West Bengal’s public healthcare delivery system has virtually collapsed, as resident doctors of government medical colleges continue to protest against the state’s non-sympathetic attitude towards their security concerns. To make matters worse, a few hundred senior doctors have tendered their resignations in the last few of days to show solidarity with the striking junior doctors.
This round of agitation started after the relatives of an elderly patient, who died on Monday at a medical college in Kolkata, alleged that he died due to negligence. Things took a turn for the worse soon after as hundreds of people entered the college premises and thrashed junior doctors brutally.
It must be noted that this is not a one-off incident. Cases of vandalism and assaults on doctors in hospitals for reasons such as a patient’s death because of alleged medical negligence have become a regular phenomenon in West Bengal. The situation became so alarming a year and a half ago that the state government wanted to introduce taekwondo for self-defence for medical students in all government medical colleges.
Despite these measures, violence continues unabated in hospitals and therefore, the question arises – How did we get there?
The genesis of the crisis
There are a few inter-related issues which are responsible for the healthcare crisis in West Bengal. One, in government healthcare facilities, people vent their anger against the staff as the services are simply not up to their expectations. As a result, doctors, nurses and other staff members who directly engage with patients become the victims of the patients’ families and relatives’ ire.
Years of neglect of the public healthcare sector has greatly affected the ability of government facilities to cater to people’s medical needs. The near breakdown of the referral system has increased the patient load on the tertiary-level facilities beyond manageable limits.
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In this respect, the medical colleges which are located in Kolkata are the worst sufferers. Patients come not only from different localities within Kolkata but they are also being referred to from adjoining districts such as North and South 24 Parganas, Medinipur, Murshidabad and Nadia. On any given day, the patient footfall is anything between 3,500 and 4,000 in each of these medical colleges.
Faced with such overcrowding of care seekers, the system by default comes up with allocative devices such as rationing of services, including time. The doctor-patient interaction time becomes so limited that it leaves the patient and her family members utterly dissatisfied.
Many of them are forced to seek preferential access to services based on personal connections or by bribing touts. This situation has arisen due to the severe inadequacy of health infrastructure in the state, critical for the delivery of health services.
Currently, on an average, a government allopathic doctor in West Bengal serves more than ten thousand people (10,441 persons), falling far short of the WHO recommended doctor to population ratio of 1:1000 (this holds true even after the inclusion of AYUSH doctors and private physicians). In addition, as of 2018, in West Bengal, there are only 5.62 beds available in government hospitals per 10,000 population.
Unfortunately, common people cannot even fathom the larger picture as to why government hospitals are in such disarray. In fact, the government campaign is such that it provides sufficient financial resources to public facilities so that people can avail free treatment.
Further, the government keeps boasting about its initiatives of setting up of several new multi-speciality hospitals, fair priced medicine shops and diagnostic centres. Through this misleading campaign, a false impression has been created in the public consciousness about the state of government health facilities. Therefore, when the people come face to face with the harsh reality, they become frustrated and at times, resort to extrajudicial means.
Besides these supply-side issues, the current crop of doctors has also contributed to this crisis to a certain extent. Earlier, the budding doctors were more eager to learn the practical aspects of medicine and hence, they used to spend more time with the patients and, through this process, a doctor-patient bond used to develop. But the current trend among the medical students is to pay greater attention to the theoretical aspects so as to clear the entrance test for PG, which would eventually help them get a job in a corporate hospitals So, it would not be incorrect to say that today’s lot lacks a bit of empathy towards their patients.
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The ongoing agitation by the doctors has hit the poor the most. It is important to know who the consumers of government health services are. According to the 71st round of the National Sample Survey, 80% of the bottom 40% (ultra-poor) depend on the in-patient care provided by government hospitals in West Bengal.
Unsurprisingly, they do not have the means to seek treatment from private hospitals and that is why patients have been lying in front of hospitals, waiting for the doctors to attend to them. The current impasse, therefore, needs to end at the earliest. One can only hope that better sense prevails and both sides soon return to the negotiating table.
Soumitra Ghosh is Assistant Professor at the Centre for Health Policy, Planning and Management, Tata Institute of Social Sciences.