A protest staged jointly by doctors and students of Jawaharlal Nehru Institute of Medical Sciences (JNIMS) inside the campus against the summary suspension of a senior resident doctor once again brings to the fore the deplorable and much contradicted public health care system in the state. While it is still too early and beyond the scope of this paper to delve into the legal aspects of the unfortunate incident, it would not be out of place to state that doctors has been the target of revenge and rebuttal for as long as one would care to recollect. And while a loss of life is always an unfortunate and saddening experience, it would be wrong to put the blame squarely on the doctor or doctors attending to the patients without proper enquiry and investigation even if any foul play or accusations of negligence comes up.
Consider the statistics- according to a World Health Organization (WHO) report of 2017, in India, there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. You don’t need an epidemic, however predictable, for the public health system to collapse. It is a matter of routine that patients share beds and doctors are overworked. India has a little over one million modern medicine (allopathy) doctors to treat its population of 1.3 billion people. Of these, only around 10% work in the public health sector, shows data from the National Health Profile 2017. Simply put, India doesn’t have enough hospitals, doctors, nurses and health workers, and since health is a state subject, disparities and inequities in the quality of care and access to health varies widely not just between states but also between urban and rural areas. Under the circumstances, it is not only understandable but also expected that the overworked and overstressed doctors and other hospital staffs working with inadequate infrastructure and facilities simply cannot cater to the needs and satisfaction of each and every sick and infirm.
Another social aspect of growing concern is the mob culture that has increasingly played havoc to the functioning of law and order in the state. Incidentally, Manipur has become the first state to take a serious step against increasing incidents of mob violence. Manipur Assembly passed ‘The Manipur Protection from Mob Violence Bill, 2018’ on December 21, The bill moved by Chief Minister N Biren Singh recommends rigorous life imprisonment for those involved in mob violence if it results in the death of a victim. And in addition to life imprisonment, the law also recommends a fine of Rs 5 lakh for those involved in mob lynching. Perpetrators may also face public humiliation through exclusion from public services and might be forced to leave his/her home without consent. The bill was introduced in the Assembly to curb increasing incidents of mob violence in the state. The Supreme Court has also condemned incidents of mob violence and lynching across the country and urged parliament to enact a law to deal with such incidents which threaten rule of law and the country’s social fabric. The court also issued a slew of directions to state governments, including preventive, remedial and punitive steps to deal with the crime. One can only hope that with stringent and timely implementation of such preventive laws and regulations much of the wanton destructions and social disturbances will be curbed.
Doctors, being humans will make mistakes and there is no denying the simple fact, more so given the stress and constant duress faced in their line of duty. There are procedures to be followed to determine the allegations and investigations to be carried out to establish facts. A summary suspension without presenting the opportunity to explain the situation and ground reality from their perspectives reduces the morality and self respect of the doctors and projects them in a light of doubtful professional efficiency and integrity. A more comprehensive investigation into the working conditions, restraints and constraints under which the doctors and other health workers in the state are performing their duties will shed more light into the overall condition of healthcare in the state and will hopefully shed light into ways to draw up a comprehensive and systematic policies to prevent any unfortunate and unwanted incidents in the future and stop presenting doctors as scapegoat for any and every unfortunate incidents, whether alleged or real. Death is inevitable and doctors should not be held accountable for every death, however unfortunate it always is.
Another area that needs immediate focus to alleviate health care system in the state is the improvement in quality of services in sub-centers (SCs), primary health center (PHCs) and Community Health Centers CHCs) with assignment of more fully operational first referral units (FRUs) of existing facilities (district hospitals, sub-divisional hospitals, CHCs) etc. National rural health mission, if efficiently implemented, can significantly improve and make positive changes in the overall health care system of the country and the state.