Dr Guna Raj Awasthi, Medical Superintendent of the district hospital at Baitadi, was busy with a line of patients in the hospital on June 5 when a group of women smeared black soot on his face. It was later understood that they were incited by a local Nepali Congress leader Ramesh Koli who badly wanted to settle scores with the doctor. Several weeks down the line, Koli is still at large.

The larger story

The assailants justified their inhumane act by proclaiming that the hospital did not provide free ambulance service to Hira Bhul, who was pregnant with triplets and was referred from there to a higher centre. Hira had been examined by Dr Awasthi a couple of days before the incident. Upon examination, he discovered the condition of one of the fetuses to be quite abnormal. For ease of managing any ensuing complications, she was instantly referred to a higher centre. Dr Awasthi even managed to collect funds for them upon learning of the patient’s financial condition. He contributed Rs1,000 from his pocket and Rs1,500 from the hospital committee. As for the ambulance, he personally requested the Dasarath Chand Pratisthan to make it available as the hospital’s ambulance was out of town. 

Such a despicable act of assaulting a dedicated doctor needs to be strongly condemned. However, it has also provided an opportunity for introspection. Why are doctors routinely facing threats and attacks in the workplace? The assault is not at all an isolated incident. News of doctors being beaten, verbally abused and hospitals getting vandalised are surfacing every now and then. Besides, Nepali doctors are not unique in facing this situation. Even in countries like China and the UK, doctors are going through this ordeal. Why?

There are plenty of reasons. Doctor-patient relationship is at an all-time low. With the mushrooming of private medical colleges, medical education has been hit hard. The crucial ‘quality factor’ in the numerous newly-produced doctors is under scrutiny. There have been several occasions in the recent past when the failure to effectively communicate with the patients has led to gross misunderstanding and unfortunate incidents, even when the low health literacy of the public is accounted for. With the continued commodification of healthcare, patient satisfaction and trust in doctors have sharply dropped. If the state fails to regulate medical education and leaves it in the hands of a medical mafia as in the present, one can only expect a rise in the cases of medical negligence. And, one can get a good sense of why incidents of violence against once-highly-regarded professionals are bound to increase in the days ahead.

Yet a question remains: Can this be averted? Of course! Dr Govinda KC has been at the forefront of the campaign to reform the health sector. If the public back him up to change this ugly underside of medical education, things will definitely improve.

Omnipresent impunity

If we try to construct Dr Awasthi’s case around the argument that his negligence had compelled people to act aggressively, we are mistaken. He is an excellent doctor with a stellar track record, both on technical and humanitarian grounds. The assault on him is without question politically motivated. Unnerved by his growing popularity, local party leaders with vested interests were seeking to transfer him. And a few relatives of the patient were coaxed to assault him.

Under Dr Awasthi’s leadership, Baitadi has witnessed remarkable progress in the health sector. Previously, Baitadi was one of the five worst-performing districts as ranked by the a government assessment based on various health parameters. Baitadi now ranks fourth, climbing up 65 positions. Even a cursory look at the statistics will reveal how much effort he put in for the overall improvement of Baitadi’s healthcare delivery system. For this outstanding performance, he was felicitated with the Health Service Award. Among health workers, he has a reputation for endless service to the people of rural areas and is seen as a constant source of inspiration for scores of doctors working in the hinterlands.

In a nation where the culture of impunity has been institutionalised, it is no surprise that the party hooligans who mount such attacks are offered political protection. We have little hope that the culprit will be booked, for anyone with political connections is above the law in this land.

Unless we end this culture of treating the politicos as equal under law, medical reform alone will not bring about the desired working environment for medics as demonstrated by the case of Dr Awasthi. Increasing the number of security guards in the hospitals is not the answer; ending the omnipresent culture of impunity is.

Let doctors be allowed to work with only the patients’ best interests in mind. By resorting to hooliganism upon the slightest pretext, we are not only harming the health care environment but also discouraging bright young minds from choosing medicine as a career and furthering brain drain. It is high time the general public understood the costs of an unsafe working environment.

Lamichhane is a Medical Officer working in Achham District Hospital