Violence against frontline workers is a long-time issue bothering the whole world, especially this pandemic led to the increased risk of the lives of doctors and other healthcare workers. The Occupational Safety and Health Administration (OSHA) agency reported that “From 2002 to 2013, incidents of serious workplace violence (those requiring days off for the injured worker to recuperate) were four times more common in healthcare than in private industry on average”. In most of the cases the violence is in the form of a threat or exposed to verbal abuse. Largely, the person who abused the healthcare workers are the patients themselves or their close relatives. The reason for such violence is many but mostly due to the lack of awareness. While many of the cases in India are of a heat of the moment reaction, some of them are cold-blooded too, prior planned violence and murder. During this pandemic, there are many cases reported on doctors and nurses treating COVID-19 patients being threatened by landlords and neighbours. One such incident was reported in Hyderabad where a female doctor was denied entry to the house by the landlord. The first case on the death of the healthcare worker was reported on 9 April 2020 in Indore and two more in Tamil Nadu a few weeks later. The ostracism of the public reached a peak when they created violence while cremating the dead bodies of healthcare workers. The ambulance carrying the bodies was attacked by a mob leaving behind the driver and workers with grievous injuries.
REASONS FOR THE VIOLENCE
This behaviour of the people could be due to panic and mistrust of the governmental steps in combating COVID-19. Most of the violence is not due to financial basis but anxiety, no proper investigation, extremely crowded and unhygienic environment and long waiting hours. Some major places in India like West Bengal, Maharashtra and Tamil Nadu where violence by patients relative, political leaders and also by police in primary health centre and government hospital have been reported recently. The total blame cannot be thrown on society alone but there are some faults on the side of hospitals and healthcare workers too, but punishing the workers for their small faults from their side is not a possible solution.
MEASURES FOR REDUCING THESE VIOLENCE
According to the reports on the IMA survey, which shows that 80% of doctors in India are stressed in their profession, while 75% of doctors have dealt with some form of violence during their practice. This includes verbal, emotional, sexual, psychological, physical and cyber intimidation, threats, abuse, and occasionally even extreme bodily harm and injury caused by patients, patient-attendants, or even mobs of ‘miscreant’. As many as 62.8% of doctors are unable to see their patients without any fear of violence; 13.7% fear criminal prosecution most days of the week; and 57.7% of doctors have thought of hiring security in their premises. There are also claims that some cases of violence go unreported. These things could only be possibly reduced if appropriate legal systems are made against these issues.
IMPROVED GOVERNMENT GUIDELINES
Indian Government spending on healthcare is relatively less compared to other countries, this must be increased, the infrastructure of the hospitals should be improved specifically the surroundings must be kept clean and sanitised often to reduce the risk of spreading, strict regulations and laws should be imposed against the violence of healthcare workers according to relevant section in Indian Penal Code(IPC) and severe punishment should be imposed on not obeying the law like announcing it as a non bailable offense, and fine to recover from damages. The government should take several steps for the safety of healthcare workers.
MEASURES DOCTORS CAN TAKE
The doctors shall be trained on dealing with patients, they should be thought on communicating with patients regarding the cause politely and clearly. The communication is the most important thing to the doctors, they should learn to remain calm while speaking and give comfort to the patient and their relatives. They shouldn’t overreact or exaggerate the situation. The next important thing is getting valid consent. The consent should be either documented or it can be an audio-visual consent.
MEASURES THE HOSPITALS CAN TAKE
The hospitals can do a lot in reducing the violence.
- The services for the patients can be improvised.
- Enhanced hospital infrastructure with clean and spacious surroundings
- Adequate number of doctors to deal with patients and also measures to reduce overcrowding
- Steps to reduce the long waiting hours
- Decreasing numerous procedures to admit a patient in hospital
- Proper security staff to assist and respond timely
- Patients or their relatives with arms/ammunition should not be allowed to enter the hospital.
- Closed circuit television (CCTV) monitoring sensitive areas especially emergency room, is a must and should be reported to police immediately if needed.
MEASURE PATIENTS CAN TAKE
First of all, patients should know violence is not the solution to any problem. The patients and their relatives at least must have basic knowledge that doctors are not god or they can do magic to cure them. They are also normal humans and cannot be held liable for all the deaths happening in hospital in the event of negligence. And they should know that the cost increases only on the advancement level of treatment. However, they must know there are redressal systems in order to deal with disputes, and violence alone cannot sort them.
Furthermore, the medical schools shall play a key role in providing awareness regarding the violence on doctors. Alongside the major medical subject the students can be thought some basic knowledge on dealing with patients, the importance of good communication, the healthcare worker-patients relations and compassionate towards patients and their relatives. They should be trained on handling the aggression of the patients and relatives. Over all, they must be thought that a calm and good communicable doctor can handle any kind of chaotic situation. Then the media both the printed and the electronic, one should avoid overemphasizing the news and thus creating negative image of the doctors. Instead, they must put unbiased news and should highlight the Doctor’s plight, also the clear reason for the rise of violence against them.
LAWS REGARDING THE VIOLENCE
The Indian Medical Association (IMA) warned the Government to draft a special law on violence against healthcare professionals, by calling all the healthcare professionals for a White Alert by lighting candles on 22 April 2020. IMA has also requested all the healthcare professionals to wear a black badge on a subsequent day as an act to register grievance against violence against health care professionals. The Government then called for a meeting with IMA to discuss their demands and put an end to the current situation. Within hours after a meeting between IMA and Government of India, an ordinance was passed in the parliament and signed by The President of India the next day to prevent violence against healthcare professionals. The amendment stated that “any commission or abetment to acts of violence shall be punished with imprisonment of three months to five years and a fine of Rs. 50,000 to Rs. 2 lakhs. If the attackers cause grievous hurt, they can be imprisoned for six months to seven years with a fine of Rs. 1 lakh to Rs. 5 lakhs. The offender was also liable to pay compensation to the victim and twice the fair market value for damage of property”. “Although several states have enacted several laws to protect violence against doctors, this amendment was the first to cover violence against healthcare professionals including doctors, nurses, paramedical workers, community health workers, and persons empowered under the Epidemic Diseases Act at both workplace and home,” said the Health Minister of India
This situation of violence against a healthcare worker is still an uncommon one, but these increasing case of violence in India, it is not good to take it light as there are chances of high risk. If the above said laws, are strictly followed with punishment and the measures put forward for both the patients and the doctors are adhered to, then this issue as high as now can be definitely reduced.
Author(s) Name: Nanthiya. N (IFIM Law College)
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 https://thewire.in/health/behind-the-violence-against-healthcare-workers-in-india-lies-a-failed-system (last accessed on 2021 July 24)
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