In continuation with my previous blog, Part 2 of this mini-series will highlight the rising number of violent attacks against doctors on duty. This blog will examine the cause behind this disturbing trend and conclude by talking about possible interventions that government and non-governmental organizations can take.
Workplace violence is defined as “…incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well being or health,” by the World Health Organization (WHO) and International Council of Nurses (ICN).
During the two peaks of COVID pandemic in India, the media was inundated with news of assaults on doctors. Unfortunately, this ugly trend is not just a product of crunched medical resources during the peaks. Such instances of violence against doctors and nurses have always been commonplace in Indian government hospitals. As a healthcare professional myself, I am well versed with the tense situations that can build up in emergency rooms during non-pandemic times; COVID-19 has infused unprecedented anxiety and fear among the population, creating additional flashpoints.
In June 2020, a resident doctor was assaulted by the kin of a deceased patient at a coronavirus facility in Hyderabad. In July 2020, a senior doctor was stabbed by a deceased patient’s relative in Mumbai. In Assam, a junior doctor was beaten up by the relatives of a deceased patient (Caution: Disturbing content). The International Committee of the Red Cross (ICRC) said in a statement that greater than 600 incidents of violence, harassment, or stigmatization had cropped up in conjunction with the COVID-19 pandemic globally — and these figures are just the reported ones. The ICRC also said that two-thirds of these incidents were directed towards healthcare workers, as violence is exacerbated by emergencies. In India, 75% of doctors have faced some form of abuse, and most of these incidents were perpetrated by the patient’s family.
The government implemented many knee-jerk reactions to improve security at hospitals. For example, an emergency ordinance was passed for frontline COVID workers, which made violence against health-care workers a non-bailable offence and punishable with up to 7 years of imprisonment. Although a laudable show of force, these policies are unable to address the root cause: these acts of violence are committed by frustrated family members, who vent out their anger on whoever is available. Crunched medical resources, insufficient doctor to patient ratios, and communication gaps are real culprits.
In addition, the dismal complaint redressal system in India accentuates these root issues. The majority of public and private hospitals in India don’t follow a consistent procedure for dealing with violence. WHO regulations also require healthcare facilities to maintain appropriate data about cases of violence against health workers; this should be followed by Indian healthcare facilities, but currently is not. Another possible reason for such ugly behavior is the lack of trust in the Indian judicial system, which deters relatives from lodging official complaints and instead prompts them to take out their emotions on doctors — who are in arms reach.
Mere laws may deter some people from acting out, but true eradication of this ugly trend would require fundamental reforms of the complaint redressal system, in addition to strengthening healthcare infrastructure. The National Medical Council, government, and the Police force need to develop a holistic strategy to prevent this menace. Increasing the number of residency positions within Emergency medicine, incorporating frequent “Effective communication” workshops, and implementing de-escalation strategies are the need of the hour.
A safe working environment is a basic necessity for any employee, let alone doctors and other healthcare workers, who are heroes without capes during these times.
The mini-series of ‘Straighten Our Spines’ was intended to showcase pressing issues that need to be rectified promptly in order to build a solid foundation for further development of the healthcare system.
In my next blog, I will discuss the strategies being undertaken by the Indian government ahead of the Omicron surge.