurred without violence. What then is the reason for the striking junior doctors’ explosive rage in these specific instances? The only way I understand it is that many patient deaths in hospitals are handled by a relatively small number of frontline duty doctors. Exceptional violence in this event is faced by an even smaller number. As all these duty doctors experience and manage the routine flow of patient deaths, violent encounters stand out as an assault on their identity as committed professionals.
My point here is not to dismiss these encounters. Yet, nearly 99.8% of these deaths have been handled peacefully. Given failing infrastructure, lack of resources, time crunch, overload, stress and senior pressure, first line doctors do a commendable job. What has gone wrong? Have some doctors been callous? Are the families of some deceased unreasonable? Or are junior doctors simply calling attention to their plight?
Why haven’t other doctors (both senior and junior), drawing on their own individual experiences of handling death with dignity, tried to mediate the current confrontation? Why have they instead joined this agitation as one body – a ‘corporation’ of doctors seeing this violence as an affront to their identity?
The Twitter feeds of the young NRS Hospital doctors display anger and dismay. One post goes, “We aren’t Gods. We don’t want to be worshipped. Just treat us as what we are: Humans. That should be enough”.
Curiously, a decade ago, a political party leader who lent similar support to a dead patient’s family in a Hyderabad government hospital said: “The poor are not stupid. They don’t think the doctor is God, that he can bring people back from death, only Allah has that power. They do expect some attention, some care for themselves, for people they love. […] But these people don’t even treat them like human beings!” (Towards a Critical Medical Practice, pp 169-170)
There is clearly a lack of love between brusque doctors and unruly patient families – with the ripple effect that all patients suffer as all doctors strike work in solidarity. There is no sign of retrospection/reflection among the body of doctors regarding a social protocol to deal with traumatized attenders (aside from the crucial absence of medical protocols like patient triage in emergency wards!).
The larger horizon is the asphyxiation of public health infrastructure, privatization of care, and costly medical education focused on profitable specialty. There is no space for a vision of healthcare, no time to teach commitment to the poor, and public hospitals become increasingly desolate corridors through which one hurries seeking elusive professional success beyond. The lack of meaningful relationship with the ill, dying and bereaved in these instances, and the corporate rage of doctors are symptoms of this malaise.
Perhaps in the looming dystopia, doctors in hospitals will dispense life across a protective iron grill as do wine shops liquor in many Indian towns.
Unless they begin to think about their social roles.
R Srivatsan is a development theorist who has worked on the politics of healthcare, development administration and tribal welfare in India. He was formerly Senior Fellow at Anveshi Research Centre for Women’s Studies. He is a member of Medico Friend Circle.
I am deeply thankful Rohini Raman, Lakshmi Kutty and Mithun Som of the newly emerging Anveshi Health Group for their sharp and useful feedback. I also acknowledge the discussions on the MFC and the Jan Swasthya Abhiyaan egroups.