Why should resident doctors live in hell?

There is a picture of Dr. Payal Tadvi in a T-shirt and jeans, against the Mumbai night sky speckled with lights from the skyscrapers behind her. It is a picture of hope, of the possibility that a 26-year-old could break away from her tribal background to build a career as a gynaecologist in this big city. Unfortunately, it is one of the pictures carried along with reports that Tadvi, a resident doctor at the BYL Nair Hospital in Mumbai to which her T.N.Topiwala Medical College is attached, had committed suicide. Payal hanged herself in her hostel room last month. Her death ended the hope of “the first MD” from the tribal Tadvi Bhil community of Jalgaon, a district which has among the highest tribal populations in Maharashtra.

The suicide comes after complaints from her parents Abeda and Salim and husband Salman, a doctor attached to R.N. Cooper hospital, that she was harassed by three of her seniors and was constantly subjected to casteist slurs and abuse. 

Among the tribal groups of Maharashtra, the Tadvi Bhils are a sub-caste of the larger ethnic Bhils. It is said that many of the Tadvi Bhils converted to Islam during the reign of Emperor Aurangzeb, but retained much of their original culture, customs and continued to speak their local languages, Marathi and Bhili. Like most of the tribal groups in India, the Tadvi Bhils, despite struggle and hard work, have been unable to move beyond labour and daily wage occupations.  Unlike her tribal community, Payal Tadvi reached out well beyond her compatriots to a career in medicine and even aspired to one day build a hospital for them in her village in Jalgaon district

The suicide comes after complaints from her parents Abeda and Salim and husband Salman, a doctor attached to R.N. Cooper hospital, that she was harassed by three of her seniors and was constantly subjected to casteist slurs and abuse. Three doctors have been arrested and charged under the Scheduled Castes and Tribes (Prevention of Atrocities Act), the Anti-Ragging Act and primarily, abetment to suicide.

It is for the investigators to find out what precisely happened that led to the death of a promising young doctor. But the death has opened eyes to a problem that State governments across India have been ignoring: the world of the resident doctor.  Resident doctors, the backbone of public hospitals affiliated to teaching hospitals, are post-graduate medical students who work as a part of the last leg of their education and are keen on completing their post-graduate studies. State governments have exploited the situation looking at resident doctors as cheap labour for their public teaching hospitals. Working long hours on low stipends, the resident doctor is often faced with the challenge of managing the rush of patients in crowded spaces. They are often strapped for time and are expected to stand in for nurses or other staffers who have not shown up.

State governments have exploited the situation looking at resident doctors as cheap labour for their public teaching hospitals. Working long hours on low stipends, the resident doctor is often faced with the challenge of managing the rush of patients in crowded spaces. 

The pressures are no excuse for slurs and ragging of course. But they also point to a complete lack of systems, support and controls in workplace, which is a which is a pressure environment that the young medics work in, a place where they are stretched to the limit. There is clearly no working system for attending to complaints of the residents, looking at team work (which is so essential for doctors who are studying to post graduate and will have to work as part of larger teams of physicians and surgeons), or taking any input from these frontline soldiers who can inform the administration and help build better response systems.

Apart from the physical constraints – place, salary, time, work pressure, accommodation – what the Tadvi case makes clear is that the doctors face mental pressures we have known little about. It is quite strange that within the community there is not enough of an understanding of what is probably going on in the minds of these young doctors. Systems like counselling, anti-ragging committees in the engineering and other professional colleges seem to be dysfunctional or absent in the medical colleges and public teaching hospitals.

The huge downside of this experience for doctors at the start of their career will certainly mark them for life. This will possibly shape them, even scar them, and many may tend to believe that work in a public hospital is a sentence that they must serve so that they are then “free” to work in shiny corporate hospitals where a different kind of corporate culture takes them off in another wrong direction.

Corporate hospitals and public hospitals are two ends of the spectrum in our country. We need more public hospitals, less corporate hospitals. Public hospitals serve the millions and of course there is pressure on the doctors working there. 

Corporate hospitals and public hospitals are two ends of the spectrum in our country. We need more public hospitals, less corporate hospitals. Public hospitals serve the millions and of course there is pressure on the doctors working there. But this is also where they learn the best, where they offer cost effective treatment and the only place where they will get to serve without linking it up to pots of money doctors think they are entitled to. So, this is a system that must be strengthened, and an important part of strengthening it is in providing support, care and a decent standard for those who look after the health of others.

In doing so, the State will also showcase public hospitals as places where these doctors can come back to serve with pride, as the cradle where they picked up important lessons in their craft and knowledge and build a bond that should last a lifetime. Any other way of handling public hospitals is virtually condemning them form inside. That only forces doctors to leave at the first opportunity, and that is killing the system from within. The system should be so good that residents should be willing to serve an extra term – with pride in their hospital.

The public health must be strengthened, and an important part of strengthening it is in providing support, care and a decent standard for those who look after the health of others.

Making that won’t be easy but the first step is to see that those with complaints are heard out and action initiated on important complaints. If this simple approach was in place, Tadvi needn’t have died.

(The writer is the Managing Editor of Foundation of The Billion Press, a non profit in Mumbai) (Syndicate: The Billion Press) (email:editor@thebillionpress.org)