Ground report: Overworked, unsafe — young doctors battle apathy in line of duty

The brutal rape and murder of a 32-year-old doctor in Kolkata’s RG Kar Medical College and Hospital last Friday has sparked nationwide protests

At 4am on Monday, a 31-year-old woman resident doctor at the Indira Gandhi Hospital in Dwarka, New Delhi, heard a scream piercing through the corridors of the government institution. The cry was not unfamiliar — the sense of fear practised; the panic in that voice an everyday occurrence. She ran towards the shriek for help, and arrived at a room in the medicine ward, locked from the inside. Inside was a shaken woman nurse, protecting herself from an aggressive, and naked, male patient who was walking the halls. “She started shouting for help. We were on duty, and we rushed to control the patient but he did not stop. We had to call for security guards, but they took 30 minutes to arrive. In all that time, the nurse was locked inside,” the doctor said.

Doctors and medical students during a protest at the RG Kar Medical College and Hospital, in Kolkata, on Wednesday. (PTI)

Eventually, the man was brought under control; the nurse emerged shaken, but relatively unscathed, and the doctors returned to their rounds. It was a stark reminder that it does not take much for the worst to happen. “We all immediately need protection. Are we waiting for another Kolkata rape-murder to happen in the Capital,” the doctor said.

The brutal rape and murder of a 32-year-old doctor in Kolkata’s RG Kar Medical College and Hospital last Friday has sparked nationwide protests and strikes by resident doctors across the country. There is outrage at the brutality of the crime; outrage at alleged police laxity; outrage that the main accused is a police civic volunteer. But there is also outrage because, as HT’s spot checks across at least five cities have found this could very easily happen in government hospitals anywhere. In Chennai, or Mumbai, or Bhopal, or Silchar or Lucknow, government hospitals seem to share the same conditions — unmanned and unhygienic duty doctor rooms, no emergency call buttons for help, unlit corridors, and no access control.

Fear of the dark At 10.30pm at Lok Nayak Hospital in central Delhi on Monday, a 26-year-old resident doctor, in blue scrubs and a stethoscope around her neck, walked out of the gynaecology department. She navigated a dimly lit corridor, reaching the duty doctor’s room. The door was open. It always is. “Combined with the lack of control of who can access each corridor, this makes sleeping in the room extremely unsafe for women. We can’t lock the room because different doctors have different resting hours. Often, we just find attendants of patients sleeping here,” she said.

Inside the room, there are three hospital beds with dirty white bedsheets, and an overflowing dustbin. A second 28-year-old resident doctor said that every time someone wants to visit the toilet, there is a battle within. “You need to find courage because it is so dirty. You don’t even want to put your feet on the bathroom floor with slippers on,” the doctor said.

A little after midnight on Tuesday, at the Guru Teg Bahadur Hospital, also in Delhi, a 32-year-old resident doctor standing in front of teeming emergency wards, pointed to all of three security guards standing at the entrance. “They stand there to ostensibly manage the crowd, but when something big happens, they are hopelessly outmatched. They start looking for their manager and leave,” she said.

This, even though as recently as July, a patient was shot dead by three people, including a minor, inside the premises of the hospital. That same month, 50 members of a family, enraged by the death of a woman who died during childbirth, charged at a group of 10 doctors who had to protect themselves in a room, forcing it shut with their hands and chairs from the inside. After these two incidents, hospital authorities ostensibly roped in the services of bouncers, but when HT visited late on Tuesday night, not one was in sight. “There is an internal proposal to introduce SOS buttons in case of a security breach but these have never been installed,” a 33-year-old resident doctor said.

Harassed on dutyAt the other edge of India, at 11pm on Monday night at the Kilpauk Medical College and Hospital in Chennai, women doctors said that they face harassment, often sexual in nature, on a daily basis. On the floors of every corridor, there are attendants of patients, with no control mechanism for entry; most sleeping next to stray dogs that roam freely. Some men, doctors said, are always inebriated. “We have not faced serious incidents like Kolkata but we do face incidents where patients and attenders pass sexual comments at us. It is mostly residents who have to face this because they are young women,” one doctor said, requesting anonymity.

Every government hospital in Chennai has a police station within its premises, and at any time, police officers said, there are three personnel on duty. Signalling towards a black landline placed next to him, sub-inspector K Damodaran said, “In the last five years, there have been no major incidents. If there is a problem, we get a call on this phone.”

But doctors said that for the 1,200-bed hospital, security is hopelessly outmatched. “There are only two spaces where the crowd is filtered. There is no crowd control and if a mob were to enter, we cannot handle it,” a second doctor said.

Around the same time, the 400-bed Jai Prakash Hospital is dark and daunting. There are all of four security guards, completely disinterested in ascertaining the identities of people walking in through the gate of the emergency ward. That gate has a police outpost 25 metres away, with one policeman. “Security just doesn’t exist. Women, doctors or otherwise, are simply not safe,” one woman doctor said.

Women interns, doctors said, are excused from working after nightfall, but nursing staff and doctors must work. The only way they protect themselves when they rest at night, is to lock themselves from the inside.

Nothing changesOver the past week, as details of the Kolkata doctor’s rape and death were dissected threadbare on national airwaves, 29-year-old Dr Aishwarya Jamnare, a second-year resident at Mumbai’s BYL Nair hospital couldn’t stop thinking about the gruesome sexual assault by a hospital janitor of nurse Aruna Shanbaug in 1973 — an assault so perverse that it left her in a vegetative state for 42 years before she died in 2015. “It seems like such incidents are just waiting to happen,” said Jamnare, who specialises in anesthesiology and serves as the vice president of the Maharashtra Association of Resident Doctors (MARD) arm of the hospital.

Over the past few years, Jamnare has worked in two tertiary care municipal hospitals, had short stints in various peripheral hospitals, and, has feared for her safety in each place. “When I started as an intern, I remember constantly being on edge. In places like the casualty department, there would always be a large number of patients and their relatives. We were always under the fear of a mob-like situation that could spiral out of control,” she said.

Most resident doctors like Jamnare are drained by long and irregular shifts with critical patients, often turned away from other hospitals, ending up at civic facilities such as KEM or BYL Nair. A serious assault on a doctor at KEM Hospital a few years ago led to a strike by resident doctors, followed by the implementation of security measures such as male and female bouncers in critical areas like the casualty department, increasing the number of security personnel, and the installation of CCTV cameras. The hospital also installed network blockers in the casualty areas. But more needs to be done, according to Jamnare. “We need quick response teams that can reach a spot within minutes, whether it is on the hospital premises or in the hostels,” she said.

But often, as events over the past two days at Assam’s Silchar Medical Hospital and College have shown, the institutional response isn’t to fix problems of security, but to police the doctors themselves. Postgraduate students at the hospital said that over many weeks they have complained about the objectionable comments passed by male attendances, the lack of lighting between the hostel and the hospital campus, no CCTV cameras or the lack of security or homeguards.

On Tuesday, in the wake of the rape and murder in Kolkata, Dr Bhaskar Gupta, principal and chief superintendent of the hospital issued orders asking female doctors from leaving their hostels at night without permission, “be well composed emotionally and interact with the public graciously” so that there is no unnecessary attention on them. On Tuesday evening, Dr Gupta told HT, “Prevention is always a better option and we wanted to ensure safety.”

The order led to an immediate blowback, with female doctors protesting. On Wednesday, it was rescinded. Salman Choudhary, president of the Junior Doctor’s Association said, “We have been highlighting the security issues at SMCH campus for a long time. We’d request them to act on those instead.”

In Mumbai, as she heads back to another gruelling shift, Dr Jamnare says, “As doctors, hospitals are our homes. Nobody should feel unsafe in their own home.”