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Why Indian medicine’s #MeToo moment is overdue
Summary
- The rape-murder at Kolkata’s R G Kar Hospital has lifted the lid on the dirty secrets of medical facilities across the country. Mint spoke to doctors, students and staff, especially women, at hospitals in every corner of India to bring you this report.
New Delhi: On a July afternoon, a group of armed men entered the emergency entrance of Delhi’s Guru Tegh Bahadur (GTB) Hospital in east Delhi. They swiftly made their way up to the fourth floor and entered surgery ward number 24. One of them pulled out a gun and shot five rounds of bullets into a patient, even as he was being attended to by a doctor. The doctor, pursuing her first-year post-graduation in general surgery, crawled under one of the ward beds as all hell broke loose. A police investigation revealed the killing was a case of mistaken identity in a feud between two of Delhi’s criminal gangs. The killers were targeting a rival gangster admitted to the same ward. The police nabbed seven men.
Four days earlier, on 20 July, when a woman died after childbirth in the gynaecology ward, a mob of 50 armed people belonging to the victim’s family stormed the premises of the hospital, vandalizing property and attacking doctors in the casualty labour ward. Some doctors made a narrow escape. The hospital filed an FIR against the patient’s family.
So, on 9 August when a junior doctor was brutally raped and murdered in Kolkata’s R G Kar Medical College, sending tremors throughout the country, GTB rocked. “It shook us to the core. It shook our belief in the profession because this could be us," says RDA president Dr Rajat Sharma, a second-year postgraduate student in community medicine. Sharma and an army of doctors and medical workers from prominent institutions joined a nationwide protest demanding justice for the victim and safer workplaces for the medical community. He was one of the 21 young doctors named in an FIR for protesting in front of Nirman Bhawan.
Last month, the Supreme Court took suo motu cognisance of the widespread protests impacting medical services and set up a 10-member national task force to make recommendations on ensuring safe working conditions for medical professionals and preventing violence against them.
While suggestions are pouring in from stakeholders, young medics told Mint what they endure in their professions and what it would take to make them feel safe again.
Vulnerable all along
According to a study by the Indian Medical Association (IMA), over 75% of doctors have faced violence of some kind at the workplace. Every doctor who works in the emergency department has faced verbal violence, a paper published in the Indian Journal of Psychiatry in 2019 notes, adding that Indian doctors face more violence than their western counterparts. Less than 20% of doctors felt safe during night shifts, revealed an online survey conducted by the IMA last month.
“The R G Kar case touched a collective raw nerve because it made us realize that we were vulnerable all along. And that nobody has our back," says Dr Christianez Ratna Kiruba, an internal medicine physician at Satribari Christian Hospital, Guwahati.
Patient harassment takes many forms. A resident doctor specializing in general medicine recalls how she was stalked and filmed by a patient’s attendant in GTB’s emergency ward recently. A physical scuffle and sexist abuses followed when she asked for the video to be deleted. The man walked out, scot-free.
GTB saw a slew of student protests this year, demanding metal detectors, CCTV cameras, panic buttons installed in each ward and a control room for security supervisors, who would be able to swing into action in case of emergencies. According to the mandate, a third of the guards are required to be ex-servicemen. But in reality, the guards are unarmed and few in number.
“There are no promises from the administration so far. We know it’s a fund crunch," says a student, on condition of anonymity, complaining about the apathy of the Delhi Government. “We are a 1,700-bed public hospital that’s unable to offer quality care. Would you believe that we’ve run out of rubber gloves and basic meds like Pantop," a resident doctor reveals in embarrassment, referring to a commonly prescribed antacid. “It’s easy to see why we’re at the receiving end of patient angst," she says, inside one of the hospital’s duty rooms on the seventh floor. The poorly ventilated room had no lock, CCTV camera or emergency phone line. This reporter walked in without a single security check. Several attempts by Mint to seek an official response from Dr Asmita Rathore, medical director of GTB, went unanswered due to permissions she needed from “higher authorities".
Violence and safety were the two primary concerns raised by Supreme Court advocate Tanvi Dubey, representing the Federation of All India Medical Association (FAIMA) and the National Federation of Resident Doctors of AIIMS, who moved the top court seeking interim protection of doctors.
Even as the Indian Medical Association called for hospitals to be declared as safe zones with “airport-like security", Dubey is confident that the Supreme Court’s judgement “will act as a bible in terms of the measures we have to take to make hospitals a safer workplace".
In the days leading up to the court hearings, she was sent photos and evidence from several remote parts of India, of medical colleges and government hospitals where “one would be afraid to spend even ten minutes". Urgent repairs apart, she appealed for CCTV cameras and separate toilets and duty rooms for men and women. The doctors she represents can’t overstate how lacking India is in the basics.
Nearly all duty rooms in government medical facilities are unisex. Women doctors have to share them with their male colleagues and always keep one eye open when they catch a nap between 24-48-hour shifts.
There should be a provision of separate resting rooms and duty rooms in each department for male doctors and female doctors and nurses; and a gender-neutral common resting space, note the terms of reference given to the national task force by the union health ministry.
A senior faculty member at Purulia Government Medical College, West Bengal, who spoke on the condition of anonymity, said that the college doesn’t have separate toilets for men and women. “We have requested the administration for years, but this isn’t seen as a priority," she said over the phone. Recently, a story on News18 Bangla showed the college’s security workers getting drunk outside the public toilet, while on duty. The college is yet to take action. Multiple attempts to reach the principal seeking an official response went unanswered.
This is directly because of neglect and low investment in public healthcare, says Dr R.V. Asokan, president of the Indian Medical Association (IMA). “The money budgeted for health isn’t commensurate with the needs of this country and our rate of expansion."
Keeping it internal
Infrastructure and security are the easier measures to fix. The part that requires real work is building robust institutional mechanisms to protect victims of sexual harassment. While the Sexual Harassment of Women at Workplace Act–2013 can be found displayed at the reception of most medical institutions, few women have the courage or faith to knock on the doors of the internal complaints committee.
“The joke is that the internal complaints committee exists to keep all complaints internal. Their involvement is to keep the reputation of the institution intact," says Kiruba.
At one of New Delhi’s premier government medical colleges, a senior professor teaching endocrinology has allegedly been a sexual predator for years. “He makes women feel uncomfortable by asking them inappropriate questions about breasts during their viva in the name of quizzing them about mammary glands. He has groped a few. And because your grades are literally in his hand, women choose to remain silent," says a recent MBBS graduate, on condition of anonymity.
Another consultant in surgery is notorious for his sexually explicit tactics. He would call junior female doctors to his room to harass them and even molest patients during surgery.
“Things don’t escalate into a complaint. When there’s already a culture of ragging, it isn’t easy to speak up," she says.
An Instagram page called @ucdome has become a popular platform for sharing instances of sexual harassment and violence suffered by medics on duty. Managed by eight PG students from the University College of Medical Sciences (UCMS), Delhi University, the page has 16,200 followers and 2,660 posts based on anonymous responses from medics across India. It has seen a surge in traction in the wake of RG Kar.
The Sexual Harassment of Women at Workplace Act mentions clearly that it is the duty of the employer to provide awareness about institutional redress. “The employer has a huge role to play in making a victim feel supported to seek justice. That even women supervisors don’t offer timely support is a matter of great concern," says Dubey, who also brought this issue to the apex court’s notice. In her interaction with resident doctors associations across the country, she couldn’t find a single medical institution that had a strong internal complaints committee in place with a proper call facility.
Even top-end private sector medical facilities, known to have better surveillance systems, buckle when it comes to dealing with internal complaints. One of India’s best-ranked multi-speciality tertiary care hospitals, located in southeast Delhi, was quick to swing into action after the RG Kar incident. They put out safety policies and emergency contacts. They promised to issue the women staff ID cards with panic buttons installed, which can be worn around the neck. Security personnel were trained to respond within 10 seconds of pressing the button. The management promised duty rooms with biometric entrances for women. When the Indian Medical Association called for an all-India strike, the doctors dutifully marched to Lady Hardinge Hospital in solidarity.
And yet, recently, when a senior resident doctor approached the medical superintendent to lodge a sexual harassment complaint, she was turned away. The complaint was regarding a senior surgeon who made it a habit of passing sexist remarks, ignoring her discomfort, which she made explicit to him verbally and in writing. “The female superintendent offered to change my unit. She acknowledged that he has a history of sexual assault. Yet, it was made clear to me that he was too important for the hospital to lose. He brings the patient flow, the income and the connections," she said, in a phone conversation. When she tried to gather signatures to escalate the matter, only one senior resident mustered the courage to put her name to it. Her male colleagues refused and said, “Arrey, Sir aise hi hain".
“These are the same people who were out protesting on the streets but can’t stand up to support a woman at their own workplace. Why is my discomfort ignored until I get raped or murdered?" she asks.
“We are appalled. We are angry. We are uncomfortable," states a formal email sent this week to the medical superintendent, reviewed by Mint, which details the casual sexism, inappropriate physical touch and vulgar conversations the women were subjected to. The letter makes their refusal to work with him clear. The hospital finally promised to look into the matter.
But justice is a tough ask in these sanitised corridors. Medical institutions don’t see that by protecting a sexual predator they are putting the lives of many more young doctors, interns, nurses and patients at risk. The medical community never saw its #MeToo moment. It is a can of worms waiting to be opened, say many.
“In medicine, we learn early to not wear our gender on our sleeve," says Kiruba. She recalls the time a pregnant colleague was made to feel like she was the weakest link in the team. A second one suffered an active miscarriage while on duty and kept quiet for fear of making her “womanly" needs known.
“The medical profession is seeing a feminization in India," says Dr. Asokan. The truth is, healthcare in India has never had more women be a part of it. But are we doing enough to make them feel at home?
The recent violence and brutality have pushed women to the edge, and not just those in the medical profession. The protests in West Bengal have snowballed into an unprecedented wave, led by women from all walks of life, demanding workplace safety. From young and old medics, ASHA workers, gig workers, factory workers, call centre employees and software professionals, they all stand united in their demand for safer cities with no night curfew.
As singer Arijit Singh asks in his protest anthem for RG Kar: Aar Kobey? When will it be, if not now?
Shriya Mohan is an independent journalist.
