New Delhi/Nagpur: The strike of Resident Doctors of Maharashtra has entered the fifth day today with MARD, their association not ready to relent despite Rulings of High Court and assurances regarding their safety.
This brings us to the question – are such happenings restricted to India or do they happen elsewhere too?
And if they do – how do those countries deal with it?
The situation in China
It was rather surprising to learn that China, despite being a Communist country, where health care is expected to be in the public sector, the practise of attacking hospitals is rather rampant.
A study initiated by Harvard University, USA showed that:
“However, the local moral worlds within Chinese hospitals are now fraught with tension and the growing friction between patients and physicians has resulted in verbal abuse, threats and physical assault. Medical mobs, called yinao, regularly protest at hospitals or harass hospital administrators in exchange for money. In 2011, a 10 province survey in China found that over half of the physicians had been verbally abused, one-third had been threatened and 3.4% had been physically assaulted by patients in the past 12 months. The level of violence observed in China is more common compared with violence against medical professionals in other countries.
The response of the Government?
A thorough study was carried out of not only the Medical front, but the financial, the economical and the moral too, to find out what had gone wrong.
They identified that various factors including low salaries of Doctors and Health care workers, and a low outlay in their budget to Health care ( which is still 15%!!) had led to erosion of trust between Doctors and patients. This was taken very seriously.
There is a quotation of Confucius that is cited –
A seeker of wisdom asked Confucius about the essential elements of governing a state. Confucius replied, “It is to provide food, protect people with weapons, and gain trust from people.” The seeker asked further which should be abandoned first if the state is forced to choose between foregoing food, weapons or trust. Confucius advised to abandon weapons first, then food. However, he advised never to abandon trust. He explained, “Trust is more important than life itself.” This story suggests that trust is important within Chinese social relationships.
The example of Israel
Over recent years there has been an increasing prevalence of verbal and physical violence in Israel, including in the work place. Physicians are exposed to violence in hospitals and in the community. The objective (of the study) was to characterize acts of verbal and physical violence towards hospital- and community-based physicians.
Methodology of Survey
A convenience sample of physicians working in the hospital and community completed an anonymous questionnaire about their experience with violence. Data collection took place between November 2001 and July 2002. One hundred seventy seven physicians participated in the study, 95 from the hospital and 82 from community clinics. The community sample included general physicians, pediatricians, specialists and residents.
Ninety-nine physicians (56%) reported at least one act of verbal violence and 16 physicians (9%) reported exposure to at least one act of physical violence during the previous year. Fifty-one hospital physicians (53.7%) were exposed to verbal violence and 9 (9.5%) to physical violence. Forty-eight community physicians (58.5%) were exposed to verbal violence and 7 (8.5%) to physical violence. Seventeen community physicians (36.2%) compared to eleven hospital physicians (17.2%) said that the violence had a negative impact on their family and on their quality of life (p < 0.05). The most common causes of violence were long waiting time (46.2%), dissatisfaction with treatment (15.4%), and disagreement with the physician (10.3%).
Verbal and/or physical violence against physicians is common in both the hospital and in community clinics. The impatience that accompanies waiting times may have a cultural element. Shortening waiting times and providing more information to patients and families could reduce the rate of violence, but a cultural change may also be required concluded the study.
In USA – Nurses found to be at great risk
(We found this in a scientific journal called Atlantic. Excerpts given below
“Here’s an alarming statistic: Around one in four nurses has been physically attacked at work in the last year. Patients often kick, scratch, and grab them; in rare cases even kill them. In fact, there are nearly as many violent injuries in the healthcare industry as there are in all other industries combined. Healthcare workers make up 9 percent of the workforce.
There are currently no federal rules mandating that hospitals attempt to protect nurses from violence in the workplace, though some states have passed them on their own. State-specific measures include requirements that hospitals develop violence-prevention programs, such as teaching de-escalation techniques, and increased penalties for people convicted of assaulting healthcare workers. In October, California passed the toughest guidelines in the country, obligating healthcare employers to develop tailored violence-prevention plans for each workplace with employees’ input. But the problem has gotten so bad that the U.S. Department of Labor is considering setting nationwide workplace-safety standards for hospitals in order to prevent this kind of abuse.
Patients with dementia or Alzheimer’s and patients on drugs were the most likely to hurt nurses, according to one study published last year in the Journal of Emergency Nursing. The study surveyed more than 700 registered nurses at a private hospital system in Virginia, and 76 percent said they had experienced physical or verbal abuse from patients and visitors in the previous 12 months. About 30 percent said they had been physically assaulted.
Working directly with patients in emotional and physical pain has always put healthcare workers at risk of violence. But in the past decade or so, there has been a 110% spike in the rate of violent incidents reported against healthcare workers.
Australia shows the way by being very strict
People who assault nurses, doctors and paramedics will face up to 14 years in prison under tough new Queensland (Australian Province) laws.
Health Minister Lawrence Springborg said thousands of health workers are punched, stabbed, bitten and spat on every year in Queensland during their daily duties.
“Assaults, whether they are physical or verbal, on our health workers will not be tolerated and the Queensland Government is appalled that even one nurse, doctor or paramedic is attacked,” he said.
“It is inexcusable and shameful behaviour.”
More than 24,500 health care employees have reported being a victim of a violent incident at work in the past five financial years.
More than 4,400 health workers in the last financial year alone were victims of violence in their workplace.
“If you think it is okay to assault our health workers, we’ll give you up to 14 years to think again,” Mr Springborg said.
“It is simply not acceptable and that is why we have doubled the penalty.”
The laws were introduced as part of the Government’s Safe Night Out Strategy.
Situation in India is the Worst
Our cursory study and the examples of the four countries cited clearly indicate that India is the worst sufferer where violence against Doctors, nurses and hospitals is concerned.
Some of the obvious reasons seem to be:
Abysmal public spending on Health care – It is merely 1.2% of our GDP
The public expenditure on health is estimated to be around 1.2% of the Gross Domestic Product (GDP), while the government’s own documents like the draft National Health Policy 2015, 12th Five year Plan and even the 11th Five year plan explicitly stated lofty targets like 2.5% health spending. The governments of the day have been unable to provide a policy direction, which could possibly improve the pathetic state of public health systems in the country.
India made phenomenal economic gains in the last three decades, but has failed to improve the health status of its population on similar terms. Infant mortality, under-five mortality and maternal mortality rates of the country are still comparable with statistics coming out from other south Asian nations or countries from sub-Saharan Africa. As per World Bank estimates, the per capita healthcare expenditure in India is around USD 60, and this has been stagnant over the last decade or so. This sum is paltry when compared to indicators from China (around USD 300) or Brazil (around USD 1000), not to mention developed countries of Western Europe or North America.
Overworked Resident and other Doctors in Government Hospitals
The situation in our ‘progressive state of Maharashtra’ is so bad that Resident Docs in Govt. hospitals had to approach the Human Rights Commission for redressal!
In a letter to MSHRC, the resident doctors said they have to work for around 30 to 36 hours at a stretch at medical colleges. Long-working hours, irregular sleep and poor food hygiene are making doctors fall ill, according to MARD.
Even the Supreme Court of India had taken cognizance of the matter.
As per the directives of the Supreme Court, in a judgment dated September 25, 1987, all the state governments, medical institutions and universities were required to amend their rules and regulations to introduce a uniform residency scheme by 1993.
Subsequently, the union health ministry sent its directive, in a letter dated June 5, 1992, to all the states and union territories administrations regarding implementation of the Uniform Central Residency Scheme. But many states are reportedly yet to take necessary actions to follow the said directive.
As Dr Sagar Mundada, president, Central MARD, said ” we are on duty 24*7. We cannot sleep, we cannot go home, we can do nothing else. This is inhuman.”
Where private health care is concerned, medical diagnostic tests are so expensive, and getting more so, that patients blame doctors and hospitals of profiteering.
Stories of ‘rackets’ and kick backs between Doctors had become rampant some decades ago. Patients have become cleverer and wiser now, they decide which lab or Disgnostic centre they will go to, yet the perception prevails.
Yes – we have to agree, there is a Trust Deficit, for which all of us are responsible – the Government, the people and also Hospitals to some extent.
But the most burning issue right now is security to our Doctors and Hospitals and sincerity from Govts is completely lacking in tackling it.
Speaking of the ongoing situation in our state, why is our Chief Minister, Devendra Fadnavis silent on this issue? He is Home Minister too, so responsible for law and order.
Just taking punitive action against striking doctors will not solve the problem now.
Our Doctors are all angry, very angry indeed.
It is time to take notice.
—Sunita Mudaliar (Associate Editor)