• Carole M

Violence against Doctors in India: Is an end in sight?

Story at a glance:

  • Violence against health workers in India has seen a sharp spike since the start of the COVID-19 pandemic.

  • In April, 9 cases of physical violence against health workers have been recorded nationwide.

  • The Cabinet on 23 April, cleared an ordinance to bring punitive measures against attackers. The offence will attract a maximum punishment of seven years’ imprisonment and Rs 5 lakh fine.

On April 18, news broke of a group of health workers, including women, who had been attacked by a mob in a slum in Indore during a routine COVID-19 survey. The group had been tracking down a man who might have had contact with a recently confirmed case of the coronavirus. When they found him, he cursed at them, asking why they wanted his information and accusing them of trying to take him away. Almost immediately, at least 100 people surrounded the team, throwing stones and other objects. Luckily, they managed to escape.

Doctors with IMA conduct door-to-door surveillance (Getty Images)

Unfortunately for health workers in the country, this was just another episode of health-care workers being subjected to violence and abuse as they try to contain the virus. Assaults have been reported across the country as people panic about catching the disease from medical workers or being stigmatized for having contracted it themselves.

Just in the last month over 9 such cases have been recorded. Health workers reported having been attacked during a door-to-door surveillance project in Bengaluru, doctors in Bhopal claimed that they were stopped by the police, accused of spreading the virus and beaten on their way back from work, and a group of residents in Delhi had attempted to force a female doctor from her place of residence.

This violence against health workers isn't a new phenomenon sparked by the confusion around the Coronavirus outbreak either. In fact, a study by the Indian Medical Association in 2017, revealed that over 75% of doctors in the study had been subject to violence at while performing their duties. So why are health workers in India forced to such atrocities and why aren't there signs of change?

Causes for violence against health workers

1. Poor image of doctors and the role of the media

In India, doctors have traditionally been regarded highly by society. The present impression of private business-mindedness of some in the profession has led to a poor image of doctors. Further complicating this image are media outlets which thrive on sensationalization of every news item, often ignoring important information that would exonerate a doctor in an incident of alleged medical negligence.

2. Mob mentality

Mob mentality frequently snowballs into a violent crisis in hospitals. In India, emotional turmoil due to death of a loved one is sometimes used by local politicians as an opportunity to demonstrate their political relevance by orchestrating violence at the clinical establishment. The 2-minute of fame and news coverage drives these antisocial elements to often damage the social fabric during a medical accident. Unique to India, the unfortunate death of a patient is sometimes given religious and caste color by some miscreants, especially if the doctor belongs to a different caste or religion than the patient.

3. Meager health budget and poor quality healthcare

Among other causes of violence against doctors in India are the pathetic conditions in which patients are treated in government hospitals. There is overcrowding, long waiting time to meet doctors, absence of a congenial environment, multiple visits to get investigations done as well as consult doctors, sharing a bed by two and sometimes three patients and poor hygiene and sanitation. There is frustration with systemic problems of government hospitals, from dysfunctional equipment to shortage of staff. Given the poor budgetary allocation for health in India, these problems are unlikely to change. Violence against the health service provider is only a symptom of this crippling underlying malady.

4. Low health literacy

This is often used to propagate myths and false accusations are made even in cases of death due to a previous illness. During emotional breakdown following death of near and dear ones, it becomes impossible to present or understand a rational view. In India, where 30%–40% of cases of acute coronary syndromes present to emergency with complaints of dyspepsia/gas, it is difficult, if not impossible, to explain death during primary angioplasty due to ventricular arrhythmia. Unrealistic expectations are also part of the low health literacy. There is an increasing expectation from patients that with modern medicine and technology a doctor should be able to guarantee a good outcome.

What is the medical fraternity doing to help its peers?

Referring to the recent COVID-related spike in violence against doctors, a spokesperson for The Indian Medical Association recently said that the organization has shown much restraint in spite of extreme provocations. "That doesn't mean our patience is endless. Abuse, violence, spitting, pelting of stones, denial of entry to societies and residential accommodation have been tolerated so far since we expected the governments to do their normal duty.” Further, the organization declared a 'White alert' for the nation and demanded stringent protections for doctors under the law.

A petition demanding action from the government recently ended with over 220,000 supporters.

The government's response

Historical inaction from the government has been a particular stimulant for the repeated protests by doctors around the country. Despite the various health worker organizations in the country organizing over 5 protests in 2019 alone, no significant laws had been passed ensuring the protection of these workers in their line of duty.

The government response to the proposed COVID-19 protest, however, has been different. The Union Home Minister Amit Shah on Wednesday assured the health workers of security on behalf of the Central Government amidst the incidents of attack on health workers in several parts of the country. While interacting with a group of doctors and IMA members through video conferencing, the Home minister also appreciated the contribution of health workers in combating the Wuhan Coronavirus pandemic.

The Cabinet today cleared an ordinance to bring punitive measures against attackers. The offence will attract a maximum punishment of seven years’ imprisonment and Rs 5 lakh fine. Whether this proposed ordinance will lead to end of all violence against doctors in the country remains to be seen. But the COVID-19 outbreak has highlighted the critical role of health workers in people's lives and the most powerful stimulus for change in recent history.