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Sunday, July 15, 2012

Attacks and vandalism at hospital: the menace and the way out

A long term solution to the increasing problem of attacks on health workers and vandalism at hospitals demands a consistent efforts of all sides: the government, the hospitals, the doctors and health workers and the public as a whole. The short term solutions, while essential, should not distract us from the need to engage in long term measures. And in that, we also do have active roles to play.

Doctors being beaten and manhandled is a symptom of very deep malaise in the society and this is exacerbated by eternal political transition without law and order that we are going through. In short term it is mandatory to have security arrangements like Health Worker and Institutions Security Act. Protests and lobbying for that is more than welcome. 

 Few factors pertinent to latest wave of such incidents:

1) The omnipresent sense of impunity is behind much of the violence taking place of late. The prevalent concept is that vandalizing property or manhandling a health worker is the surest way of securing good amount as 'compensation' instead of the punishment that they deserve. 

2) The public attention and media glare these incidents invite is another factor: particularly for jobless vigilantes who are otherwise faceless. 

3) The expectation that, after paying money, any illness should be cured by the hospital regardless of severity or nature. Also the perception that every doctor should shape the outcome of an illness, just like a carpenter does with a wooden log. 

In the question of long term security and decent work environment, however, things get much more messy. A complex interaction among many factors related to patient care, doctor-patient and doctor-attendant relationship determine the particular way in which the people behave with the doctor and health workers. The psychological state of the people, largely a function of the society from which they come; and that of the doctor, a function of his/her competence, confidence, prudence and inter-personal communication skill; both have important roles to play. Thus multiple variables on the two sides are at constant interplay and some kind  of imbalance leads to such deplorable incidents. 

To exemplify some of the prudent variables on the side of doctor or hospital, there is a small but significant minority of doctors who routinely practice imprudently and often unethically ( in forms of irrational MR-dictated prescription of drugs, over-treatment, procedures done without required qualification, etc. ) and also the hospitals (particularly private) that charge people disproportionately to the service provided. Thanks to the environment of impunity and lawlessness, public sees all the hospitals as one and has same image of all the doctors. Consequently, the majority of law-abiding doctors are being punished for the misdeeds of their maleficent colleagues. 

Also, the health system itself of the country is in very poor health with ailing and mismanaged government hospitals increasingly incapable of handling the no. of patients. This forces more people to seek health service in private institution not by will but by compulsion and that increases the likelihood of unfavorable interaction between the people and health institutions. 

A long term solution thus demands a consistent efforts of all sides: the government, the hospitals, the doctors and health workers and the public as a whole. The short term solutions, while essential, should not distract us from the need to engage in long term measures. And in that, we also do have active roles to play.  While there is little that can be done about variables on the other side, much remains to be done to optimize our own position vis-a-vis the service-seekers. 

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