Early this week India woke up to the news of a mob of “so called” family members of a patient, who had come in trucks and pelted stones in a Kolkata medical college alleging delay in handing over dead body . In the ensuing violence against doctors, a junior doctor suffered severe head injuries while may others were injured.
This lead to a flash strike by doctors demanding security at hospitals and arrest of all attackers. However strangely the Chief Minister (CM) of West Bengal, came forward only to threatening doctors of consequences and saying “I condemn doctors who have gone on strike. Policemen die in line of duty but the police don’t go on a strike”. This triggered a series of actions including resignations of about seven hundred doctors across the state,attack on striking doctors by political thugs in other medical colleges and finally the current deadlock wherein India is staring at a nation-wide doctor’s strike .
I have also been in the midst of similar violence as a junior doctor almost a decade back when hoodlums attacked doctors in Bankura Medical College. While much has been written and will be written about the incident in West Bengal, considering its political undertones, it is unfortunate to note that violence against doctors is increasingly common across the country. This is a key reason that this has resonated with the medical community leading to nationwide support. The Indian Medical Association (IMA) has for example demanded a new central law making such violence a non-bailable punishable offence with long jail terms. What is appalling though is that long term causes for this and the consequent solutions are not being finding space in the narrative.
Faltering justice systems
For one, new laws are not going to solve any problems. There are enough laws for attacking fellow citizens, damaging government property, preventing government employees from discharge of duties etc apart from those related to attempted homicide.
In any civilised country medical negligence cases are fought in courts wherein doctors, when found guilty are punished leading to justice being served. However patients in India resort to violence because of two reasons, both of which indicate a faltering justice system. Even a well-resourced, knowledgeable and well connected person like Dr Kunal Saha took more than a decade to get justice for his wife’s medical negligence. The Medical Council of India and the corresponding state medical councils are known to be behaving like trade unions for doctors trying to protect them rather than acting in the interest of justice. With the doors of medical councils virtually closed and courts in India known to be costly, complex and time consuming, it is no wonder that common people resort to the concept of “instant justice” by attacking health professionals and destroying health facilities.
However, this would have stopped if those attacking actually faced any legal consequences. Political patronage has meant that mostly they are left scot free and in fact encouraged to act as “messiahs” delivering justice in return for votes in the future.The police is known to be in toe with the political bosses and hence a new law does not mean anything ( a fact we are seeing even now in West Bengal when only 5 of the 200 mobsters have been arrested and the CM not committing to any further arrests). The issue is non-enforcement of laws and not absence of laws or legal gaps.
The IMA , Ministry of Health and Family Welfare (MoHFW) and the Prime Minister’s Office (PMO) needs to immediately work with other stakeholders including the Chief Justice of India to ensure reforms of the Medical Council as well as judicial and legal systems. Reforms in both these systems is long overdue but is now an emergency. A strong and neutral justice system will ensure not only redressal of those aggrieved but in the long run break the nexus between local thugs and their political patrons.
It is important to realise that to “provide access to justice for all and build effective, accountable and inclusive institutions at all levels” is a Sustainable Development Goal(SDG) . Attaining this goals is essential for a society to function. We are seeing the consequences in health system early because it involves matter of life and death but a failed justice systems (real or perceived) can mean more internal strife and violence across the society. It is also time for the global health community to start research on the possibility of using violence against healthcare professionals as an indicator to monitor progress of SDGs.
Crippled health systems
In the letter to the CM of West Bengal, Dr Harshvardan , Union Minister , MOHFW says that doctors, “work for long hours under stressful working conditions, grappling with huge loads of patients.” This in effect is acceptance of the fact how crippled our health system is. Will the MoHFW look at reforming the health system such that there are “no huge loads of patients” and doctors are actually not overworked? Healthcare professionals are at the interface of the system and are for long acting as buffers to give the best for patients in spite of severe infrastructural deficits. But the system has now reached its breaking point . Hardworking doctors alone are no longer sufficient to overcome the deficiencies of the system.
The solutions for this are complex and long term (focusing more on preventive and promotive healthcare rather than curative, investing on primary healthcare, more doctors, clarity on working rights and harmonisation of remuneration of junior doctors across states etc.) but a key fact that underlines the issue is poor investment. We continue to hover around only 1% of GDP being allocated to health. This is in spite of the launch of ambitious schemes like Ayushman Bharat being launched. It is time for the MoHFW to actively work with the PMO and Ministry of Finance to underline the dire nature of the scenario. Public investment on health to 2.5% of GDP (a target set under the National Health Policy 2017) from the next union budget would be the “shot in the arm“ the health sector needs.
All systems are complex and have the property of “path dependency” . Path dependency implies actions taken now limits the options in the future.The slow incremental nature of the change in reforming the justice , police and the health systems limits policy options. Many doctors are already migrating out of India to other countries. Citizens are losing trust and getting habituated to arbitrary instant justice solutions.
Tougher new laws , more CCTV’s and security personnel might be good “news bytes” they are not the solution to violence against doctors. It is important to reform our justice, policy and health systems radically in the next few years. A society with doctors with “broken dreams” cannot be and will not be able to attain SDGs.
About the author:
Dr. Soumyadeep Bhaumik is a medical doctor and an international public health specialist . He is the Associate Editor, Evidence Syntheses for BMJ Global Health and tweets at @DrSoumyadeepB .
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no relevant conflicts of interests to declare.