Why The Kolkata Hospital Crime Could Be The Story Of Any Healthcare Worker

Trigger Warning: The report contains mentions of rape and sexual violence. Reader discretion is advised.

On the morning of August 9, two days before lakhs of students were going to take the NEET PG exam for a postgraduate seat, a woman postgraduate trainee doctor was found murdered in the seminar room of the emergency medicine building of RG Kar Medical College Hospital in Kolkata. This was exactly a week before India celebrates its 77th Independence day.

The autopsy report concluded that the victim had been sexually assaulted, severely injured and strangled to death. 

On the night of the murder, the trainee doctor had been posted on a 36-hour duty in the emergency department. After she had finished dinner with her colleagues and watched Neeraj Chopra’s silver-winning javelin throw at the Olympics, she had sought out the quiet of the seminar room to rest. The hospital does not have duty rooms for doctors working in the emergency department.

The principal of the medical college, Sandip Ghosh, initially attempted to dismiss the murder as a suicide, while also maintaining that “it was irresponsible of the girl to go to the seminar hall alone at night”. The Calcutta High Court while criticising the role of the West Bengal government in the handling of the case – Ghosh was appointed the principal of the Calcutta Medical College and Hospital after he resigned from the RG Kar Hospital – ordered him to ‘go on a long leave’.

Responding to the incident, the Silchar Medical College and Hospital in Assam has, in an order issued on August 13, asked its women doctors, students and other healthcare workers to “avoid isolated, poorly lit and sparsely populated areas”.

Women healthcare professionals in India, doctors, nurses, paramedics and administrative staff who work in shifts, have always been vulnerable to violence given the poor infrastructure and security systems of the medical facilities where we work. "It could have been any of us" that is what most women doctors or indeed any female  healthcare worker would say of this tragedy. 

Many women health workers I know walk through abandoned corridors, empty and unlit roads, and attend to patients in darkened buildings at night. Many of us, especially those working in public hospitals, have slept in seminar rooms, unoccupied OPD rooms, and inpatient beds in the wards because we could not find unoccupied duty doctor's rooms. Many of us have also had to share these rooms with male health workers. All this while working for inhuman hours between 24 and 48 hours, forgoing food and sleep. Now that I look back, I wonder why we found it acceptable to not have a place to rest our heads in the midst of a punishing schedule.

This incident has also brought the focus back on women’s safety and safe workplaces in India. Cases like this and Jyoti Pandey’s rape and murder (known as Nirbhaya case in the media) in 2012 tend to gather mainstream attention while countless women, especially from marginalised communities like Dalits and Adivasis, routinely face violence from upper and dominant castes as a means of control. 

In 2022, more than 4 lakh cases of crimes against women were reported per the National Crime Records Bureau. Of these, 31,516 were rape cases–averaging to one every 16 minutes. And these are just  cases where women have reported them and the police have filed an FIR. The latest data from the National Family Health Survey (NFHS-5) indicates a higher prevalence of violence.

As many as 30% of women between the age of 18 and 49 have experienced physical violence since the age of 15 years, while 6% have experienced sexual violence in their lifetime per data from the NFHS-5.

Everyone Is At Risk

Violence against doctors and other healthcare professionals such as nurses and paramedics has become a common issue in India, and being a woman in healthcare deepens anxieties around safety issues. 

At night, when the likelihood of this violence is at its peak especially in remote areas, there are several women at work in hospitals and health facilities. Nursing staff (of which 80% are women), women lab technicians, billing clerks, pharmacists and sanitary assistants too are busy at work in public hospitals at night. This vulnerability in healthcare workforce goes back to the  brutal rape of Aruna Shanbaug at Mumbai’s KEM hospital which left her with brain damage in a vegetative state  in 1973.

There are several reported incidents of assaults by relatives of patients whose condition may have worsened or who may have died during treatment. But the violence is often internal too. The existing power dynamics and heirarchical nature of the medical profession has created multiple layers of oppression - doctors above other healthcare workers and men above women. Women healthcare workers often find themselves at the bottom of the ladder and at the receiving end of verbal, physical and sexual harassment from coworkers and seniors as well, according to reports.

For example, studies mention that around 43.5% of female nurses have faced harassment at the line of duty from various stakeholders. ASHA workers, India’s frontline community healthcare workforce have routinely faced different kinds of violence, emotional, physical and sexual violence from their co-workers to beneficary families but there are few studies on this. A 2021 study from North Karnataka reports that 88% of ASHA workers reported economic violence, 73% reported emotional violence, and 32% and 26% reported sexual and  physical violence. 

Infrastructure, Work Hours, Security 

As a duty doctor in a secondary hospital in Chittoor, I used to transfer critically ill patients who needed specialist care to the tertiary hospital in Vellore. There were times when, as the duty doctor, I was the only woman in the ambulance with a male driver, patient, and their male relatives.

These transfers often used to take place in the middle of the night and looking back, I realise the risks involved in doing such duties. It is clear that the existing guidelines do not reflect the real world problems a healthcare worker would face while transferring patients. A single doctor would anyway not have been able to manage any emergency during this transfer so why not enforce regulations on hospitals to have a trained team of an EMT or a nurse to accompany the doctor? 

In public hospitals, toilets are sometimes not gender segregated and mostly out of maintenance, say women doctors. “The toilet we had didn’t have a latch,” says one. “We had to put a board saying ‘do not open without knocking’ and then keep the door closed by parking some object in front of it.”

Another female doctor recalls that the door to the duty doctor’s room did not have a sturdy lock. “I had to place a chair or something in front of it to keep it closed and even then it would be opened by ward boys and so on,” she adds.

A doctor tells me on the condition of anonymity that the Government Hospital at Royapettah in Chennai has only about 20 security personnel, and most of them are elderly and frail. "I have always wondered whether they could protect anything if needed," he adds.

In emergency situations many security guards throw their hands up, says another doctor. “There have been times when a security guard would come to me and say ‘I tried controlling the crowd of angry relatives but they are not listening, ab aap dekhlo (now you handle this)’. I was shocked – shouldn’t they be calling a senior or police or something?”

However, a security guard at the Pentland Hospital in Vellore told a doctor I know that being a guard at a government public healthcare facility is not seen as a desirable job because they take the first impact of an attack by angry relatives of patients. Most of these offenders also get bail within a few days and come to harass the staff again, he says.

No Political Will

Violence against healthcare workers (VAHCW)  essentially boils down to very structural issues that underpin the healthcare system in its entirety. India’s public health system is underfunded and understaffed. As per the latest available Rural Health Statistics from 2021-22, there are not enough primary and secondary health centres. And in the existing centres, there are significant staff shortages.  There is an 80% shortfall of specialists in community health centres.

While the situation calls for increased funding to improve health infrastructure, the central government’s allocation has seen a decrease in real terms, despite the introduction of a health cess in 2018.

Underfunded healthcare is the one of the biggest reasons behind most cases of VAHCW, Parth Sharma, physician and my colleague at Nivarana wrote in TOI. Staff shortage leads to long working hours and limited communication and healthcare workers are not trained in communication or conflict management.

Moreover, existing power dynamics that place doctors above the patient, lack of trust in doctors due to over medicalisation and privatisation and lack of redressal mechanism and accountability are also factors influencing VAHCW.

At the institutional level, mandated structures like the  internal complaints  committees under the Prevention of Sexual Harassment Act (POSH) are mostly filled with doctors themselves and occasionally they are those accused of unethical practices. Secondly, these senior doctors do not have any formal training  in administration or human resource issue management. This means that even without any conflicts of interest, they will be unable to skillfully manage such complaints. The cost of dissent is also high for healthcare professionals, especially junior doctors. There are worries  that the college or hospital administration could be vengeful and there could be repercussions – exams failed, thesis kept unsigned, job loss or transfers. A urologist from Tamil Nadu told me how he was threatened with repercussions, from withholding his pension to firing him from his job, after he gave evidence in the sexual abuse case of his female colleague. 

"When I speak about women's issues in any of the doctor's association Whatsapp groups, people are completely uninterested," says another doctor. "The reason is that women are not represented  well in health leadership and associations. The leadership in organisations like Indian Medical Association (IMA) and Federation of Resident Doctors Association (FORDA) is all male. And these doctors are genuinely uninterested in matters such as women's safety until an incident as large and as gruesome as this takes place." He suggests including women doctors in leadership and associations and pushing quotas and incentives for them to do so.

Among the past IMA presidents, there is only one woman among the 94 names listed on the website. In the state lists, women only occupy the two token posts allotted to women doctors. A study published this week assessing women’s leadership in professional medical associations across the world reveals that only 9 out of 46 associations are currently headed by women. They also reveal dismal representation of women in sub chapters of associations as well.

We need to demand for a gender just healthcare policymaking and safe workplaces for women in the healthcare sector.

---

This report was first edited and published by Behanbox

Image by Gayatri Sharma