‘What about our safety?’

CHENNAI: The shock and outrage of rape and murder of a doctor in Kolkata has reverberated across the country, with the medical fraternity up in arms over unsafe work places that often prey on women. The Indian Medical Association has called for a ‘nationwide withdrawal of services of doctors’ — a massive disruption of hospital services, except emergency care, for 24 hours on Saturday. All outpatient services and treatment in government and private hospitals will be cancelled.

“All essential services will be maintained, and casualties will be manned but routine OPDs will not function, and elective surgeries will not be performed,” read a statement from the IMA.

In Tamil Nadu, women doctors and medical students working in public hospitals narrate their everyday ordeal — from lack of amenities like restrooms and beds to rest to facing emotionally-wrought families who get violent over the death of a loved one and even intimidation from other hospital staff, etc.

While lamenting over the lack of safety measures in hospitals, it’s noteworthy that not even a single woman doctor expressed regret over choosing to become a doctor. While they take pride in their work, and are more than willing to serve, they urge the State government and the Medical Council of India to ensure that safety is granted as a basic right to all women medicos. They also demand basic amenities such as duty rooms, resting areas and bathrooms in adequate numbers.

When duty calls…

Kala, a postgraduate resident at a government hospital in the city, dreads taking phone calls from patients, especially men, as some have queries that are completely unrelated to the illness they were treated for.

“I would have treated them for a completely different illness but some men call us to ask how they can enhance their sexual performance or if they can have intercourse. We’re duty-bound to respond to them, even when we know it’s inappropriate,” she says. “We cannot deny them answers or do an examination because we’re meant to serve patients. Some use abusive language to address us or get violent because they might be inebriated but it’s common in cases of drunk driving.”

With the highest number of medical colleges and top ranking medical institutions in the country, Tamil Nadu is known for medical tourism and public healthcare services. However, women doctors point out that though their parents are proud of them, worry about their safety overshadows everything.

“It has come to a point where we’re grateful if we’re physically safe and can return to our accommodation and/or workplace safely,” states a senior doctor doing a speciality course at a government medical college hospital.

Her mother keeps track of her location on the phone, and her ‘last-seen’ status on a daily basis, especially when she’s on night duty.

“There are no canteens or proper washrooms for women doctors on campus. During night duty, we go to our hostels to access washrooms. It’s horrible when we get our periods. There have been several incidents of harassment inside the campus. Some folks use the hospital as a passage and trespass through the campus,” she narrates.

No security personnel

Security, especially in government hospitals, is often a misnomer, as GHs are notoriously short-staffed at any given point of time, even though the patient-load has increased exponentially over the years.

Also, there’s another problem: attendants of patients. Since visitor hours do not apply to attendants, they come and go round the clock to the hospital. When doctors have to relay the message of a loved one’s death to the attendants, they attack the doctor en masse.

The emergency departments and ICUs of any GH have reported incidents of attacks on surgeons and nurses as well. Neurosurgeon Chithra knows it all too well.

“I had to pronounce the death of a patient. I had counselled the family for a long time about the patient’s prognosis. When the time came to inform the family about the patient’s death, I requested the hospital several times for a security guard or at least a security officer to be with me when I gave the bad news to the family. In this case, we expected trouble, as the family was very emotional,” recalls Chithra.

For more than 40 minutes, she kept asking for security personnel. Even the guard usually stationed outside the ICU had disappeared at the time. “When I told the patient’s family that their loved one had died, one guy tried to hit me. I was lucky enough to have escaped. I have no doubt I would have been grievously injured if other patients’ attendants hadn’t held them back,” she shudders.

However, having security personnel nearby doesn’t guarantee a risk-free workplace, as it’s a question of whether the personnel is working on a contractual basis at the hospital, and is physically capable of handling unruly patients and attendants. After the rape and murder of a doctor in Kolkata, medicos here wonder if security personnel can be trusted since it was a civic volunteer working along with the Kolkata police, who is the prime suspect.

Lack of basics

Student doctors claim that there aren’t enough duty rooms in a public hospital, given the number of doctors in a department or speciality. “There will be 40-50 students on duty but the duty rooms will just have 4-5 beds at the most for all postgraduate students,” tells Dr Malli, who recently completed her post-graduation.

Night duty is worse, as student doctors, often, have to attend calls from different departments located in multiple institutes located across the city. For instance, a doctor on night duty in Rajiv Gandhi Government General Hospital (RGGGH) would be called to attend a patient at the Institute of Obstetrics and Gynaecology, Egmore, Institute of Child Health, Egmore, and even to the Institute of Mental Health, Kilpauk.

“The calls we get at night, especially from another institute, would most likely be emergency duty. We’re not given transportation, and have to rely on our own vehicles,” she explains. “Self-driving between institutes when you’re doing a 24-hour or 36-hour night shift is a safety risk for anyone, especially for doctors as we have to be on alert all the time.”

Though there are empty rooms available in several GHs, these are almost always turned into a storage room. “They can provide a cot and bed, and turn it into a duty room. Some of us have slept in linen rooms because 36-hour duty takes a toll on the body,” says Dr Vijaya*, a student doctor.

Doctors, whether they’re students or professionals, are always expected to be on call. Working hours are not seen as a health or safety risk — one of the reasons for the lack of duty rooms or other common space in any GHs. “Two of my colleagues were studying in the teaching room. Three attendants of patients came in and asked them to vacate the space for them to sleep. After arguments, the students had to leave,” she says.

Since GH campuses are huge, thefts are common, and happen every day. “We don’t report them because nothing is done in most cases. There is no dedicated space for us to even sit because everyone is free to enter or exit a GH. So, even anti-social elements go unchecked,” she points out.

Hierarchy rules

It was only in October last year that 27-year-old postgraduate student at a private medical college from Kanniyakumari died by suicide after alleged harassment by the medical superintendent of the college.

She was found unconscious in her hostel room, and later, it was alleged that she had taken anaesthetic drugs to die by suicide. In her suicide note, the student had stated that sexual harassment, physical and mental abuse and toxicity from seniors at the hospital had forced her to take the extreme step.

Though suicides among doctors and student doctors are rare, the hierarchical culture in GHs is very toxic. “I was working in the emergency department of a city-based GH at the time. I was menstruating while on duty but my senior doctor did not allow me to use the washroom. That’s how they exert their dominance over us,” avers Jayanthi, a PG resident at a GH in the city.

Way forward

It’s time for multiple changes and interventions at the policy level in the medical sector. However, for now, doctors are asking for basic amenities so they don’t have to choose deserted spaces to rest, even if the space is located inside the campus.

Dr Dhruv Chauhan, national council coordinator, IMA-Junior Doctors’ Network, says: “All spaces in a hospital, including the outpatient block, operation theatre and other facilities that are not functional at night, must be monitored 24-7. Policy level changes have to be made to address safety concerns. Adding additional security personnel is not enough; they should undergo a background check before being employed in any hospital.”

Concurring with him is Dr V Vignesh Rajendran, president, TN Resident Doctors’ Association, who adds: “At present, most government medical colleges in the State do not have a well-equipped duty room for residents. There are no proper restrooms for either gender. Residents on 24-hour shifts are forced to sleep on the floor and even on their tables, and sometimes under the patients’ beds, completely at the mercy of anti-social elements.”

(All names changed to protect privacy)