India's Covid doctors demand action after attacks

Dr Seuj Kumar Senapati vividly remembers the afternoon in early June he thought he would die. It was his first job and his second day at work at a Covid care centre in Hojai district, in India's north-eastern state of Assam.

He was asked to check on a patient who had been admitted that morning. When he did, he found him unresponsive.

The patient's family was furious when he told them the man had died. In moments, Dr Senapati recalled, all hell broke loose. He said they started hurling chairs around the room, breaking windows and abusing staff.

Dr Senapati ran for cover, but soon more people joined the family and they found him.

A horrific video of the attack shows a group of mostly men kicking Dr Senapati and hitting him on the head with a bedpan - then they drag him outside and continue to beat him. Dr Senapati, bloodied and shirtless, can be heard howling in pain and fear.

"I thought I wouldn't survive," he said.

Since the start of the pandemic in India last year, several doctors have been attacked by families of Covid patients. The recurring complaint: their loved ones weren't treated properly or weren't allotted a bed on time.

Doctors have protested and gone on strike demanding stricter laws, as well as more staffing and better infrastructure to relieve the pressure on them.

Hospitals too are ill-prepared. When Dr Senapati was being attacked, no-one came to his rescue because the remaining staff were also being beaten up or hiding. A lone guard was helpless against the mob.

"My clothes were torn, my gold chain was snatched and my mobile phone and spectacles were smashed. But after about twenty minutes, I managed to escape," Dr Senapati said.

He drove straight to the local police station and registered a complaint. The video of the attack, which has since been shared on social media, caused a furore. The state government promised swift action and 36 people, including three minors, have been charged for the assault.

While attacks on healthcare workers have been spotlighted during Covid, they occurred at alarming regularity before the pandemic too. Yet most incidents don't lead to police complaints or investigations. When they do, the accused are often released on bail quickly and the case is settled outside court.

Earlier this year, the family of a Covid patient who died in India's devastating second wave damaged property and abused staff at Apollo Hospital in the capital, Delhi. Despite being a prominent private hospital, it did not press charges. In fact, hospital administrations rarely get involved in such cases, leaving staff more vulnerable.

Doctors say one problem is that there is no specific law protecting them.

"We have found that existing laws are not effective and that is why they are not a deterrent. A strong law is urgently needed so people understand that there will be consequences for beating doctors," said Dr Jayesh Lele, secretary general of the Indian Medical Association (IMA).

With more than 330,000 doctors as members, the IMA has been campaigning hard for a stringent law to deter attacks against healthcare professionals.

But can a law fix the problem?

"Such violence is not premeditated, but more an outcome of an emotional trigger caused by death. Hence, laws don't work as a deterrent," said Shreya Shrivastava, who has been tracking violence against doctors.

Ms Shrivastava is part of a research team at the Vidhi Centre for Legal Policy that studied newspaper reports of 56 attacks between January 2018 and September 2019 to understand what had caused them and how they can be curbed.

She said the government introduced a jail term of up to seven years as punishment for attacks on health workers treating Covid patients. But that hasn't helped.

Dr Vikas Reddy, a doctor at Gandhi Hospital in the southern city of Hyderabad, was attacked with iron and plastic chairs in June last year by relatives of a man who had died due to Covid. He filed a police complaint, but no-one has been arrested yet.

"It was difficult to go back to work," Dr Reddy said. "I was in the same acute medical care ward, seeing critical patients. I got flashes of the attack in my mind."

He said he spent a lot of time thinking about what happened.

"I was in a dilemma," he said. He wanted to know how to explain the diagnosis or break tragic news better to prevent another attack.

"I realised that we have to spend time with patients and their families to explain the things we can and can't do. And if they disagree, they need to take the patient to another hospital. But we don't have that kind of time. I see 20-30 patients in a day."

India has one of the worst doctor-patient ratios globally. In 2018, there were 90 physicians per 100,000 people, according to World Bank estimates. That's far lower than China (200), the US (260) or Russia (400).

And the pandemic has stretched an already thin workforce.

Ms Shrivastava's research revealed that attacks on healthcare workers usually happened when patients were in emergency wards or ICUs, shifted from one hospital to another or when they died. And all of this has become more frequent during the pandemic.

"Being inside a Covid ward is like being at war," said Dr Lele. Then there is the issue of trust.

A largely unregulated and an expensive private sector provides two-thirds of all healthcare services in India.

Ms Shrivastava said people have been dying of Covid despite costly care, weakening trust in the system. And media reports of medical negligence, which tend to outnumber stories of doctors' struggles, make people more suspicious.

"The best we can do is give our best to the patient," Dr Reddy said. "We can't expect every patient [or family] to be nice [to us], just that they respect us as professionals and respect that we chose this profession to save lives."