The doctors’ strike in Kolkata: A critical analysis

The death of an 80-year-old patient in Kolkata’s Nil Ratan Sircar Medical College and Hospital (NRSMCH) on 11 June 2019, for which the agitated family members and relatives of the deceased blamed the medical staff of the hospital, led to a fracas that instigated a nationwide agitation and movement of doctors. The junior doctors of NRSMCH allege that a mob of 200 goons were brought by the relatives of the deceased when the doctors on duty asked them to apologise for their abusive behaviour over the death. The mob attacked doctors, ransacked the premises and pelted stones, which severely injured one junior doctor — Paribaha Mukhopadhyay —  along with others who suffered minor injuries.

This event sparked a major outrage among the junior doctors of NRSMCH, who started an agitation against the government’s apathy towards their security that allowed the brutal attack against them. Very soon, the junior doctors of almost all state-run hospitals and medical colleges joined the agitation in solidarity, demanding an end to this routine affair of doctors getting assaulted by relatives of patients who die during treatment at government hospitals. The junior doctors’ agitation got the support of resident doctors, senior doctors and even the medical faculty, who have experienced such heinous crimes against doctors for years. More than 700 doctors resigned from the public healthcare sector protesting the attack on the NRSMCH junior doctors and the government’s indifference towards their cause.

The doctors started an Out Patient Department (OPD) strike throughout West Bengal’s government hospitals and health centres, causing an immense problem for many patients, especially from the poor and marginal backgrounds, who can’t afford healthcare services in the private hospitals. Though the doctors have kept the emergency and casualty sections open, and in many places, the OPD job is done by them in the open, in the larger scenario it has hurt the interests of the patients more than anything.

During this agitation, junior doctors, participating in a sit-in protest at Burdwan Medical College and Hospital, were attacked by a mob with bricks and bamboo sticks. A doctor lost one of his eyes in the attack. Many more suffered injuries. This incident added more fuel to the fire. The doctors’ agitation over the NRSMCH incident became a rallying point for the entire Indian medical fraternity to unite over the demand for security at workplace and protection from violence. This resulted in massive movement by the interns and junior doctors in Tripura, doctors’ movement in Delhi, Jharkhand, Maharashtra, Odisha and Rajasthan. Wearing black bands and in some cases, helmets and bandages, the doctors participated in the agitation for better security at government hospitals and better working conditions.

West Bengal Chief Minister Mamata Banerjee, who is also the health minister of the state and the leader of the ruling Trinamool Congress (TMC), didn’t bother to listen to the demands of the agitating junior doctors of NRSMCH. Exhibiting her usual hysteria to any form of mass agitation or movements by any section of the society that’s not led by her, she started hurling choicest abuses at the doctors during her visit to the SSKM Hospital. She accused the junior doctors of being outsiders and “agent provocateurs” trying to score political brownies on behalf of her opponents. She didn’t listen to the demands raised by the doctors, she didn’t talk to their representatives, she didn’t promise any stern police action against the culprits who attacked Dr Mukhopadhyay and his associates; she only reiterated her threats of taking strong actions against the junior doctors if they don’t wind-up their agitation. At SSKM, she ordered the agitating doctors to either join work or vacate their hostels. She said they’ve no right to protest as their study is funded by public money.

This arrogance and audacity showed by Banerjee during the agitation actually aggravated the crisis. Even the doctors who were eager to find a truce through a written assurance from the TMC-led government of showing documented evidence regarding the prosecution of the culprits, documented evidence of increasing security of the doctors in the government hospitals, intensified their movement. Thousands of patients faced harassment. Banerjee, shedding crocodile’s tears for the patients, continued blaming the junior doctors for the fiasco and the crisis, shrugging off any responsibilities from her shoulders. This gave an immense opportunity to her political opponents to capitalise the event and build up momentum against her.

Exploiting such a volatile situation, the Hindutva fascist Bharatiya Janata Party (BJP), the Rashtriya Swayamsevak Sangh (RSS), the BJP’s paternal organisation, and their propaganda outlets, started a vicious campaign. Capitalising upon the genuine public sympathy that the doctors gained initially, the BJP and the RSS tried to foray into the movement and hijack its leadership using influential Hindutva-incensed doctors. By citing the religion of the attackers and the victims, Muslims and Hindus respectively, the BJP leaders in West Bengal and outside the state started inciting Islamophobic, upper-caste Hindu elites and urban middle class, from where the majority of doctors hail from.

Though the RSS and the BJP are trying hard to penetrate in the movement and hijack it, a large number of junior doctors are thwarting such attempts while fighting a battle solely on spontaneity. There is no organisational structure, no common minimum programme and these make the movement vulnerable to breaches by different right-wing forces. Due to such loosely threaded, yet intense struggle, the doctors’ struggle is missing out raising some of the crucial issues, which remain unspoken during the entire course of their movement.

The dilapidated public healthcare sector in the era of liberalisation

Ever since the Indian rulers embraced the neo-liberal economic system in 1992, the governments at the Union and state levels have been increasingly doffing the gear of healthcare provider to make room for big foreign monopoly and finance capital, along with their Indian comprador lackeys, to profiteer from the health of the common people. In the last three decades, the goal of providing proactive, preventive and universal healthcare by the government is replaced by the concept of allowing big corporate-controlled healthcare entities to profiteer from the critical sector, while the government’s role has shrunk to that of an insurance agent, selling health insurance plans that benefit big finance capital to the vulnerable masses under health protection schemes.

Despite incessant rhetoric on healthcare, the principle of the governments remain the same — providing healthcare isn’t the government’s responsibility — as it’s in all other essential sectors. Thus, public healthcare has always received a minuscule part of India’s budgetary allocation, which is quite negligible vis-a-vis the GDP. Health, which is an essential component of an economy’s smooth functioning, has been grossly neglected by the state machinery.

As per Forbes, “...in India, two children younger than five die every minute. There is one government doctor for every 10,189 people, one hospital bed for every 2,046 people, and one government-run hospital for every 90,343 people. Deaths in government hospitals — which are in tatters — are an everyday occurrence.”

In the same report, it’s shown that at a $2 trillion economy, while India spent merely 4.7% of total GDP on health in 2014, at the same GDP, Russia spent 7.1%, while at a much smaller economy of $0.30 trillion, Singapore spent 4.9% on health.  

Lack of funding has affected the infrastructure of public healthcare, rendering the doctors and staff in the government hospitals technologically crippled. Forget upgradation of available assets, even maintaining them becomes a big challenge. To aggravate the problem, there comes the crisis of available doctors.

According to a report by McKinsey prepared for the Confederation of Indian Industries in 2012, India had 2.2 doctors and trained nurses per 1,000 population in 2010 vis-a-vis the WHO recommended benchmark of 2.5 doctors per 1,000 population. The underutilisation of resources due to inactivity (choosing other professions or not working in the domain) leads to actual availability falling to 1.9 per 1,000 population. This is a serious threat to India’s healthcare sector. A majority of these doctors and nurses are hired by the private healthcare sector, creating an acute crisis for public healthcare.   

Indian medical colleges, both private and public, aren’t producing enough doctors required for the growing healthcare needs. The lucrative bait of higher salary and perks draw a majority of doctors to the private healthcare sector, resulting in a dearth of doctors in the public healthcare sector. Add to this, the reign of utmost corruption and nepotism in the public healthcare sector that poses immense difficulty for honest doctors who ignore the luring by the private healthcare sector and remain in the public healthcare sector to provide the best care to the poor patients.

These doctors, especially the junior doctors and interns, who run the show in the public healthcare sector, are dissuaded to not continue their career in the public healthcare sector by repeatedly showing them the limited career growth opportunities, the immense challenges and the low salary that they can earn. While the private healthcare sector exploits the doctors more than the public healthcare system, yet, by sharing a part of the booty they loot from the patients, these corporate healthcare providers try to keep the doctors silent and loyal to their cause of exploiting the masses.

Even in such adverse situation, many doctors remain loyal to their profession and stay in the public healthcare sector to serve patients in government hospitals and health centres, though their number is diminishing every year due to the domination of consumerism and self-centricity.

Junior doctors and interns are the backbones of the public healthcare service. They manage the frontline and treat the patients, especially in the emergency and casualty sections. Their work hours can continue for 48 hours at a stretch without or with a very little break in between. Even in such a stressful condition, they’ve been providing their best services to as many patients possible.

Yet, the lack of adequate doctors, nurses, attendants, support staff, etc, renders the public healthcare system in a pathetic state and saving lives with limited resources becomes a challenge. In such circumstances, and in many cases due to the negligence of the medical staff, many patients are deprived of proper treatment and it results in unfortunate deaths. However, to solely blame the doctors or medical staff for such deaths will be escapism because it’s actually the state that’s responsible for such deaths. It’s the state that allows the public healthcare sector to suffer while allowing the private healthcare sector to thrive.

Mob violence and its implications

Even though the state is responsible for such deaths, at times of crisis, the politically-backward masses hold the doctors, who are visible before them, of being responsible for the deaths. It’s important to note that there’s no uniform category of doctors and many doctors, even within the public healthcare sector, due to their origin and privileged position, behave badly with patients and their family members, which infuriates the people. So, normally, the doctors and frontline staff become the targets of the mob that shows its anger against the diseased public healthcare system.

The governments of various states and the Union, look up for such incidents to help the ruling classes propagate and popularise the concept of private healthcare. The advocacy of the neo-liberal economy’s lackeys in favour of private healthcare always cites “unaccountability” of doctors towards their patients in public healthcare as a case of unaccountability of service providers towards the customers. They reduce the healthcare sector to the level of any other service and turn the doctor-patient relationship to an ideal capitalist relationship between the seller and buyer.

Such propaganda, coupled with the cases of medical negligence in the public healthcare sector, always portray the private healthcare sector in brighter shades, though, the experience of poor, marginalised and middle class patients has always been worst in the private healthcare sector due to the latter’s practice of unbridled loot. Such propaganda and negativity about the public healthcare sector have already pushed the urban middle class to the private healthcare sector, while the public healthcare sector reels under severe pressure. None of the unrests is allowed by the state to take place in the private healthcare sector to protect the profiteering motive of the big corporations. Thus, fuelling mob attacks on the junior doctors for the failure of the state and the system is a conscious effort by the very forces that want to gift India’s ever-growing healthcare sector to the private players.

The way forward

Though the doctors aren’t fighting for the sake of public healthcare system but fighting for their own safety, it’s important that they, like their predecessors of 1984 doctors’ struggle, also integrate the crucial demands of the patients regarding the worsening condition of the public healthcare system. Only police security at the workplace won’t allow them to fight an uneven war and race against time. They need better infrastructure, medicines, research grant, laboratories, facilities and beds to treat patients, and these won’t come from anywhere but from the public exchequer, whose key the government holds.

The doctors must learn to force the government to accept their demands and if they use the people’s cause, the support for them will grow manifold and the doctors’ movement can become a mass movement for better public healthcare. In such cases, the fear of the movement getting hijacked can be dealt with the fact that none of the mainstream parliamentary parties will stand with the doctors and their demand for a robust public healthcare as all of them, including the BJP, the TMC, and others, have mortgaged India’s healthcare to big corporate capital.

Though according to their class identity, these doctors are placed higher on the echelon than the working class and the peasantry — the majority of the population — they still play a crucial role in running the society and the contradiction between them and the patients in the public healthcare sector is a contradiction within the people, it’s a manifestation of people’s anger against the apathy of the ruling class towards public health. Thus, in all cases, the doctors in the government hospital must ensure that they provide utmost services to the people and at the same time, make the people aware about the importance of public healthcare and why it must be protected.

By building up a massive movement against the TMC government’s and the BJP’s agenda of selling off the healthcare sector to the big corporations, the doctors can create a new historic movement which can stimulate a major people’s movement for better healthcare through the public healthcare sector. No government is strong or tyrant enough to defeat a movement when it becomes an organised, streamlined, goal oriented struggle with the massive participation of the broad masses, who consider the demands of the movement as their own demands. The junior doctors of NRSMCH and elsewhere must realise that their movement for security can’t cocoon itself, can’t remain isolated from the broader cause of preserving and strengthening the public healthcare system upon which the health and lives of 1.3 billion people rely. They must organise and broaden their struggle for a better working condition and better healthcare for all.