Doctors’ distress is real and they have a right to strike

Should doctors strike?

I have been a part of many protests as a medical professional. As a medical student, as an intern, and as a resident. So I can fully understand the sentiments of how this strike has come about. So I believe I can speak on behalf of the striking doctors.

Believe me, it is always a moral and ethical quandary — we make no bones about it.

As with all doctors all around the world — Indian doctors too suffer from being absent to their own families, many going through bad marriages and suffering the stress of being overworked. Doctors have a higher incidence of alcohol and tobacco usage as well as drug abuse than other professionals. Depression is real in this profession riddled with uncertainties. In addition to these problems in the context of India, we have several other problems.

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We want to treat patients. I could say with some confidence that the vast majority of us in this profession love what we do and would rather not do anything else. That is why we were willing to give the high cost it takes to become a doctor. Not just financially to study and train to be doctors but also cost to our own health and personal life.

Residents in government hospitals are forced to live in appalling conditions.

Resident doctors stay poorly furnished hpostel rooms in Mumbai. Image courtesy Raghuraj S Hegde

Resident doctors stay poorly furnished hpostel rooms in Mumbai. Image courtesy
Raghuraj S Hegde

Mumbai’s doctors live subhuman lives in filthy shacks

Every year several doctors die from contracting tuberculosis, malaria, and dengue due to long hours, poor diets, high stress and unhygienic conditions they are forced to work in. The junior doctors of hospitals have a higher incidence of contracting severe communicable illness than the general population. News pieces like Mumbai doctor dies of Extremely Drug-Resistant TB are all too common.

Junior doctors work terribly long hours and much beyond anything they are paid to do. As residents or even as junior consultants 100 hour weeks and 36–48 hour duties are par for the course in India.

How inhumanly long work hours are killing young doctors in India

Public hospitals in India are poorly equipped. Many of the existing basic equipment — CT, MRI, ultrasound machines etc., are out of order on most occasions. Tertiary care hospitals are overburdened because the infrastructure in rural areas is mediocre and most patients have to come to cities, stand in long lines to get even basic treatment.

Conditions in private hospitals are somewhat better but come at a price — which is why the entire middle class hates doctors and hospitals. They won’t go to government hospitals because they have to wait in long lines and know they won’t get personalised care while insisting the private players should work at cost. People who don’t know anything about what medicine is about decide how much doctors should be paid and how much treatments and surgeries should cost.

Politicians do one better — they get treated in VIP wards in already crowded public hospitals sometimes bending rules — Sushma Swaraj undergoes kidney transplant at AIIMS or they go abroad for treatmentKarnataka minister gets treatment abroad, govt decides to foot Rs 1.16 crore medical bill. Either way, they are not affected by the problems of the general public or the doctors. Which is why India has one of the lowest public health expenditures in the world and 80 percent of medical expenses are out of pocket.

Also read:Violence against medics makes them defensive in practice, paranoid in outlook

I bring up work conditions because one has to understand the cost that the doctors pay in serving the poor patients in government hospitals in India. If people only did this for the financial compensation, you will not have many people in this profession. Doctors working in such challenging conditions should have extraordinary motivations to make them tick in such environments. If a doctor working in these circumstances is now faced with constant threat of assaults it all just blows up.

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Whenever doctors in India have a grievance – whether salaries not being paid for six months at a stretch, that there is no access to basic medicines in city hospitals and in rural areas, or now like the present issue – the very frequent assault on our colleagues in hospitals, etc., – we try our best to go through all the available channels so that we not stop what we love doing.

The role of an anarchist doesn’t sit well with what we came into the profession to accomplish. We really don’t want to hold marches in the hot sun catching placards, chanting slogans against the authorities, wearing black ribbons to work, creating awareness over social media about all the bad things happening in the medical profession. We would rather do things that make us happy and talk about the amazing things in our profession (they do exist despite all this). We would like to spend less time on negativity after a day’s worth of fulfilling work.

We understand that strikes inconvenience and antagonise needy patients – our most valuable assets. It is counter-productive because you then pit them against you. It deteriorates an already fast eroding doctor-patient trust as well prevent them from sympathising with your plight. To add to that, when doctors strike it is often the poorest among them who suffer – those that can’t afford a private hospital. We understand this all too well, which is why you don’t see doctors striking without keeping the emergency services intact.

If you see doctors striking, it means the issues have reached tipping point and they have tried all other methods to mitigate this matter. Junior doctors run the entire show in government hospitals in India. So them not working for a few days collapses the entire healthcare system in India. The junior doctors bear the brunt of the attacks when mobs decide to assault doctors. Yet the indifference of the government authorities is baffling. The unwillingness of the successive governments to take action on this issue is what has brought about this strike to a flashpoint.

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What does the law say regarding striking doctors?

The state governments are armed with the Essential Services Maintenance Act which they are not shy of using when faced with doctor strikes.

Doctors’ strike: Delhi govt invokes ESMA

I fully agree that healthcare is an essential service. It might be unethical and morally untenable to go on long strikes for doctors – especially ones that compromise emergency services. The problem is if medical care is an essential service, then protection of healthcare providers too is essential. When the government cannot ensure safe working environments, to expect doctors to work under a sword is unfair. This is a question of safety of not just the doctors but also the patients. What is the quality of care you can expect if doctors are going to be scared about being beaten all the time?

This is not a new issue. This has been happening for many many years. If anything it has become worse in recent years.

Why Are Physical Attacks On Doctors Commonplace In India

Someone recently told me, they have never known that doctors in India are beaten up regularly. I hadn’t either until I started working as a doctor. If people are hearing about it, it is because of this strike and several smaller ones before this. The people who sit in judgment on this issue are narrow-minded and self-serving — the government, courts, police, media and even doctor-administrators. No one is listening to what the doctors have been saying. There is no interest in protecting doctors from nefarious elements. These junior doctors don’t have clout- they are viewed as cheap workers who are expendable according to the government. There is no incentive – financial or political for any politician to help doctors in their work.

Many doctors today are discouraging the next generation from taking up the same profession. Seeing that this profession comes at such personal costs and there’s so much disillusionment waiting for them further down the road, I really don’t blame them. I keep reading the following article by a doctor from time to time and keep thinking that things haven’t changed one bit.

Why I will never allow my child to become a doctor in India

The author Raghuraj S. Hegde is an ophthalmic plastic surgeon based in Bangalore.

It would be catastrophic to follow high-cost healthcare model of US: Sujatha Rao

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Private hospitals have been in the news for all the wrong reasons lately. Sujatha Rao, former Union health secretary and author of the book, Do We Care? India’s Health System, tells Rema Nagarajan that the recent exposés underscore the need for greater investment in public healthcare delivery as well as better systems to regulate the private sector

You say in your book that the government has an ambivalent policy towards the overwhelming private sector. Why?
The recent exposes in the media regarding the overpricing of cardiac stents and establishing fake colleges by the private sector show what happens in the absence of regulations. Fraud on such a large scale cannot happen otherwise. As traced in my book, the evolution of public policy in health clearly shows how the private sector in India grew by default and the persistent failure of the political system to articulate a consistent and coherent policy to manage this elephant in the room. This is a serious omission since the health sector has severe market failures making government intervention an imperative, not a choice. Such indifference to develop an appropriate framework of laws, systems, protocols and the institutional architecture to regulate the sector is a failure of governance.

Does the government have any option but to purchase healthcare from the private sector?
As the private sector provides three quarters of outpatient treatment and two thirds of hospitalisation, options to ignore it are limited and the perception that government can provide all health services is impractical. The government still has room to bring in a balance in two ways. One, by creating the fiscal space to step up public investment with at least 1% of GDP only for building the health infrastructure, particularly in areas where government is the sole provider. Two, by keeping its dominance in primary and secondary care markets that address over 95% of medical ailments, prevent disease, promote wellness, and in the long run, reduce costs for government and households. Every country tries to keep control over healthcare expenses, either by controlling primary care so that the push to more expensive hospitalisation is regulated, or by regulating secondary and tertiary care with protocols and price caps so that there are no runaway surgeries and unnecessary care. If the whole chain is privatised and unregulated as it is now, then it can become unaffordable. In any case, government’s first charge is to ensure universal access to public goods like basic healthcare, clean air, water, environmental hygiene and nutrition. In my opinion, this is an obligation the state cannot abdicate. This alone will reduce a substantial burden of disease and out-of-pocket expenditure.

You say public policymaking is trending towards greater reliance on consultants than building institutional capacity. Why?
If you take a historical view, you will see a transition from reliance on classical public health experts to commercial consulting companies like Ernst Young or McKinsey, in helping draft public policy. This is not a stable solution. What is needed, and government does not do adequately enough, is investing in institutionalised research and promoting knowledge to anchor policy on evidence. Our success in reducing the incidence of communicable diseases like malaria, guinea worm, polio or HIV/AIDS is largely on account of good quality evidence that helped guide policy and implementation strategy. Health falls in the realm of behavioural economics and regulating that requires policies to be rooted in our own cultural and behavioural preferences, social realities and political and administrative contexts. Besides, such accounting firms also have conflicts of interest as many are also consultants to private companies in the health sector and carry a bias against government intervention and public health.

Budget 2017 does give a lot more to public healthcare delivery, doesn’t it?
It’s not the 28% increase that should concern us but the quality of spending proposed. More worrying is the absence of a clear vision. In this context I am glad to see the recently released National Health Policy embedding a vision. One may disagree with it and there may be some contradictions, yet at least there is a vision that will now enable bringing in required regulations to mitigate any harm. The challenge today, rather than spelling out schemes, is articulating a vision for the next decade and an implementation plan that has a national consensus to ensure it is placed above partisan politics. Public health goals have been stated but realising them would need huge investments in terms of trained people, and appropriate infrastructure, particularly at the level of primary care. Primary care is not just about polio drops and institutional delivery. It’s about averting diseases that are expensive to treat. For example, there would be no need for too many dialysis centres if we can control hypertension and diabetes. Neglecting primary care means opting for the high-cost, specialist-led and hospital-based US system of care. The US is already paying a heavy price because of their model; in India, it could be catastrophic.

Government doctors work in trying conditions. The least they need is safety

Maharashtra Doctors' Strike

Here’s what they don’t teach you in medical school: Self-defence. Perhaps they should. After all patients, or more accurately their relatives, are known to beat up doctors who bear bad news.

Think I’m exaggerating? Watch the YouTube video of the assault that landed Dr Rohan Mhamunkar of Dhule in the ICU. The doctor’s suggestion that a patient with severe head injuries should be taken to another hospital since his didn’t have a neurologist, provoked an attack by some 25 relatives. As the doctor falls back on an empty bed, you can see one of them repeatedly stomp on him.

The Dhule attack is one of four in the span of a week in Maharashtra. In Nashik, three doctors and a nurse were assaulted after a patient they brought in died of swine flu.

At Sion Hospital, Mumbai, relatives of a patient who died of chronic kidney failure beat up a first-year resident. The most recent attack on a senior woman pediatrician, also at Sion Hospital, took place after 4,000 resident doctors had already gone on strike, ironically, to demand protection.

“We’re only asking for safety measures,” says Dr Parthiv Sanghvi, secretary of the Indian Medical Association’s Maharashtra chapter. Specifically, the striking doctors want security, action against the culprits and restriction on the number of relatives accompanying patients.

“Exemplary punishment,” adds Parikshit Tank, a doctor in private practice who is supporting his colleagues in government hospitals, “Would be a strong deterrent.” Right now, of the 53 cases of assaults on doctors in the past three years in Maharashtra, there have been zero convictions. “The message is, assault a doctor and get bail,” says Tank.

We constantly complain about the state of government hospitals, often with good reason. Doctors don’t show up or turn up late. Appointments can take forever. Medicines are in short supply, diagnostic machines don’t work and unethical practices, including the demand for bribes by hospital staff are why 67% of people said government hospitals are corrupt in a 2007 Mint survey.

Yet, the view from the other side, while seldom seen, is equally compelling. Doctors aren’t to blame for lousy infrastructure. They work despite it. With one doctor for every 2,000 patients (the World Health Organisation recommends one for every 1,000), our doctor-patient ratio is worse than Algeria’s.

Doctors can be super-heroes in white coats. Last year they wrote about their working conditions — long shifts, short sleep, bad food – to the state Human Rights Commission. Shifts in a stressful job can stretch to 48 straight hours. But when you’re short of five lakh doctors in the country, what choice do you have?

The AIIMS outpatient department sees 10,000 patients a day. Some, particularly if they’re from outside Delhi, could be accompanied by five-six relatives to help with appointments, medicines and food.

Overworked doctors simply don’t have the time to allay patient anxieties. Patients feel doctors are rude and brusque. The old idea of ‘respect’ for the doctor is gone, says former AIIMS professor of medicine Anoop Misra, now in private practice. Thirty years ago when he was a resident, physical assault was simply unheard of. Now, a fraught situation, with nerves on edge on both sides can lead to, heated exchanges, or worse, even in private hospitals.

Increased security including CCTVs could help. So could the new health policy, announced last week, that raises the health budget from a miserly 1.2% of the GDP to 2.5% — still far below the global average of 5.4%. If some of those funds go to infrastructure and to additional primary hospitals and health centres, it might ease the burden. But none of this will happen overnight.

Until then, the least we can do is assure our doctors that we will not tolerate any sort of assault against them.

In Dhule, there are reports that Dr Mhamunkar might lose sight in one eye. Surely, no doctor signs up for this.

Namita Bhandare writes on social issues and gender. She tweets as @namitabhandare

Violence against medics makes them defensive in practice, paranoid in outlook

Resident doctors display placards during a protest rally at the KEM hospital in Mumbai. PTI

Even as 4,500 resident doctors in Maharashtra continue to protest against the recent string of assaults on their colleagues, the Indian Medical Association (IMA) on Friday ended its agitation after state chief minister, Devendra Fadnavis, assured better security in government hospitals.

Resident doctors across the state are protesting in the wake of a string of attacks on their colleagues by patients’ relatives at government hospitals. The issue came to light when Rohan Mhamunkar, an orthopaedic resident doctor in Dhule, was allegedly assaulted by the relatives of a patient. He sustained serious head and soft tissue injuries, that nearly cost him his left eye.

Following the incident in Dhule, reports of similar attacks surfaced all across Maharashtra. The resident doctors’ strike, backed by IMA and Association of Medical Teachers, ultimately led to a series of written announcements by the state government, aimed to improve security in government hospitals.

The government proposed that security audits of all public hospitals will be conducted by an expert within the next fifteen days. To start with, 1,100 new armed guards will be posted at public hospitals across the state. Measures like CCTV monitoring, restriction on number of visitors, special security measures at sensitive places like the Intensive Care Unit, Operation Theatre, Emergency Care or Casualty department etc will be put in place immediately. It is pertinent to note here that the Bombay High Court will periodically monitor the implementation of these measures – every 15 days, till the process is complete.

But violence is not new to the medical profession. In medieval times, the treating physician was buried alive alongside the royal deceased. A similar practice prevailed in certain European Kingdoms until a few hundreds years ago. That the doctor is held responsible for every adverse outcome or death and is assaulted in India even today, in the 21st century, is preposterous.

It seems that people in India don’t understand that not every complication or death is a result of the doctor’s negligence. They need to understand that the doctor can only promise standard and committed care; he can not always ensure a cure.

For redressal of grievances, the aggrieved patient has many avenues – Medical Councils, Civil Courts, Criminal Courts and Consumer Courts. But how can one ever justify an assault on the treating doctor’s life or damage to hospital property? If we are going to resolve our differences in this manner, then what is the need for courts of law?

In January 2001, a doctor, Vasant Jaykar, was murdered in Khar, Mumbai, because a patient ailing with terminal liver cirrhosis had died under his care. He was known to be an extremely ethical, mild mannered and helping physician, who lived only for his patients. His murder, incidentally, was not an isolated incident. Many more doctors have lost their limbs or even their lives in similar incidents due to mindless violence of patients or their relatives.

It appears that treating serious or terminal cases has become particularly risky these days. The immediate threat to life, it seems, is not to patient but rather to the treating doctor. Then there is also the possibility of vandals destroying hospital property. The destruction of property at Thane’s Singhania Hospital in 2001 serves as an example. This prime medical facility had to shut down post the extensive ravaging.

The doctor, unfortunately, is the perceived face of the healthcare system. No matter what the infrastructural deficiency is, he has to bear the brunt of the problem. Be it a shortage of qualified nurses, lack of blood in the blood bank, scarce ambulance services, shortage of medicines and equipment;it is seen as the doctor’s problem, who ends up taking the blame and the occasional thrashing. Even in the Dhule case, since no neurosurgeon was available to take care of the patient’s head injury, Mhamunkar ended up sustaining life-threatening injuries.

The frenzy whipped up against the medical profession has reached a point where every doctor is considered guilty unless proved innocent. Campaigns to educate the consumer (read patient) have swung the pendulum to the other extreme – now every action of the treating doctor is seen with extreme doubt and suspicion.

Unfortunately, there are no guarantees in medicine – it is an inexact science. Here, unlike mathematics, two and two do not always add up to four.

The problem arises when some doctors or institutions, in their zeal to promote their services, start offering bogus guarantees. State-of-the-art gizmos, too, have raised the expectations of the patient to the point where he presumes a hundred percent favourable result.

Doctors at the Byramjee Jeejeebhoy Medical College protest against the recent attack on their colleagues. Firstpost/Prachee Kulkarni

Doctors at the Byramjee Jeejeebhoy Medical College protest against the recent attack on their colleagues.

Add to that the poor bedside manner, lack of proper communication skills and the doctor’s packed schedule, who has multiple attachments and many patients to look after. Thankfully, some medical schools have now introduced courses in medical ethics and communication skills.

Such incidents are setting a sense of despondency in medical profession. The doctor feels harassed and demoralised, he is beginning to treat almost every patient as a potential aggressor or litigant. He is becoming defensive in practice and paranoid in his outlook, which can not be good for anyone. A fearful mind or a trembling hand can never give efficient service to the patient.

The Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act was enacted in 2010. The Act made offences against doctors non-bailable, with imprisonment up to three years and fine up to Rs 50,000. The offender is also required to pay twice the amount of damage or loss caused to property as compensation.

The problem is not in the act but rather in its implementation.The police is not sensitised to the Act and thus does not invoke it in cases of violence against doctors. Even filing an FIR in such cases at the local police station becomes a Herculean task. Post the promulgation of this Act, there have been 72 recorded cases of violence against doctors – most of them being tried under IPC sections and not this Act – but not one has reached sentencing till date.

The doctor-patient relationship is under severe strain at this point. And unless both, the doctor as well as the patient, understand and learn to honour the finer point of their relationship, the healing process will not be complete.

The author Arshad G Mohammad is consulting surgeon and trustee, IMA, Mumbai West.

‘Public will hit you’: Resume work or face termination, Bombay HC tells striking resident doctors

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The Bombay High Court on Friday asked the striking resident doctors in Maharashtra to resume work by Saturday morning or face action.

The court hit out at the agitating resident doctors for taking “undue advantage of its sympathy,”

Irked by the doctors’ failure to resume work on Friday despite giving an assurance to the court that they will do so, a bench of Chief Justice Manjula Chellur and Justice G S Kulkarni said if they stretch the matter, the “public will hit” them.

The bench had on Thursday asked all the resident doctors to resume work immediately and resolve their issues with the government amicably.

But it got upset when it was informed by the Maharashtra government and the Brihanmumbai Municipal Corporation (BMC) that despite the court’s order, the doctors are still on strike.

“If this is the attitude of the doctors, the respective hospital management can initiate suitable action against them and terminate their services,” said the bench tersely.

The bench, however, gave the agitating doctors time till 8am tomorrow to report back to work or else face action.

BMC counsel Suresh Pakhale today informed the court that 135 people have lost their lives in the three civic body-run hospitals (Sion, KEM and Nair) due to the resident doctors’ strike since March 20.

To this, Chief Justice Chellur said, “The life of the patients are more important than your (doctors) demands.”

“Despite assurances, if the doctors have not resumed (work), we think we made a mistake yesterday by showing them sympathy and appreciating their work,” the bench said.

“The doctors are taking undue advantage of us and our sympathy. If you (doctors) keep stretching the matter like this, the public will come and hit you. You are creating this atmosphere,” remarked an upset chief justice.

“Let the hospital management take suitable action against the doctors then. Let them all be terminated,” the court said.

Nearly 4,000 resident doctors have stayed away from work since Monday, demanding enhanced security in the wake of a string of attacks on their colleagues by patients’ relatives at government hospitals across the state.

On the court’s direction today, the secretary and the president of the Maharashtra Association of Resident Doctors (MARD) filed an affidavit stating that the association has asked all its members to resume work immediately.
“The association has no objection if action is initiated against those doctors who fail to resume work,” the affidavit said.

4500 resident doctors likely to continue agitation

Resident doctors display placards during a protest rally at the KEM hospital demanding security after an intern was assaulted by a patient's relatives, in Mumbai on Friday. PTI

Even as 4,500 resident doctors in Maharashtra have not indicated yet if they are going to end their strike anytime soon, 40,000 medical practitioners associated with the Indian Medical Association on Friday afternoon ended their strike after state Chief Minister Devendra Fadnavis assured them of security at their workplaces.

A meeting was held on Friday between Medical Education Minister Girish Mahajan and representatives of the resident doctors, an IMA member said.
The representatives of IMA called on the chief minister at Vidhan Bhavan in afternoon. Fadnavis told them that security has already been provided in 16 hospitals since Thursday. “Government is working on (providing) security to doctors and more arrangements will be done within ten days,” he said.

The IMA had joined the strike two days back. The strike was originally started by the resident doctors in Mumbai following a brutal beating of a doctor by relatives of a patient, who passed away during treatment.

With the IMA associated doctors returning to work, the surging number of patients have heaved a sigh of relief as they were at the receiving end following the agitation. The civic hospitals usually cater to the economically weaker sections, mostly those who cannot otherwise afford treatment in expensive private hospitals.

Meanwhile, the state’s Chief Minister Devendra Fadnavis also gave an ultimatum to striking resident doctors to resume duty or face legal action even as the Bombay High Court gave the state-run hospitals an option to terminate their services. “Enough is enough. If the doctors fail to resume work today, government will not sit quietly,” Fadnavis said, describing as “adamant” and “insensitive” the attitude of doctors whose strike in support of enhanced security at hospitals entered the fifth day.
“We cannot leave the patients to die. I am making a final attempt to break the deadlock by meeting the doctors’ representatives. If no solution is found and doctors don’t resume work, they should be prepared to face legal action,” the Chief Minister told the state legislative assembly.

The Bombay High Court also stepped in, seeing the plight of the patients, asking the government to provide security and directing the doctors to return to work.

With the doctors away from work during the strike, the functioning of the OPDs and general wards in the government and the civic hospitals took the actual brunt.

“The OPDs in KEM, Sion and Nair hospitals have not yet become fully operational. Some doctors are managing them but it has increased the waiting period for patients,” Avinash Supe, dean of KEM Hospital, had told PTI earlier.

Asked about the striking doctors resuming duty, Supe said, “Very few have returned to work. Hence, full medical services will not be available immediately.”

The High Court had on Thursday directed the resident doctors to resume work immediately. However, the order was not available on the high court website till Thursday night and therefore, protesting doctors decided to wait.

After the court order, the Maharashtra Association of Resident Doctors (MARD) late Thursday night appealed to the striking medical practitioners to join duty.

“The order is now available on the HC website and we find it satisfactory. Now, there is a meeting scheduled with some state ministers at 1 pm today where we will discuss the issue (about their safety) once again,” Swapnil Meshram, general secretary of MARD, had said.

After holding a meeting with Fadnavis on Wednesday, the doctors decided to wait for a copy of the minutes before taking a call on joining duty.

In a bid to end the strike, Fadnavis proposed setting up a panel to resolve security issues in state-run hospitals.

“We have been fooled in the past when promises and assurances made by officials were not strictly implemented. This time we are being careful,” said a MARD official, explaining the delay in the doctors returning to work.

Nearly 4,000 resident doctors have stayed away from work since Monday, demanding enhanced security in the wake of a string of attacks on their colleagues by patients’ relatives at government hospitals across the state.

Fadnavis’ warning to agitating doctors is unwarranted; security is a basic right

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If there is one thing that most Mumbaikars should really be proud of, it is their public heath care system. Mumbai’s major public hospitals run by the Government and the charities have some of India’s finest doctors, who are placed directly at the disposal of the public at subsidised prices. In a 2014 report released by the Praja Foundation, Mumbai had the best public healthcare system in the country. According to a report in IndiaSpend the city had 403 hospitals, with Chennai trailing far behind at the second position with 106 hospitals.

However, despite this, the fact is remains that even India’s “best public healthcare system” is in dire need of improvement. It’s woefully underfunded, understaffed and under resourced. The 2015 report released by the Praja Foundation shows that there is a 60% shortage of medical staff (Page 18) just at the State Hospitals in the City with an average shortage of 28% across the board. This for a public health system that caters to a population that is now bordering on 21 Million (210 Lakh) people.

But even then, somehow, despite these chronic shortages, the public health system in Mumbai ticks on. It manages to do so because it is staffed by resident doctors who literally work round the clock at it’s public hospitals. These doctors form the backbone of the city’s public health infrastructure.

So last Sunday, when fifteen relatives of a patient attacked a junior doctor at LT Hospital Sion Mumbai after the patient died of kidney failure, it should have shocked more people than just the medical community. Our city’s doctors work shifts of more than 18 hours a day — and sometimes that extends on to 36 hour at a stretch — to keep the hospitals functioning. Today they are being forced to strike, not to demand things like better working conditions and infrastructure, but to merely seek basic security to do their job.

To work as a doctor in a public hospital is a choice that should be celebrated. It is a service to the community and those who perform it deserve to have the right to basic safety. The Government’s response to this strike seems to be rather highhanded, from serving expulsion notices to threatening pay cuts to the striking doctors.

The government notice has, however, been kept in abeyance on Thursday after the Bombay High Court order directed the government to resolve the matter amicably, while requesting the doctors to resume work . But the Government’s response of issuing those expulsion notices itself is wrong.

It’s sad that instead of actually assuring that the healthcare system would be fixed, the government would go after the striking doctors. It is evidence of a sense of misplaced priorities. The demands of a safe working environment are not unreasonable. Add to this the fact that this was not the first time an incident like this has happened — the doctors have good reasons to be wary of what the government says. But instead, the government comes out and demonises the doctors for apparently “neglecting their duties”, which remain sacrosanct; after all it’s easy to make them the targets. The argument goes that doctors should work in all conditions as they have a sacred duty to heal their patients.

However, this argument does beg an answer to a fundamental question.

Is being subject to violence from angry relatives of the patient/members of the public now an essential condition to practice medicine in India, which is why the strike is deemed immoral by our government?

Being subject to violence in the event of failure to deliver an expected outcome shouldn’t be an essential condition to practice medicine in India and the Government should be able to guarantee that. The Government should have immediately stood by it’s doctors,  who literally work round the clock to keep this city healthy. They deserve better. It’s a matter of shame the city hasn’t stood by them through this.

CM Fadnavis appeals to doctors to end strike

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Municipal Commissioners have undertaken a security initiative for the protection of the doctors in the state.

In a two-hour long intensive meeting, the AMC (WS), the Director, the deans and the security chief among others made an individualised security plan for each hospital, defining everything clearly.

The plan lists the following instructions.

  • Different entry points for doctors, nurses, patients and the other staff members.
  • The number of passes per patients and the colour code for the passes to be kept in check and to be positively returned before leaving.
  • At any given point not more than 2 relatives to be allowed inside hospital.
  • Surprise inspections to be held to ensure that relatives remain close to patients and do not loiter around.
  • Security cameras to be scanned to throw out suspicious people.
  • Signboards to be put up all across the hospital.
  • No exits to be allowed without returning the passes.
  • Mischief mongers to not be allowed to enter the hospital again.
  • Apart from all this, 600 armed guards to be recruited from the Maharashtra state security corporation. (300 within a week and 300 after a month)

CHIEF MINISTER DEVENDRA FADNAVIS’ APPEAL TO RESIDENT DOCTORS

Chief Minister Devendra Fadnavis on Thursday appealed to the resident doctors in the state to call off their strike and assured them that the government would ensure their security in hospitals. The Bombay High Court too has asked the state to not undertake punitive action against the doctors if they resume work.

Even then, full-time medical teachers from Sion, JJ, KEM and Nair hospitals have joined the strike and have decided to continue it until they get written assurance.

“Our strike is on. MARD has not communicated anything to us. Earlier also we got verbal assurance but unless we get concrete assurance we will not end our strike,” said one doctor.

The agitation, meanwhile, has entered its fourth day today, and there is no indication of when the physicians will call off their protest.

Doctors attacked on duty will be given medical aid borne by government: Maharashtra CM Devendra Fadnavis

Maharashtra Chief Minister Devendra Fadnavis on Thursday said if a doctor is attacked on duty, he will be given medical aid borne by the government.

The Chief Minister directed to provide security to sensitive hospitals with armed policeman and work for a long-term plan like monitored CCTV network.

Fadnavis proposed setting up of an apex council with the government representatives and doctors and its interaction every  three months to solve the issues time to time.

The representatives of MARD met Fadnavis to discuss their issues.

Ministers Girish Mahajan, Dr Deepak Sawant, DGP Satish were also Mathur present.

Meanwhile, the Medical Teachers Association gave ultimatum of 48 hours, and said that they want their demands to be met otherwise they would go on mass resignation.

Fadnavis earlier in the day requested the resident doctors to withdraw their strike immediately and ensured them security.

“We will take strong legal action against those who attack doctors and will ensure security to the doctors,” he said.

Meanwhile, the Bombay High Court has ordered the doctors on strike to resume their duties and give some time to the government for providing them proper security.

The court also ordered the state government to provide security at all government hospitals so that the doctors can work without fear.

More than a thousand doctors in Maharashtra have been protesting since Monday, demanding better security at hospitals with the increase in incidents of attacks by patients’ relatives.

Health policy wants public hospitals certified for quality

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Targets safe water for all by 2020

The long awaited National Health Policy (NHP), announced a few days ago, proposes to raise public health expenditure as a percentage of the GDP from the current 1.15% to 2.5% by 2025. The resource allocation to individual States will be linked with their development indicators, absorptive capacity and financial indicators. “There will be higher weightage given to States with poor health indicators and they will receive more resources. The Policy aims to end inequity between States. But at the same time, States will be incentivised to increase public health expenditure,” says Manoj Jhalani, Joint Secretary — Policy, Ministry of Health and Family Welfare.

While public health expenditure as a percentage of GDP will reach 2.5% only by 2025, many of the goals listed in the Policy have a deadline of 2025, some of them even sooner.

Preventive healthcare

The policy stresses preventive healthcare by engaging with the private sector to offer healthcare services and drugs that are affordable to all. It wants to reduce out-of-pocket “catastrophic” health expenditure by households by 25% from current levels by 2025. It wants to increase the utilisation of public health facilities by 50% from the current levels by 2025.

The Centre is working on introducing a health card — an electronic health record of individuals. “The health card will be for retrieving and sharing health data by lower [Primary Health Centre] and higher [secondary and tertiary] healthcare facilities,” says Mr. Jhalani. “It will be launched in six months to one year’s time in those States that show interest to roll it out in certain districts or across the State.”

Like the Health Ministry’s national strategic plan for tuberculosis elimination 2017-2025 report, the Policy wants to reduce the incidence of new TB cases to reach elimination by 2025. In a similar vein, the policy has set 2017 as the deadline to eliminate kala-azar and lymphatic filariasis in endemic pockets, and 2018 in the case of leprosy. In the case of chronic diseases such as diabetes, cancer and cardiovascular diseases, it envisages a 25% reduction in premature mortality by 2025.

Challenging ambitions

The policy “aspires” to provide secondary care right at the district level and reduce the number of patients reaching tertiary hospitals. For the first time, there is a mention of public hospitals and facilities being periodically measured and certified for quality.

But the most ambitious target is providing access to safe water and sanitation by all by 2020. As per the January 2016 Ministry of Drinking Water and Sanitation’s country paper, sanitation coverage was only 48%.

Other challenging targets set by the Policy include reducing the infant mortality rate to 28 per 1,000 live births by 2019 and under five mortality to 23 per 1,000 live births by 2025. According to the National Family Health Survey 4 (NFHS-4), IMR was 41 in 2015-16; it took 10 years to reduce IMR from 57 to 41.

As against 62% children 12-23 months old, who were fully immunised in 2015-16 according to the NFHS-4 data, the Policy has set a target of 90% by 2025.

Doctors up in arms against assault

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The recent attack on a doctor in Dhule has brought to fore the aspect of security for medical professionals and the rising incidents of doctor-patient friction.

Two days after an orthopaedic doctor of Dhule civil hospital was thrashed by a patient’s relatives after a quarrel over alleged medical negligence, medical students have declared a mass boycott of classes on Friday in protest. The youth wing of Indian Medical Association (IMA), Maharashtra and the Maharashtra Association of Resident Doctors (MARD) have organised the protest.

Terrified resident doctors have demanded more security on campus. “The CCTV footage shows how brutally the doctor was assaulted. The visuals are terrifying and the degree of the attack has scared many of us,” said Swapnil Meshram, a third-year resident doctor from JJ Hospital.

Students on medical campuses are raising the issue of lack of ‘well-trained’ security personnel. “Most medical campuses lack well-trained security guards. How can doctors concentrate on treating patients when they are concerned about self-defence?,” asked Meshram.

Yashovardhan Kabra from KEM Hospital agreed with Meshram. “Medical education is a long and tiring process. Doctors are overwhelmed with work. Attacks on doctors only add to their pressure,” said Kabra.

Aniket Gaikwad from Sion Hospital said that most colleges didn’t have a Rapid Action Force. “The forces should be in place to ensure quick intervention in cases of attack,” said Gaikwad.

Another concern for the doctors is the poor implementation of the Doctors Protection Act. Offenders are booked under the Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage of Property) Act, 2010, commonly referred to as the Doctor’s Protection Act (DPA). “There have been 45 cases registered under the Act so far but none of the accused have been brought to book,” said Meshram.

Dhule doctor in ICU

The orthopaedic doctor who was assaulted by a mob in Dhule Civil Hospital was transferred to the intensive care unit of Jupiter Hospital in Thane Wednesday. According to doctors, Dr Rohan Mhamunkar has suffered an orbital fracture and an undisplaced fracture in the skull and may require a surgery. Mhamunkar had suffered several blows of rods wielded by a mob of over 20 people in the Dhule Civil Hospital on March 12, leading to multiple contusions. Dr Niharika Mehta, who checked Mhamunkar in Dhule, said in her report that his soft brain tissues were swollen in the right frontal region. A CT scan showed the sphenoid bone, situated in the middle of the skull, was also fractured.

“He was brought to the hospital late last night (Tuesday). Doctors have examined him and he continues to remain under observation in ICU,” said Dr Ajay Thakkar, CEO at Jupiter Hospital. Mhamunkar’s colleagues, however, said he was slated for a “craniotomy surgery”. The Dhule police had arrested nine persons in the case. They were all relatives of a 25-year-old accident victim who had been brought to the hospital but was referred to another hospital for want of a neurosurgeon.

 

Police say more offenders identified, arrests soon

The Dhule police Thursday claimed to have identified several people who vandalised the Dhule civil hospital and thrashed an orthopaedic doctor. Search for those identified is on and arrests are likely, officers said.

According to the Dhule police superintendent, the nine persons already arrested have been booked under various sections of the Indian Penal Code for attempt to murder and for assaulting a public servant, along with sections of the Maharashtra Medical Act. Chief minister Devendra Fadnavis has also instructed the police to take strict action in the case and propose ways of ensuring security of doctors.