So we don’t repeat R.G. Kar

How can a woman doctor be raped, brutalised and murdered in a busy hospital in a big city? We have gone terribly wrong somewhere. We need to do more than search for answers — we need to act, urgently.

I go back to my own residency 30 years ago in a paediatric hospital in Jaipur.

Our duty rooms were next to the wards and were shared by both women and men. There were no latches on the doors. A night guard would often take a nap there.

We were lucky nothing happened to us, but many other women were not so fortunate. Can we ever forget Aruna Shanbaug?

The case traumatised the medical world for four long decades after the 25-year-old nurse from King Edward Memorial Hospital, Bombay, was sexually assaulted and choked with a dog chain in 1973. Suffering from brain damage, paralysis and cervical cord injury, she died after a coma that lasted 42 years.

From Edward Memorial to R.G. Kar, nothing much seems to have changed.

The paediatric hospital in Jaipur where I interned has grown substantially in size, but the duty rooms stay frozen in time. There are not even enough toilets for women doctors, who have to travel to their hostel each time they need to change their sanitary napkins.

I come across so many situations and cases that go unreported and unremarked.

For instance, a colleague in another city was “sad and depressed” for a long time. When her father asked her what was troubling her, it turned out that her professor and his friend, both senior doctors, had been making sexually explicit remarks and forcing her to meet them in private. Her father had to threaten them both to put a stop to their reprehensible behaviour.

Another young colleague who completed her residency in gynaecology from another busy government hospital recently shared the following incident.

The duty room next to the labour room doubled as an examination space for pregnant women. One night, she was woken by the husband of one of the women admitted to the hospital. He was leering at her with his face barely inches from her own.

Another wealthy patient’s brother kept intruding on her space in the labour room, sitting there during duty hours, harassing her for a date until she blocked his number. “There were five of us friends from medical school who went to different hospitals across the country. All of us had similar experiences,” she says.

Embarrassment kept her from sharing her experiences with anyone. Besides, she did not know where to go to complain. She had no idea about the Prevention of Sexual Harassment (POSH) Act, or whether such a committee existed in her hospital.

A senior doctor, now in her 80s, recounts the days of her training. “No unpleasant incidents happened, ever. No one dared do anything. There were fewer doctors and students, and we all knew each other personally.”

This has changed now: the number of doctors has grown, with students/ residents outnumbering their teachers. Earlier, the teachers were a supportive presence on the premises; now they spend much less time in the hospitals that employ them than at their own practices. Who’s thinking of the safety of women residents, the condition of their duty rooms and toilets? No one.

Women colleagues also mention making repeated requests to better their working conditions.

Be it the duty rooms, the canteens, or just places where they can sit and have their meals and take a well-deserved break, it matters a great deal. After all, they spend the better part of their days (and often, nights) in hospital.

But hospital administrators invariably turn a deaf ear to their requests and suggestions. Who are these administrators?

Let me cite the situation in Rajasthan, which may not be so different from other states. Ninety per cent of the district health officials and hospital administrators are men. This includes the reproductive and child health officers, who are responsible for the well-being of women and children.

Colleagues who have studied at premier institutions like the PGIMER (Postgraduate Institute of Medical Education and Research) in Chandigarh have the luxury of separate duty rooms for women and men, labour rooms with security guards posted at several entrances and a well-functioning canteen. Such bright spots are few and far between.

If we move from the big cities to the smaller towns and villages, and from hospitals to CHCs (community health centres) and PHCs (primary health centres), the absence of women doctors is striking — for every eight male doctors, you will see only two women doctors. Concerns about their own safety naturally influence their choice of where to work, and this is something we need to understand and address better.

For our nurses and ANMs (auxiliary nurses and midwives), harassment is par for the course.

In a study conducted two decades ago, several nurses spoke up about harassment at the hands of community members, and reported a gruesome case of rape and murder.

Even now, none of the women in these essential community workforces are aware of POSH or indeed any complaint redressal mechanism. None of this crucial information is displayed in any public health facility.

I have witnessed first-hand the threats that women face at the PHCs we run. Nurses receive calls from drunken men, including senior panchayat members. At times, these men visit the clinics at night on some trivial excuse or the other and demand their services. No woman feels she is in a safe space.

One good thing is that many of these incidents and cases of sexual harassment have come to the fore and been promptly acted upon. But the majority do not even see the light of day.

Systemic tolerance for such acts of indecent assault and an administrative blind eye coupled with the victim’s fear of reprisals, perpetuate silence, leading to more violence. This can, and does, become explosive.

The message from the Kolkata case is loud and clear. Rebuild our healthcare workplaces with the intent of making them genuinely safe and gender-inclusive.

Enhancing security by posting guards is not enough. Fixing latches on those duty room doors won’t keep the predators out.

Women must be brought to the decision-making table, the deadwood of internal committees that do nothing must be cut away, awareness about the POSH Act must be spread and life infused into the systems that are supposed to protect us.

In this case, half-begun is not well done. And half-done just won’t do.

The writer is a doctor and co-founder of Basic Healthcare Services, a Rajasthan-based NGO that runs primary healthcare centres. Courtesy: The Billion Press