Opinion | Kolkata Rape Case, And All That's Wrong With India's Medical System

The heinous incident at Kolkata's RG Kar Medical College, where a female resident doctor was allegedly raped and murdered on the institute's premises on August 9, has sparked nationwide outrage among the medical community. Doctors from several hospitals across India have announced an indefinite strike to protest the gruesome crime. They have declared that all elective services (non-urgent and not medically necessary) will be suspended until a thorough investigation is completed. The strong reactions from resident doctors working in government colleges are understandable given the challenging conditions they face.

Doctors at government hospitals, often located on sprawling campuses, work in dark and poorly maintained areas. Security is lax in many sections of these hospitals, lacking technology or CCTV to monitor potential perpetrators. In contrast, private hospitals generally offer better security and working conditions, with improved access control and a safer environment.

Numerous cases have highlighted the vulnerability of women in the medical profession to sexual attacks, intimidation, and violence from patients, their attendants, hospital staff, colleagues, seniors, and teachers. Even female patients are at risk.

The Kolkata incident evokes memories of the horrific assault on nurse Aruna Shanbaug at KEM Hospital in Mumbai in 1973. Aruna remained in a coma for 42 years before passing away in 2015. In May 2023, Dr Vandana Das was murdered by a drug addict brought to Kottarakkara Taluk Hospital in Kollam, Kerala. In 2019, in West Bengal, a mass resignation of doctors occurred after a mob attacked a junior doctor, triggered by the death of a patient and allegations of medical negligence.

"We care for patients, work long hours, and sacrifice our personal time. Yet, when a patient dies, relatives often blame us," says Dr Nikita Jain, a junior resident at a government medical college. "Who will safeguard our safety, our lives, and our well-being? It is shocking how we are treated, especially in light of recent incidents," she adds.

A Tough Road For Students

According to NMC data from February 2024, among those who dropped out of medical programmes, 153 were MBBS students and 1,117 were in postgraduate courses. In the past five years, at least 122 medical students, including MBBS students and postgraduate doctors, died by suicide due to academic pressure, burnout, mental health challenges, hostile work environment, and punitive bond policies.

For students entering the medical profession, distress, mental stress, and uncertainty begin as soon as they fill out the NEET (National Eligibility cum Entrance Test) form. Many who qualify the NEET struggle with the vast medical syllabus and consider dropping out but are often compelled to continue due to financial constraints. Conditions for postgraduate residents, especially in larger medical colleges, are particularly dire.

Most states impose bond conditions on medical students at all levels-undergraduate, postgraduate, and super-specialty. There are two types of bonds: 'seat leaving' bonds and 'service' bonds. The former impose heavy fines on students who leave their courses prematurely, particularly postgraduate students, to deter resignations and avoid perceived waste of medical education. Service bonds require doctors to work in the state's healthcare system for 1-5 years after completing their education, with penalties ranging from Rs 10 lakh to Rs 1 crore for breaking the bond.

The NMC mandates a compulsory three-month residency posting at the district level for all postgraduate residents.

In May, Divesh Garg, a 26-year-old resident doctor at a private medical college in Dehradun, died by suicide. His parents cited poor working conditions and harassment by seniors as factors leading to his death. Despite the pressure, he could not resign due to the prohibitive cost of the seat-leaving bond. In response to his death, the government of Madhya Pradesh abolished the seat-leaving bond policy, becoming the first Indian state to do so.

Despite these challenges, young doctor interns often remain silent for fear of being bullied, victimised, or failing internal exams.

Immediate Action

In the recent Kolkata incident, the semi-naked body of the postgraduate doctor was found in a seminar room, underscoring the inadequate facilities for resident doctors, who lacked a designated rest area in a medical college in central Kolkata.

There is no proper support staff for resident doctors to manage emergencies and other needs at night. Strict safety measures, such as cameras and security personnel, are essential in hospitals. Resting areas for resident doctors are basic necessities," says Dr Vasundhara Pawar, Vice President of the All India Medical Students' Association.

The operation of medical colleges needs to be regulated by the government and the NMC. The government must instruct the NMC to ensure safe and dignified working conditions for resident doctors. Mere assurances on paper are insufficient without concrete action.

"At this moment, we expect the government and the NMC to investigate this case impartially, free from high-level influence or manipulation. A joint committee with resident doctors and NMC officials should be formed to address the issues faced by on-field doctors," says Dr Pawar.

Medical colleges must invest in suitable and safe lodging facilities for resident doctors. The long-overdue need for legislation to address violence against doctors and the abolition of punitive bonds must be urgently addressed. Disciplinary bodies at the college, state, and national levels should ensure that students can raise their concerns without fear of persecution.

Additionally, stipend scales vary across states, with many medical residents receiving inadequate compensation. It is the responsibility of medical colleges to provide well-structured education in a supportive environment without overburdening students.

(Bharti Mishra Nath is Contributing Editor, NDTV)

Disclaimer: These are the personal opinions of the author