A medical worker in PPE tends to a COVID-19 patient, at the Lok Nayak Jai Prakash Hospital, New Delhi, July 17, 2020. Photo: Reuters/Danish Siddiqui.
The COVID-19 pandemic has exposed numerous flaws in our healthcare system, both public and private. The public health system is groaning under the weight of the pandemic while corporate hospitals stubbornly stay out of reach of most care seekers with over-the-top prices. Either way, the common person is at a loss.
As it happens, it isn’t a good time to be a doctor either. The pandemic has become a golden opportunity for administrators to expand their ‘contract culture’, and deprive healthcare professionals of their labour rights, including salaries and casual leave. All major hospitals in the country have been recruiting healthcare workers in the form of doctors, lab technicians, staff nurses and sanitation workers but now they are being hired for a period of one or two years only, on fixed contracts that don’t accommodate workers’ needs beyond their responsibility to ‘save lives’. When the pandemic ends, they might just be shown the door.
This ‘use and throw’ policy is rampant in all big institutions at this time – even as the government calls health workers “corona warriors” and requires the people at large to cheer for us. Permanent appointments are quite rare even as hospitals face a huge human resources shortage.
In the most recent example, more than 400 nurses went on strike demanding permanent posting at the All Institute of Medical Sciences (AIIMS), Patna. At AIIMS Raebareli, an advertisement dated July 2 invited applications for junion and senior residents’ posts solely on an ad hoc basis. Lucknow’s principal public sector hospital, the Dr Ram Manohar Lohia Institute of Medical Sciences, also invited applications for senior residents in the departments of medicine, critical care, pulmonary medicine and obstetrics and gynaecology for a limited period of 89 days. JIP Puducherry also recently recruited senior resident doctors for just 89 days. There are many such examples around the country.
In some states, including Karnataka, Punjab, Rajasthan and Uttar Pradesh, interns have protested their low stipends even as they have been asked to treat COVID-19 patients. The stipends were increased in Punjab, Karnataka, Maharashtra and West Bengal but they remain low in Uttar Pradesh and Rajasthan, and protests by healthcare workers have gone on.
In light of the unprecedented public health crisis brought on by India’s COVID-19 epidemic, it’s very important to acknowledge the psychological impact of these decisions by hospitals on health workers. The mental and physical strain is significant and frequently debilitating. Workers are under constant pressure to test and successfully diagnose, isolate and treat patients – all while under intense scrutiny by the people, the press and the administration.
The fundamental workforce consists of junior residents and intern doctors. However, executives and medical superintendents often fail to understand that they are learners and clinicians-in-training, not full-time employees. Constantly pushing them without encouragement or guidance is bad for health. There is also an entrenched conviction that treating patients is the sole duty of doctors – a belief that has allowed some administrators to take advantage and excuse themselves from addressing doctors’ needs.
Specifically during the pandemic itself, workers are also beset with long working hours, inadequate supply of PPE, more clerical work and lack of accommodation to quarantine or isolate themselves. Even when PPE is available, using it is not easy because it limits opportunities to wash oneself or use the toilet, leading to physical and mental fatigue. In these circumstances, workers are expected to work for 8-12 hours on paper but often work for longer, and often with high quality and attention. This can and does get agonising.
A 2018 study in the Indian Journal of Psychiatry found based on a survey that 30% of India’s doctors and physicians could be suffering from depression and 17% could be having suicidal thoughts. Almost 80% of doctors, especially at the earlier stages of training and work, are at risk of burning out. Incidents of deaths by suicide in the last two months of junior doctors at AIIMS Delhi and the R.G. Kar Medical College, Kolkata, speak to this crisis.
Doctors and medical students also often feel isolated and struggle to seek help. Many are also fearful that even if they are able to seek help, doing so might affect their professional prospects.
In some states, MBBS undergraduates have been asked to help with the COVID-19 response without checking whether they are clinically fit. The Government Medical College of Surat appealed to final year MBBS students to serve in COVID-19-affected areas for disease management. In return, the college’s management promised them 50% internal marks and a stipend of Rs 10,000 per month. The Haryana medical education department issued a similar last month, to deploy final year MBBS students for duties related to COVID-19 care,
However, it’s not clear who is checking if these orders and appeals are legal or even ethical vis-à-vis patient care. Due to the lack of specific directions from the Medical Council Of India (MCI), multiple bodies have resorted to such measures. On July 16, MCI convened a meeting on the matter and the medical community expected a fixed set of guidelines to come out of it, but two weeks later, there is no word.
What we need at this time is for hospitals to recruit doctors and non-postgraduate junior residents with extra emoluments and other benefits. This will help reduce the workload of junior doctors to a large extent and also mitigate the risk of burnout. According to the MCI website, there are 19,998 non-postgraduate junior residents in the country at present. If they are recruited on proper terms – including, as the Progressive Medicos and Scientists Forum has pointed out, insurance coverage, timely pay and appropriate working hours – we can turn the tide against COVID-19 to a significant extent.
Extraordinary circumstances require extraordinary solutions, and humane care. Senior medical professionals and superintendents must find ways to assist junior doctors serving at the frontlines instead of forcing them to work long hours at the expense of their education or under threat of suspension. Manpower shortage is no excuse to exploit workers, especially younger ones.
The ongoing coronavirus pandemic has been truly unprecedented in many ways but medical professionals are human, too. They don’t need to be worshipped or labelled “corona warriors”. Simply attending to their needs, and the needs of their supportive families, will go a long way towards making them feel respected and will allow them to undertake their responsibilities with a sense of dignity.
Dr Faiz Abbas Abidi is a junior doctor working on biomedical research, public health issues and digital health interventions. He tweets at @doc_faiz. Dr Rajnish Raj is state president of the Indian Medical Association – Students’ Wing. He is a junior doctor in Varanasi. Dr Garima Mishra is a junior doctor conducting biomedical and epidemiological research.