In early August, a doctor was raped and murdered in a Kolkata public hospital by a “civic volunteer” who was neither a patient nor a staff member. The crime has enraged and rattled the medical profession in India. For weeks now, doctors have been protesting throughout the country, demanding among other things “justice for the victim” and a safer work environment. In the state of West Bengal, where Kolkata is located, junior doctors in public hospitals have been on a month-long strike.
But those protests are missing something important: The terrible crime was less about medicine and more about the ongoing epidemic of violence against women.
Most parts of India, like many other places in the world, are generally unsafe for women and particularly dangerous for women from marginalized communities. Official estimates say that the country sees almost 2,600 incidents of rape every month — and that’s a very conservative figure.
A few days into the protests in mid-August, a doctor made a telling commentary on the state of affairs. She drew people’s attention to a social media post shared by India’s federal Ministry of Health, and asked “What do you notice?” The Minister had met representatives of the national Federation of Resident Doctors’ Association and assured them that he would work to “ensure a safer and better work environment” — but neither the post nor the accompanying photographs featured any women. That was to be expected. While women medical students and doctors abound in all regions of the country, leadership and decision-making positions remain dominated by men, and institutionalized ideas and attitudes are infused with sexism and misogyny.
As a medical student in the mid-2000s, I was myself trained in that tradition, with textbooks and professors teaching us, for example, to examine rape survivor women with the “finger test” to check if they were “habituated” to sexual intercourse, and senior resident doctors showing by example that it was OK to yell at and hit pregnant women during labor. There were also more sinister examples that were only discussed in hushed tones, like tutors and professors engaging in sexual harassment of women students or making unsolicited sexual advances. Later as a practicing doctor in a public hospital, I saw that a medical officer who was found inappropriately touching a patient was handed the “punishment” of a simple temporary transfer to a nearby town.
To be sure, highly ethical colleagues and dissenting groups of doctors were also around. However, they remained marginal to the “mainstream.”
That partly explains why medical leaders’ and organizations’ framing of the tragic Kolkata rape and murder has left a lot to be desired. In their multiple statements, the Indian Medical Association (IMA) has focused primarily on “doctors’ safety,” spending little time explicitly on women health care workers’ safety or the safety of women and other gender minorities in general. Two major threads run in common through all IMA statements and open letters to the Health Minister and the Prime Minister: an assertion of doctor-exceptionalism (“doctors are a class apart in sacrifice”), and a list of demands that does not include enabling a safe workplace environment for women or championing systemic measures to prevent sexual harassment and violence.
Apart from the IMA, even the doctors’ groups organizing the protests in Kolkata and West Bengal have skipped what might seem like a pertinent fundamental demand: proper and strict implementation of the already-existing federal legislation called the PoSH Act, or Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013.
In other words, the medical profession has refashioned the broad issue of widespread objectification of and violence against women into a problem of violence against doctors by irate patients and relatives. To quote from an IMA statement: “[Doctors] suffer in silence. Doctors take huge stress on themselves. They die young. In life they are abused, trolled, sued, even beaten to death.”
Some physicians on social media have gone to the extent of asserting that “India doesn’t deserve doctors.” Interestingly, this relentless victim mentality has been a historical hallmark of the Indian medical profession.
In 2012, when I was still practicing in India, a popular reality TV show took up the issue of corruption and negligence in the health care system. Nothing in the show was shocking to most doctors, and many of us were glad that those issues were getting more limelight. But I was quite taken aback by the crazy outpouring of anger and outrage from my fellow professionals — not against the massive deficiencies in medicine and healthcare, but against what they thought was an unfair “targeting” of doctors. It’s just a few black sheep, they kept saying.
As a historian, I have come across the few black sheep line on countless occasions in the medical archives of India: Whenever the larger public discourse takes note of corruption in medical practice, doctors’ groups deploy it right away, and at the same time emphasize that the medical profession also suffers and needs to be empathized with. This unique victim mentality, with the accompanying elitism and entitlement, dates at least to the 1980s. In 1986, a Parliamentary law called the Consumer Protection Act made it easier and more convenient to sue doctors for suspected negligence. An unprecedented number of malpractice suits followed. For example, between 1988 and 1994, the Bombay chapter of a nonprofit that assisted victims of malpractice was “literally flooded with cases, as if there was an explosion of public anger against a system substantially alienated from people’s needs.” After decades of unbridled paternalism and wielding of tremendous power in the patient-doctor relationship, doctors finally were forced to acknowledge that the general public was highly dissatisfied with their profession.
What did doctors do at this critical juncture in the history of their profession? Despite malpractice, negligence, and corruption being common in Indian medicine for decades, doctors decided to wrap themselves in denial and righteous anger. They even petitioned the courts to exempt their profession from the Consumer Protection Act. A doctor wrote in a letter to the Times of India in 1992: “If people do not have faith in the doctors, they may try the post office or the railway station the next time they are ill.”
This potent combination of entitlement and victim mentality has led to many unfortunate consequences: Doctors have hardly taken any steps to curb the pervasive violence, verbal and physical, that underprivileged patients experience every day in medical settings. They have forgotten to adequately acknowledge that other practitioner groups like nurses and rural community health workers have been at the receiving end of violence, including sexual violence, for decades. And most importantly in the current context, doctors have failed to recognize the inappropriateness of hijacking a matter that affects all women and other gender minorities and making it into a doctors-as-the-paramount-victims issue.
To be clear, physical assaults on doctors by patients and their relatives are not uncommon and are unacceptable. The fundamental weakness in how most doctors’ organizations have always framed this issue is the absence of an awareness of the larger culture in India of pervasive violence and unofficial impunity to perpetrators of violence. It would serve doctors well to recognize that physical assaults and vandalism of property are not strictly confined to medicine and health care, and that these phenomena intersect deeply with the social, cultural and political context at large. For example, physical assaults on (and lynching of) Muslims and Dalits have always been common in India, and have become more frequent over the past decade. Doctors unfortunately are obsessed with asserting their exceptionalism and chasing the chimera of a state-ordained separate “safe” zone for themselves. The adage of “no one is safe until everyone is safe” finds no place in the medical discourse in India.
But I believe it needs to be put front and center. As regular victims of violence, doctors need to find common cause with other groups and communities in India that too face violence — including the victims of medical negligence and corruption — and join forces with their leaders and activists.
Some doctors have been doing that already, like the ones who work for marginalized and underprivileged communities with human rights groups or with organizations like the People’s Health Movement, and those who are at the forefront of advocating for patient rights and eliminating corruption in medical practice.
But will the rest of the profession, especially the medical leadership, abandon their victim mentality? While most senior doctors give little reason for optimism, one hopes younger doctors and medical students will be able to transcend the tired self-absorbed narratives of their profession.
Kiran Kumbhar is a former physician and public health professional who now works as a historian and writer studying the history of medicine and health care in India and the Global South. He is based at the Center for the Advanced Study of India at the University of Pennsylvania.