Intolerance” is the current buzzword in the media, with more than adequate justification. So far it has related to beef eating, dance bars, pubs, Valentine’s Day, the clothes you wear, intellectuals, activists, FTII students and any other issue that the looney fringe may fancy taking an exception to. However there is one aspect of intolerance that society, looney or otherwise, appears to be totally oblivious to and uncaring about; namely the intolerance towards health care personnel and facilities all over the country. Attacks on healthcare establishments and personnel have become widespread, and increasing both in frequency and virulence; and Goa has its fair share.
The most recent attack occurred at the Chicalim hospital last month. A patient was brought in an advanced stage of liver disease. He was advised immediate admission and transfer to the Goa Medical College. The escorts refused and took him away, it later transpired, to a “doctor” of dubious credentials. His condition deteriorated and he was brought back to the Chicalim hospital, where once again immediate admission and transfer to the medical college were advised. This time he was transferred, but shortly thereafter expired. The group then returned to the Chicalim hospital and went on the rampage causing damage worth over Rs 1.5 lakhs. The duty doctor was abused, threatened and terrorized to the extent that she had to lock herself up in a room for safety. Some arrests were made and promptly released on bail; further enquiry does not appear to be going anywhere. Shortly before that, there was a similar incident at the Hospicio hospital once again with no punitive action taken. And it is not just Goa. A lady doctor on call at the Lok Nayak Hospital in Delhi was physically assaulted and apparently threatened with rape by a patient’s relative. Her crime: two patients had come in at the same time and on the principles of triage, she attended to the more urgent case first. This upset the relatives.
Why do such incidents occur in the first place? After all, there will always be a mortality rate or undesirable outcome in the treatment of any disease anywhere in the world. And no amount of violence is going to alter this basic fact of life; some will survive and some will succumb. The issue has been analyzed with concern at various levels, including the WHO and the WMA. In 2014 alone, the WHO received reports of 372 such attacks in 32 countries, resulting in 603 deaths and 958 injuries. It is acknowledged that this is just the tip of the iceberg, with many more cases going unreported. Various explanations have been proffered. One such explanation is perceived medical negligence. In one case in Goa, the doctor was assaulted whilst he was in the process of actually suturing a wound; how this translates into negligence is beyond me. Fortunately the doctor did file an FIR, the matter did go to court (in spite of considerable political pressure to “compromise” and the assailant was found guilty and sentenced to the minimum six months in prison even though he was a known history sheeter. The matter is now in appeal. Another explanation is deficient communications skills on part of the doctors. In many cases the doctors do not even get an opportunity to discuss the issue. Even so there has been an initiative on many fronts to conduct workshops on communication skills; the first being conducted at the initiative of the author many years back, and now incorporated into undergraduate curriculum.
The fundamental reason in my opinion is the degree of confidence the assailants have that there will be no repercussions to their actions. This stems from the political patronage enjoyed by them. When Anand Dighe a Shiv Sena leader expired in Singhania hospital in Thane, party workers trashed the hospital causing damage estimated at Rs 10 crores. The hospital was shut down depriving a Mumbai suburb of a badly needed specialty centre. The perpetrators were never brought to book. Indeed in many cases, the enforcement agencies remain mere spectators. In the Chicalim incident, the security personnel declared their inability to do anything faced with a mob!
The profession has reacted. Nineteen states including Goa have a law making violence against healthcare personnel and facilities a non-bailable offense. Unfortunately government negligence and disinterest, coupled with police apathy due to ignorance or reluctance to pursue the matter due to political pressure has rendered the law impotent. FIRs are not filed or investigated so shabbily that culprits are rarely brought to book. A central act is required with amendments to the CrPC and police manuals. Perpetrators, in many cases, are regular “campaign workers” for politicians of various hues. Attempts to bring them to book are check mated by the politicians themselves; after all their services are indispensable during elections (and otherwise too). Hence if there is to be any meaningful change in this trend of violence, it must come from the politicians themselves displaying a little moral fibre.
However it is the more subtle reactions that society and politicians need to take heed of. Medical practice is gradually being labeled a “dangerous profession”. A survey by the IMA has revealed that 75% of doctors have faced some degree of violence; of which about 48% have faced serious violence. Providing security hardly solves the problem. Many a talented student is discouraged from entering the profession, opting for a much higher paying and less stressful occupation in the IT industry. Those that do enter the profession end up practicing defensive medicine and are reluctant to take on challenging cases. Others make a beeline for foreign shores as soon as possible. Whatever the reaction, healthcare standards in Goa and in India, have taken a very hard knock, with no hope of recovery. A violent society can never be conducive to the practice of humane medicine; the instinct of self-preservation will always dominate over any altruistic tendencies amongst doctors who are after all, only human.
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member, Executive Committee, Goa Medical Council)
