So you think you live in crazytown? Quick recap:
1) 87 year old patient is brought to hospital in Kolkota and dies. The three family members are in a scuffle with the junior doctors. They are unhappy and leave in a huff. They return later with several vanloads of “goons” and beat up the doctors.
2) one young doctor is hit by a brick and sustains a depressed skull fracture. Initial reports said he was killed. (turns out he was not, but did get surgery for a skull fracture). Another is also injured. The government arrests the alleged perpetrators.
3) the young frontline doctors go on strike to protest. the hospitals are closed and the strike spreads to other cities in India, including Mumbai and Delhi.
4) relatives of other persons needing medical care start a protest because their sick relative is not able to access care. This also spreads to the major cities. Thousands of protesters and counterprotesters are now mobilized. (video below).
5) The Minister of West Bengal goes on television to tell the doctors they better get back to work or they will be fired. This was not popular.
6) 550 doctors (including faculty at various medical colleges) resign in protest instead.
Got it?
I am in Nepal, not India, but the story is familiar. I recently wrote a blog right here on DailyKOS about providing critical care training in Nepal and asking for donations to buy equipment. But teaching cardiac arrest protocols is only about half of what I do.
The other half? dealing with stuff just like this…. step through the steel gate past the guards and I will give you a tour….
Quick geography lesson: West Bengal is in eastern India. It is the part nearest Bangladesh, the former East Pakistan. Kolkota used to be “Calcutta” and is said to be the sixth most densely populated city on earth.
On the one had it’s community support
Here in South Asia, the friends and extended family of a sick person will appear, rallying to their aid. In fact, if you are admitted to a hospital, it is expected that a family member will sleep under your bed so as to deliver personal care when needed, and that the family supplies caste-appropriate food. Where I am right now, we had an incident earlier this week when three hundred people showed up to support a family who lost a relative in a Road Traffic Accident ( this particular batch was not blaming anybody but themselves, fortunately).
On the other hand, it’s called “thrashing”
In South Asia, there is a widespread practice of using communal action to enforce group norms and to deliver a sort of “frontier justice” to somebody with whom you disagree. Traditionally in a village, everybody keeps a fourfoot stick behind the door. if the hue and cry goes out, everybody grabs the stick and gets together to fight the attackers or the transgressors, or whoever it may be. In Nepal one time, a young man robbed an old lady plowing her field behind an ox, stabbing her. The villagers beat him to death. She got to the hospital for surgery and survived.
Thrashing does not always kill the target; we took care of various other people who had been beaten in this way.
from Twitter:
It’s a manifestation of communal culture.
Thrashing happens a lot. The reported incidents are just the tip of the iceberg. And it happens throughout India, Bangladesh, Pakistan and Nepal.
Here are two videos:
and this one, which includes CCTV footage of the incident in which the doctors were assaulted:
It’s been a problem for decades, contributing to the Brain Drain of trained doctors to the West where it is safer without the hassle. In Nepal, every experienced doctor has a story to tell. Small scale versions of this happen on a daily basis over this whole region, causing most hospitals to have security and a system to deal with this.
Okay, so — circling back…..
I first came to Nepal in summer 2007 to teach nursing, because I wanted to see how healthcare got delivered in a Low Income Country. I taught at a nursing school affiliated with a Christian Mission Hospital in the hills. It was an eye opener and I wrote my first book about the experience. In 2009 I had my first exposure to a mob reaction to the death of a young woman in childbirth. I was not a direct target but it made me re-evaluate what I was doing there. I stayed away in 2010 and went backpacking with my daughter.
In 2011, I decided to return to Nepal but to focus on teaching of critical care skills to nurses and doctors, under the idea that a higher level of knowledge would improve resuscitation outcomes. I made a systematic study of knowledge gaps and designed a short course to address them.
At the beginning of that summer I was advised by various people “You will never improve emergency care in this country unless you can address the issue of thrashing.” and so I started looking into what to teach from this angle. Over the intervening eight years, it morphed into including material about situational awareness, threat assessment, de-escalation, building design, and effective family counseling (“patient party counseling”). In every session of my critical care class we did role-play of a tense situation that led to discussion of how to improve things.
I started keeping a file of reported incidents of thrashing in South Asia. Nobody was keeping statistics on this.
My work has caused many Nepal hospitals to rethink their security approach and young doctors to rethink their counseling approach. I get rave reviews from participants. As an aside, by the time the 2015 earthquakes rolled around there were 800 doctors and nurses in Kathmandu Valley who had taken my training and used it in the first response.
Other background
A year or more ago, the Indian Parliament considered a bill to allow doctors to carry handguns at work. This was ultimately withdrawn. They did pass a #JailWithoutBail law, and the police have been prodded to be more active in responding to these incidents. The prestigious medical journal Lancet also follow this issue every now and again.
New York Times?
Usually the New York Times doesn’t print anything from this region of the planet unless it happens on the slopes of Mount Everest. They are now covering this story.
Monday June 17th
The initial protest by the young doctors will now become a national one-day strike, called for Monday June 17th.
And, it’s still not too late to help me crowdfund some teaching equipment.
So far I taught ten sessions of my class and I expect to teach a few more. I will be here for another six weeks; but at long last my daughter will visit for two weeks. We will then do touristy things. I hope to write a pictorial diary of my favorite things in Kathmandu when that comes….