Nomadic Insights

Safety First: Shielding our healthcare heroes

A middle-aged tailor from Kolkata, referring to his daughter who was pursuing a post-graduation in medicine, told the BBC: “We come from a lower middle class and built everything on our own.” These could have been the proud words of a father whose daughter successfully climbed the steep ladder of the healthcare profession after clearing India’s highly competitive medical entrance examinations.

Tragically, these were the words of a grieving father whose daughter was brutally raped and murdered while working a gruelling 36-hour shift at one of the reputed government-run medical colleges in the country.

The horrific incident of a woman doctor being raped and killed at RG Kar Medical College in Kolkata sparked widespread outrage and led to protests erupting across India. The public, along with medical professionals, was left questioning whether our nation, one of the major global powers, is capable of protecting its daughters, even those serving in public institutions.

The outrageous incident occurred just over a decade after the Nirbhaya case, which brought about many changes in India aimed at ensuring the safety of women. The case led to the introduction of stricter anti-rape laws and the establishment of fast-track courts to ensure quicker trials for sexual violence cases.

Women in healthcare
Over the past few decades, the medical profession has seen a significant increase in the number of women globally. In the United States, women made up the majority of students in prestigious medical schools for the first time in 2019.

In India, women have been outperforming men in medical college admissions since 2014 – a remarkable achievement for a country striving to empower its daughters through initiatives such as 'Beti Bachao, Beti Padhao' (Hindi for Save the Girlchild, Teach Her).

However, this progress raises an unsettling question: Are women, especially those in healthcare who work odd hours, truly safe in their workplaces? Have governments implemented the necessary legal reforms to ensure the safety of those working in critical yet vulnerable professions such as healthcare?

The World Health Organization (WHO) reports that a significant proportion of healthcare workers, ranging from 8 per cent to 38 per cent, face physical violence during their careers. According to the American Medical Association (AMA), healthcare workers experience a workplace injury rate up to four times higher than that of other private sector employees. This results in more missed workdays and, consequently, impacts public health.

A 2023 study of 2,400 doctors across all 14 districts of Kerala, published in the peer-reviewed journal Cureus, reveals that 66 per cent of doctors reported experiencing some form of workplace violence.

Although half of these cases were reported to authorities, preventive measures were taken in only about a quarter of them. Alarmingly, the study also found that a majority of the young doctors interviewed were considering relocating abroad, a brain drain that poses a serious threat to the sustainability of a quality healthcare system in India.

High-stakes realities of Indian hospitals
Hospitals are places where life and death intersect, and where fortunes can change in seconds. The ER or casualty ward, in particular, is a high-pressure environment where multiple crises often unfold simultaneously. It’s a space where acute medical situations must be managed swiftly, where unmet emotional needs can manifest as physical ailments, and where psychiatric emergencies must be addressed alongside severe physical conditions.

In India, medical professionals often face additional challenges, such as dealing with curious bystanders and strangers who readily meddle in conflicts — situations that differ from those in developed countries, where hospital access is strictly controlled.

Given the intense and unpredictable nature of the work, it is not surprising that medical professionals face a high risk of violence. While improved doctor-patient communication and trust-building can help mitigate some incidents of violence, they cannot fully eradicate the problem without the implementation of robust laws and preventive measures.

Just a year earlier, another young female doctor was stabbed to death while working at a government hospital in southern Kerala. This occurred despite the Kerala Legislative Assembly passing the 'Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Act' in 2012 to ensure a safer working environment in hospitals.

“We are now reaching a stage where people feel it is unsafe to be a doctor – not because they are afraid of catching a disease, but because they fear being attacked and suffer violence. That should not happen in a country like ours,” said Thiruvananthapuram MP Shashi Tharoor in response to the Kolkata rape-murder incident.

Need legislative reforms
Workplace safety is a fundamental requirement for any profession to remain sustainable, attract skilled professionals, and deliver quality services. Most developed countries have implemented comprehensive laws that hold employers accountable for providing a safe and secure working environment. These laws not only address safety concerns but also regulate work hours, ensure the availability of essential amenities, and uphold the basic rights of workers.

In India, we need a law that establishes safety standards set by the government, requires hospitals and employers to be vetted, and mandates periodic reporting. The Cureus study put forward several practical suggestions to enhance hospital security, such as panic buttons and physical security systems. The study also suggests implementing a “strict zero-tolerance policy for violence, offering psychological support to victims, and regularly updating security protocols.”

In 2019, although a draft bill was introduced to prohibit violence against healthcare service personnel and damage to clinical establishments, it did not become a central law due to objections from the Ministry of Home Affairs. This gap in legislation leaves healthcare workers – especially women – vulnerable to violence, exploitation, and burnout.

The tragic cases of two young female doctors who were brutally attacked and killed while on duty should serve as a wake-up call for India. It is imperative that the central government introduce legal and institutional measures to ensure that healthcare workers operate in an environment where they can thrive and perform their best to save lives. Such reform is not just about shielding our healthcare heroes but also about sustaining and strengthening our healthcare system.

(Social anthropologist and novelist Thomas Sajan and US-trained neurologist Titto Idicula, based in Norway, write on politics, culture, economy, and medicine.)