13 June,2021 07:17 AM IST | Mumbai | Prutha Bhosle
Dr Sparsh Kumar, 30, who has been on COVID duty at DY Patil Hospital, Nerul, says he reconsidered the profession after his doctor friend was attacked by a mob in Kolkata in June 2019. Pic/Sameer Markande
Since March 2020, Sparsh Kumar has worked countless hours at Nerul's DY Patil Hospital, doing the rounds of the Covid-19 wards at a time when the country has witnessed two waves of the pandemic, the second worse than the first. Nothing he handled, though, came remotely close to what his fellow doctor friend at RG Kar Medical College and Hospital in Kolkata, experienced. His friend, along with other doctors, had gone on a strike in June 2019, to express solidarity with a doctor, who had been attacked by the relatives of a deceased patient. But, the protest went awry when the doctors were attacked by social workers with acid, bricks and country-made explosives. "He [Dr Kumar's friend] locked himself in a room at the hospital and was continuously tweeting to be rescued. The goons had secured the whole area, so it was difficult for him to get out. I was in Mumbai reading minute-by-minute updates of the assault. I asked myself, am I in the right profession? Is it safe to be a doctor in India?" Dr Kumar, 30, says his friend had worked very hard for three years to secure a post-graduation medical seat. "After that incident, he was willing to give up on his dream."
The Navi Mumbai-based doctor has been on COVID-19 duty since his post-graduation in surgery exams were postponed due to the pandemic. "Thankfully, I haven't faced assault. But, who knows what the future holds? When I was an undergraduate student, I used to think that only the ill-informed take to violence. But I was proven wrong in 2016, when I was deployed as an RMO [resident medical officer] in the cardiology department at Fortis Hospital in Vashi. The entire ICU was vandalised by relatives of a patient over his untimely death. The intensivist was beaten black and blue, as we juniors hid on the first floor. None of the attackers seemed unschooled," Dr Kumar says.
Numerous incidents of violence against healthcare workers have been reported, with the trend hitting a new low in June 2019, with the assault on two junior doctors at Kolkata's NRS Medical College and Hospital. The nationwide protests by doctors that followed this incident, prompted the Ministry of Health and Family Welfare, Government of India, to propose the Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019 (Draft Bill), specifically criminalising violence against healthcare personnel. The draft bill proposed imprisonment between three and 10 years and imposition of fines anywhere from R2 to R10 lakh for "grievously hurting" doctors and other healthcare professionals in clinical establishments. During inter-ministerial consultations, however, the Ministry of Home Affairs opposed the enactment of a special law, since existing provisions of the Indian Penal Code, 1860 were considered sufficient to deal with such acts of violence.
Such attacks become all the more worrisome during a pandemic, when frontline workers are key to winning the fight. The most recent target of public wrath was Dr Seuj Kumar Senapati, who was "kicked and thrashed with brooms and utensils by a mob" at the Udali COVID-care centre in Assam's Hojai district last month. Dr Senapati was carrying out the government-mandated rural service duty after completing his post-MBBS internship.
He was only recently posted at the Udali facility. The incident sparked a furore, and led to the arrest of 24 accused.
Between July 2020, when a doctor was assaulted and stabbed by a deceased patient's relative at Alpha Superspeciality Hospital in Latur, and May 2021, when doctors and nurses were attacked at Citi Care Hospital in Ahmedhnagar, nothing seems to have changed.
A letter published in PMJ, a peer-reviewed medical journal, in October 2020 described the growing violence against doctors, as "an emerging epidemic". "Despite many reactionary measures like enhanced security to doctors at the workplace and stricter medical negligence laws, Indian doctors are teetering on the brink of a silent crisis, which will prove detrimental to society in the coming times."
Aurangabad-based Dr Pradeep Benjarge is, however, still awaiting justice. The 47-year-old, who founded Krishna Hospital in Rokadiya Hanuman Colony, was assaulted after a severely-ill COVID-19 patient died mid-May. A mob blocked him on his way to the facility and threatened to set him on fire. "Nobody could have saved that patient, not even God. When he was admitted, the oxygen saturation was as low as 70. We did everything to save his life, but he gave up the fight two days later. Which doctor wishes that his patient dies? I didn't intend for this to happen. Why was I assaulted and humiliated publicly?" asks Dr Benjarge.
For the last 10 years, he has been working to improve healthcare infrastructure at his hospital. In 2008 and 2009, when swine flu cases were peaking in the region, he had observed a dearth in ICU facilities. A year later, he took it upon himself to set up an ICU unit with 50 beds at Krishna Hospital. "My colleagues said there are two options - either watch people die due to shortage of intensive care or do something about it. I chose the latter. I was running a maximum 40 ventilators at that point, which was the highest for any corporate hospital in the region. In the pandemic, I was using 30 lakh litre oxygen per day for my patients. Many patients, who couldn't afford to clear their dues, were spared. In April this year, I got a bill of Rs 47 lakh for oxygen supply alone. And this is how I was paid back. I had to run from pillar to post to get an FIR lodged against the assaulters."
Taking cognisance of incidents of doctors and other healthcare professionals being assaulted by family members and relatives of patients, the Indian Medical Association (IMA) on June 7 wrote to Prime Minister Narendra Modi, seeking his personal intervention in ensuring "optimum milieu" for medical professionals, so that they can work without any fear. "In the midst of this pandemic, we are deeply hurt to see the increasing incidents of physical violence against doctors and healthcare professionals in this country," IMA said and cited the attack on Dr Senapati. "The Health Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019 ought to be promulgated immediately, along with the incorporation of provisions from the IPC/CrPC and with stipulations for a fixed time schedule for speedy conclusion of trials," the letter stated further.
Dr Rajendra Kulkarni, practising paediatrician and action committee member of IMA Maharashtra for 20 years, feels there's a need to redefine what violence against the doctors entails. "It cannot just be physical assault, but a verbal one, too. Verbal violence can be derogatory and equally detrimental and depressing for the doctor. There have been instances when self-proclaimed social workers do a Facebook Live inside the hospital and shame doctors by accusing them of extorting money from patients. Only recently in Nashik, a man took off his clothes and refused to get dressed until all the dues were cleared by the hospital management. Imagine how harrowing this is for a doctor present at the scene. These doctors need counselling soon after. It's unfair to even expect them to return to work the next day."
Dr Benjarge says that though these incidents can leave doctors traumatised, they don't have the luxury to switch off. "A few seconds after I was rescued by my staff from the mob, I went into the ICU to check up on my patients. Time is critical in this profession. I cannot afford to take a break to heal from an assault trauma," he shares.
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A key finding in a 2015 IMA study reveals that "more than 75 per cent of doctors in India have faced at least some form of violence, with 12 per cent of such violence occurring in the form of physical attacks". These cases have increased exponentially in the pandemic, says Dr Ramkrishna Londhe, president of IMA's Maharashtra unit. "Patients are brought in with oxygen saturation as low as 30 and 40. Some come to us on the seventh day of fever, when the COVID infection has reached the lungs. All the senior doctors are in a rush and have to hop from one hospital to another, so they go on rounds briefly, and check only severe cases. It is the junior doctors who have to bear the brunt. They are the ones facing violence first-hand. They are scared for their lives. We want topmost security for our healthcare professionals," he demands.
Dr Prathik Hegde, a post-graduate student of orthopaedic surgery
Dr Prathik Hegde, 28, who hails from Shimoga in Karnataka was keen on pursuing an arts degree, but his parents wanted him to become a doctor. "They felt that I should pursue a more serious future, and in medicine. At some point, their dream became mine," he tells mid-day. After an undergraduate degree from Mangaluru, he was pursuing a post-graduation education in orthopaedic surgery from Bengaluru, when the pandemic struck. He was then put on Covid-19 duty. For the last eight months, he has been working at a hospital in his hometown Shimoga. "We are in PPE suits for nearly eight hours a day. I earn about Rs 40,000 monthly despite starting my education in medicine almost 10 years ago," he says.
In March this year, sometime in the beginning of the second wave, Dr Hegde experienced first-hand what many of his colleagues had warned him about. "It was just after midnight. A 38-year-old father of two kids collapsed on his bed and died. He was brought to us a few days earlier, when his oxygen saturation was 78. It was also his eighth day of fever, so the family had delayed his treatment. We had put him on higher oxygen and were giving him injections."
Soon after, the deceased man's wife barged in to his private chamber and held Dr Hegde by the collar. "The woman was screaming at me, asking me to revive her husband. I was already traumatised to see a young patient die. We gave him CPR, but it didn't help. A few minutes later, a bunch of men entered the room and tried to hit me."
That night, he spoke to his parents over the phone. "They were petrified. My father, who is a businessman and was instrumental in convincing me to become a doctor, suddenly felt that I should have taken up another profession."
The relatives, he says, later apologised. "They were in mourning, and I felt their pain, too. But I also told them that I never wished to see them as patients again."
A 2016 study published in The National Medical Journal of India on violence against resident doctors at a tertiary care hospital in Delhi found that almost 80 per cent of the 169 doctors surveyed and interviewed believed that poor communication skills was the most common factor that led to workplace violence, while 56 per cent felt that this could be attributed to poor conflict resolution skills. "We have counsellors in the ICUs, who inform the family members of the patient passing on. But there has been a tremendous lack of resources in the pandemic, and so, junior doctors are expected to do this task. But, not everyone has the skillset for the job," admits Dr Hegde.
He remembers taking a day-long break to recover from the assault. "I had to resume work a day later, but I admit that I continue to be wary and nervous. And yes, I have been reconsidering my future in this profession, which is unfortunate."
Also Read: IMA to hold country-wide protest on June 18 against assault of doctors
75
Percentage of doctors in India who have faced some form of violence, according to an IMA study conducted in 2015
