What does the doctors' strike in West Bengal augur?
The system that runs the government hospitals has long failed both the patients and the doctors who work there.
It has been almost a week since junior doctors in government hospitals in West Bengal have struck work. They have been demanding physical security at the workplace and better work conditions. The protest began on Monday, June 10, when outraged family members and neighbours of a 75-year-old patient who died in Nil Ratan Sircar Medical College and Hospital in central Kolkata, assaulted juniors doctors on duty.
The assailants believed that the patient died on account of the negligence of duty doctors. Paribaha Mukherjee, a resident doctor at the hospital, sustained major injuries on his brain. While his condition is stable now, he has been advised against driving and several other strenuous exercises for life. Soon after, there were reports of grievous assaults against resident doctors from at least two other government hospitals in the districts.
Mamata Banerjee, the Chief Minister of West Bengal, had initially refused to visit the injured doctor and threatened his colleagues with termination, unless they resumed duties within a few hours. It was met with a total failure. The doctors not only did not resume work but hundreds of senior doctors in almost all medical colleges and hospitals have tendered their resignation.
Meanwhile, the Indian Medical Association, the premier professional body of all doctors in India, weighed in with solidarity. Resident doctors in government hospitals elsewhere in India, including All India Institute of Medical Sciences, have carried out symbolic protests. There is a call for a suspension of work for a day all over India on June 17.
In reality, the doctors have not entirely stopped working. Critical care patients continue to receive treatment in all government hospitals in West Bengal. Yet, the newspapers are replete with reports of the suffering, and of even deaths, of hapless patients. In one of those instances, a three-day-old baby lost his life when his poor father could not take him to a hospital equipped with a ventilator.
The helpless man ran to several government hospitals, all reportedly without a ventilator, before he brought the baby back to the hospital where he was born. The baby died soon after, and the photo of the desperate father with the baby wrapped in a white sheet has since hit the front pages of major newspapers.
This unfortunate image ironically also highlights exactly where the problem lies. The baby did not die of the negligence of any doctor. He died because a major government hospital was not equipped with a ventilator machine. The machine here is only a metaphor for all equipment. Government hospitals have always been notoriously understocked with infrastructure, both mechanical and human.
Patients typically have to wait for months for availing themselves of basic services such as X ray or pathological tests. Surgery patients brace themselves for a waiting period of several months. Emergency patients without the means to afford private healthcare are completely dependent on government hospitals, where treatment is largely free of cost or subsidized.
Given the demography of West Bengal, it is not an understatement to say that an overwhelming majority of Bengalis rely solely on government hospitals. On any given day, the outpatient departments in all government hospitals, whether in Kolkata or the districts, treat at least several hundred patients, if not thousands.
With outpatient departments not functioning, and surgeries except the critical ones suspended, for nearly a week now, the total number of patients suffering must be running into lakhs. Almost all of them are irredeemably poor, for those who could access private healthcare even by selling property or other assets have already done so.
There is therefore a great deal of mass anger bubbling up against the striking doctors, and it will sooner or later erupt into an uncontrollable fury. Yet, the doctors too cannot in all honesty be blamed for the impasse.
There has been a steady increase in the number of attacks against them over the last few years. Not too long ago, the Chief Minister herself was known to carry out unannounced visits to government hospitals and pull up senior doctors in front of their junior colleagues and patient parties, ostensibly for negligence. Still later, she had, in a celebrated public meeting, read the riot act to private hospitals.
Little, however, has been done over the years to address the root cause of the problems in the government hospitals. While several new ‘super-speciality’ hospitals have been hastily built up, few of them are supplied with either equipment or personnel to start functioning.
On the other hand, hundreds of local primary health care centres in remote areas have been allowed to stagnate or shut down. Newspapers over the years have reported about their dilapidated buildings and absent infrastructure. A journalist said that the entire Darjeeling hills in north Bengal till some years ago did not have something as basic as a scanning machine. Patients from the hills had to be carried down to Siliguri for availing that facility.
A handful of junior doctors were employed in these inadequately equipped ruins to handle hundreds of patients on a daily basis. Most of these doctors are fresh out of their medical colleges, and the sheer number of patients is large enough to intimidate them. On top of it, they are often saddled with long duty hours, with little rest or sleep for as long as 72 hours.
Many of them live away from home, without any social life or recreation to help them reduce the stress of work. Without exception, these junior doctors are overworked, underequipped and without any special training to handle the abnormally large traffic of patients. It is no small miracle that they do not make too many mistakes. The system that runs the government hospitals has long failed both the patients and the doctors who work there.
More importantly, the aspiring middle classes have over the years deserted the government hospitals, particularly since they have acquired the means to pay for private healthcare. Their only exposure to public healthcare system in the state these days, barring exceptions, is through their children, who continue to study and work in government medical colleges and hospitals. This peculiarity does not allow the articulate middle classes to approach the current crisis as stretching beyond a question of security of the doctors. They cannot be faulted either, for people interpret a crisis primarily from the point of view of how it affects them most intimately.
Another mischievous optic that has lent additional charge to the public discourse around the issue is religion. It so happens that that the patient whose death directly led to the impasse was a Muslim. Mamata Banerjee has in the recent past been accused by many of ‘appeasing’ the Muslims in West Bengal as a bulwark against a possible BJP takeover of the state in future. The doctors, to their credit, have refrained from colouring the controversy with any religious overtones.
There are murmurs that she should have at least publicly condemned the miscreants and instructed the police to book the culprits at once. Statistically, though, there is no evidence that assaults against doctors in government hospitals in the state are all carried out by members of one religious community. But there is evidence that in a majority of recent assault cases against government doctors, the dead patients whose relatives often mount these despicable assaults come from Muslim, OBC or Dalit families. Historically or statistically, these three communities have been both materially and socially disadvantaged in the state, and indeed in the country.
Ironically, again, among the doctors assaulted, a majority belong to the so called upper castes. There is no need to read a caste war hidden in these statistics, in the sense that upper caste doctors are out to neglect their subaltern counterparts by choice or design. However, given the collapse of the material divide onto the social and cultural between doctors and patients, it makes for a strain in their mutual credibility and trust.
Not all doctors are saints, and no amount of grief at the death of a parent or neighbor is a fair enough cause to assault doctors. Many doctors work solely for money and misbehave with patients, and some indeed may be guilty of gross negligence. Likewise, no language is strong enough to sufficiently condemn the forced entry within the hospital premises of a gang of hundreds and a near fatal assault on an unsuspecting young doctor on duty.
At the end of the day, however, they are all human, and cannot wholly help making mistakes, deliberately or otherwise, as individuals. However, the state, as the third major stakeholder in this crisis, cannot refuse to intervene constructively, both to defuse the crisis now, and to infuse the much required vitality in the public healthcare architecture in the long run.
It is strange indeed that public discourse around the present crisis is swinging between two extreme narratives. If the doctors emphasize the physical security of their colleagues, the others appear only to highlight the plight of the poor millions who wait for the outpatient departments to resume work.
Even if the Chief Minister swallows her ego and eventually agrees to visit the striking doctors at the NRS hospital in Kolkata, and assures them of greater security, she cannot arrange for installing sufficient infrastructure in the ailing government hospitals, in the absence of a major hike in the health budget for the state as a whole.
Likewise, the doctors are free to resign and set up private practice. But they too must remember that without a robust system of subsidized medical education, junior doctors like Paribaha Mukherjee are unlikely to emerge in future. Incidentally, Mukherjee’s father is a retired primary school teacher.
The crisis offers a major opportunity for all stakeholders to take a searching look at the system of public medical education and healthcare in India as a whole. If it is allowed to die an unsung death, medical education and healthcare will be monopolized entirely by the profiteering private sector. The poor in India, whether they are Muslim or Hindu, will be the collateral damage.
(The writer teaches at Karnavati University in Gujarat. The views expressed are entirely his own)