It is perhaps one of the worst healthcare crises to have befallen the state of West Bengal ever, with the impasse in state-run hospitals showing no signs of resolution even as the strike by junior doctors in Kolkata and neighbouring districts enters the fifth day today. In fact, ripples of what started on the premises of the Nil Ratan Sarkar (NRS) Medical College and Hospital in Kolkata are now being felt in cities and towns across the country, with doctors everywhere expressing solidarity with their counterparts in Kolkata.

According to latest reports, the Indian Medical Association has called for a  24-hour-strike on Monday, June 17th, in which approximately 3.5 lakh doctors from across the country are expected to join in.

But why are doctors going on strike?

It all started with an incident on June 10, 2019 when septuagenarian Mohammad Sayeed, breathed his last at the NRS Hospital in Kolkata following what the hospital calls a massive cardiac arrest. His death triggered a series of unfortunate events. Distraught relatives of the deceased alleged negligence by the doctors who had been treating the cardiac patient. Abuses and threats were reportedly hurled at the staff in the wards of Nil Ratan Sircar (NRS) Medical College and Hospital.

The situation spiraled out of control when a frenzied horde of people — supposed family and friends of Sayeed — arrived at the hospital gates to stage violent protests. Three junior doctors were assaulted and gravely injured in the melee that ensued.

Dr Paribaha Mukhopadhyay sustained a near-fatal blow during the clash which resulted in a fractured skull. The young intern’s CT scan revealed a depression in the frontal lobe caused by a blunt object. He has undergone a surgery and is stable now though still critical. “He is fine now but there is a chance of infection and future convulsions,” reported a doctor treating him.

The abominable attack has sparked a doctors’ strike in government hospitals. The agitation has spilled to private hospitals as most of the out-patient departments and emergency wards in the city remained closed on Wednesday and Thursday.

A black day

The doctors in NRS report that 200 truck-borne assailants landed in the facility and turned it into a battleground. The police posted in the hospital were unable to bring the situation under control.

The deceased patient Sayeed used to run a small stationery shop in Tangra. He held great respect in the locality, with his elder son being the Imam of a local mosque. The locals cited this as the reason behind the massive gathering at the hospital.

However, Dr. Nodee Chowdhury a resident intern at a general hospital in Kolkata comments that “This was a premeditated and organized act of violence against the doctors. Over a span of four hours following the death of the patient, two truckloads full of people attacked the staff on duty.”

Even though the police station at Entally was alerted as the incident unfolded, cops failed to act. The daughter of Firhad Hakim, Mayor of Kolkata, who is herself a doctor, denounced the government inaction. “Please question the government as in why the police officers posted in government hospitals do little to nothing to protect doctors?” inquired Shabba Hakim.

As the strike of the doctors gained momentum, more reports of attacks on the demonstrating doctors began to pour in. Chandrima Bhattacharya, the West Bengal Minister of Health stated that she was in touch with the resident doctors and four arrests had been made in connection to the case.

“When there are 200 people who perpetrated the incident, how can the authorities get away by arresting just four,” questioned Dr. Chowdhury.

Deep-rooted issues surface

Incidentally, this is not the first case of violence in medical institutions in Bengal, or even Kolkata. Upturned furniture and vandalized wards have become routine sights in hospitals. Three people were arrested for vandalism in the emergency ward of the Peerless Hospital last year. A mob had wreaked havoc in CMRI the year before that.     

“It is a common incidence for the kin to become agitated, especially after the death of a young patient. They raise their voices and often become physically aggressive,” remarks Dr. Chowdhury.  She says that there have been 200 odd cases of agitation against doctors in the past two years alone which have not been filed with the judiciary or portrayed on social media. However, there has never been a cease-work of emergency services on this scale for any of these earlier cases. Perhaps because they were largely seen as stray cases of hooliganism or genuine ire among patients. “But in the event of such organized violence, it is not possible for any junior doctor to continue their work without an assurance of safety,” she feels.

“The junior doctors have to bear the brunt of this violence as they are first in line to treat the patients. Senior doctors oversee the interns and intervene at a later stage,” comments Dr. Tabinda Hossain, a PG Trainee in a medical institution. “The patients are always our first priority, but the authorities also need to show responsibility towards doctors by giving them the protection that they deserve.”

The current incident has also led to articulation of long standing grievances among doctors in the state.

The government hospitals in Bengal face an acute dearth of manpower, medicinal resources and funds. In these understaffed hospitals, the interns face immense pressure. The doctor-patient ratio itself is overwhelming. It is habitual for one junior doctor to tend to 75 patients in a ward, points out Dr. Chowdhury. This makes it difficult for the doctor to give their undivided attention to each patient or explain the patient’s illness in detail to families. Due to the nature of their work, they are often misunderstood and distrusted.

Despite the adversities, these doctors serve for 30-40 hours at a stretch — for a fixed stipend. As one PG Trainee explains in this video to a journalist, they do this out of a commitment to their profession and to the people, and all they want in return is a basic guarantee of safe working conditions from the state. Yet, for years on end, the state has not been able to provide that and law enforcers do nothing to stop or punish troublemakers.

Many citizens also agree that it is unfair to expect doctors to work in such a hostile or unsafe environment after years of academic toil and professional service.

Political mismanagement aggravates situation

The current incident has also become embroiled in a political imbroglio, with communal undertones. BJP leader of the state Mukul Roy fueled the controversy by stating “Trouble broke out at NRS over the death of a patient from a particular community. Trinamool men led the rampage inside the hospital.” The BJP has been accusing the state government of appeasement politics in a bid to milk the minority vote bank.

Chief Minister Mamata Banerjee retorted by saying, “This strike is a BJP conspiracy. The protesters are disrupting medical services. This should end at once.” She intervened by issuing a four hour ultimatum for the protesting doctors to get back to work or face eviction from hostels as a repercussion. She even said that it was ‘outsiders’ who had infiltrated these campuses and were orchestrating the unrest.

Addressing the media on June 13th, she said that “Medical services come under the Essential Services (Maintenance) Act and doctors cannot afford such protests. If the strike is not called off, we will be forced to take action after 2 pm. This will be done as per the laws laid down by the Supreme Court.”

Surprisingly, the Chief Minister made these statements on Thursday afternoon in the compound of the SSKM hospital and not in NRS. She went on to remind the doctors of the oath they had undertaken to serve their patients, and was quoted as saying, “The state spends Rs 25 lakh on each doctor’s education and they shirk work. This will not be tolerated. Are they doctors?”

Her comments infuriated the protesting doctors and failed to quell the strike. Several interns vacated their hostels and the Principal and Vice Principal of NRS handed in their resignation as the gridlock could not be resolved. More than 70 other doctors across the state also resigned from their posts.  Shabba Hakim responded by stating that even though she was a Trinamool supporter,  she was “deeply ashamed at the inaction and the silence of our leader”.

Earlier in 2018, Chief Minister Mamata Banerjee had promised to ensure the safety of the medical staff and punish vandals. The state government had agreed to install around 1440 CCTV’s as a preventive measure to mob violence. But in the light of the NRS fiasco, the failure of all such lofty plans have been exposed.

The doctors on strike themselves denounce the communal undertones which are being given to their protest. Dr. Chowdhury confirmed that the doctors are not interested in the political or communal affiliations of the attackers. “We just want the attackers arrested and our safety ensured,” she added.

Cascading protests

The Indian Medical Association (IMA) headquarters declared an All India Protest Day on June 14, 2019. “The gruesome incident in NRS Medical College, Kolkata is of barbaric nature. Dr Paribaha Mukhopadhyay who was brutally attacked is critical and fighting for his life. IMA condemns the violence perpetrated on a young doctor. Entire medical fraternity expresses our solidarity with the Residents who are on strike,” read a notice issued by the IMA.

Later the IMA extended it to a four-day protest, culminating in a 24-hour strike on Monday, June 17th which would see a suspension of all non-essential health services. The apex body of doctors has also demanded a central legislation in the form of a law against violence against doctors and health care establishments.

Doctors across the metropolitan cities including Delhi, Mumbai, Hyderabad and Bengaluru have already shown their solidarity by protesting against the turn of events. Resident doctors at AIIMS, Delhi wore helmets and donned bandages on their foreheads as they worked on Monday.

Delegates met with the Health Minister Dr. Harsh Vardhan to demand better conditions for doctors. He has appealed to Mamata Banerjee to not turn this into an issue of prestige.

Meanwhile, hundreds of patients spent agonising hours outside government hospitals. A large number of patients staged their own dharna in response to the protest by the doctors, and tried to force entry inside the locked hospitals in an act of desperation.

Voices of support

The doctors on strike have called for stricter police protection and government regulations after the rising incidents of attacks against them. They have asked for the arrest of all the culprits involved in the NRS attack. They also want the chief minister to tender an unconditional apology for the intimidating manner in which she addressed protesting doctors at the SSKM Hospital.

The Calcutta High Court has declined to pass an interim order on the doctor’s strike. In a hearing of a public interest litigation, the Chief Justice has reminded the protesting doctors of their ‘Hippocratic Oath’ in serving their patients, but asked the state government to negotiate and persuade the striking doctors to resume work. It has also directed the government to keep the Court informed about steps taken against the attack on the NRS doctors on Monday night.

Meanwhile, support has come in from various quarters.

“A surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient,” observed Justice Katju, former judge in the Supreme Court.  Renowned film maker and actress from the state Aparna Sen has also appealed to Mamata Banerjee to stand by the young doctors and ‘take care’ of them.

But for now, the strike shows no signs of slowing down. The attack on Dr Paribaha Mukhopadhyay has opened the floodgates of public outcry across the state of Bengal and beyond.  It is clearly difficult for the doctors to perform their duty under threat of life and limb, and they will continue to protest until the government takes concrete measures towards their security. Unfortunately, the state shows no inclination towards a conciliatory approach.