Doctors are scapegoats for India’s failing health system

At New Delhi’s All India Institute of Medical Sciences, India’s premier public hospital, junior doctors have just added a course to their training: Taekwondo, the Korean martial art.

The aim is to give young doctors the requisite techniques to defend themselves, should they be attacked while on duty at the overcrowded, undermanned hospital. Fears of such assaults are not far-fetched.

In March, a doctor at a government hospital in the town of Dhule was badly beaten by a patient’s relatives, who were infuriated that there was no CT scan machine available at the facility.

Punched and kicked repeatedly, the doctor suffered multiple fractures, including a fracture to his eye socket, which has impaired his vision.

It was one of the most brutal of a growing number of assaults on doctors by Indians enraged by the disintegrating and under-funded public healthcare system.

“Violence is increasing day by day,” said Dr Vijay Kumar, president of the AIIMS Resident Doctors’ Association, which demanded the self-defence training for its 1,500 members. “You never know when you will get hit by the patients’ attendants. You should have self-defence techniques so you can defend your vital organs.”

The attacks on doctors are a symptom of a bigger public health crisis.

India suffers from an acute shortage of doctors, with just one physician for every 1,800 people.

The government is also miserly about its public health spending, allocating just 1.4 per cent of gross domestic product, compared with 3.1 per cent in China.

As a result, India’s public healthcare system — on which working-class and poor Indians still rely — has neither the manpower nor equipment to provide a reasonable standard of care for the seriously ill and injured patients seeking treatment.

Many patients are turned away from public hospitals for lack of beds, and even when they are seen, doctors have little time to spend with each patient.

Waiting lists for emergency, life-saving surgery can be anything from six months to two years long.

“The majority of the Indian population is truly disenfranchised from access to healthcare,” said Dr Vivekanand Jha, executive director of the George Institute for Global Health, India.

“Public healthcare is completely broken. It’s difficult for everyone to be given the kind of attention they deserve.”

Yet, public expectations of hospitals are rising.

“They are used to watching TV medical shows like House MD and Scrubs — and seeing the awesome facilities available,” said Dr Roshan Radhakrishnan, a 36-year-old anaesthetist in southern India.

“Come to a public healthcare centre and you will see in an outpatient department, we can’t spend more than 10 minutes per patient,” he said.

“Obviously that man is going to be disgruntled with us if we try to speed up the process so the next six guys can come in.”

The collision of expectations with reality is often explosive, especially as many patients arrive at hospital accompanied by large groups.

“In India, the patient doesn’t come to the hospital with just one or two family members.

“They come with a crowd — sometimes their entire neighbourhood,” said Dr Jha.

“You just need a little spark to be lit and the emotion of the crowd feeds off each other.”

Frontline doctors end up as the scapegoats.

According to a study carried out last year at a large tertiary hospital in New Delhi, 40 per cent of the medical residents there had been exposed to violence at work in the previous 12 months.

The Indian Medical Association has said that 75 per cent of Indian doctors have been attacked physically or verbally by patients or families at some point.

For now, young doctors are focusing on the need for better protection — through more security staff at hospitals, or self-defence training.

But genuine security is likely to come only when the government recognises that the public health crisis is a drag on its economic aspirations, and takes the right steps to cure it.

“It’s a country which is pushing to be a superpower,” said Dr Radhakrishnan.

“But you are trying to gloss over these shortages and shortcomings, pretending they don’t exist”. FINANCIAL TIMES

ABOUT THE AUTHOR:

Amy Kazmin is Financial Times’ South Asia Bureau Chief.