It has been stunning to witness how a case of horrific sexual violence — and that is what the RG Kar hospital atrocity is — has been cast as an issue of healthcare workers’ safety. Even in the hallowed portals of the Supreme Court. Let us be clear — this is a case of yet another woman being brutalised in what has seemingly become a norm in India. That it has happened in a hospital gives it another layer of egregiousness, if that were even possible, because certain locales are meant to be shelters for all. So, while it is a workplace safety issue due to the crime’s location, this is essentially a case of sexual violence. Had it happened in a school, corporate office or government ministry, this would still be a case of sexual violence at its core, and not about the security of teachers, executives or government functionaries.
Let us also recall that violence often comes from within. In the last six months alone, women (a dental student, a nurse and a doctor) were at the receiving end of assault, rape and molestation in Rohtak, Moradabad and Rishikesh respectively. This is surely the case in other professions too, and as lawyers who write this, we must unsparingly look at our own ecosystem. In the RG Kar atrocity, it is still far from clear that the perpetrator was a patient, visitor, or an “outsider”.
This incident should be a wake-up call to ensure that all workplaces are secure for all women, and that the culture of patriarchy within which perpetrators carry out violence with such impunity is radically altered. Not just in city hospitals but in hospitals, within homes, in colleges, or while traveling by public transport. Particularly in relation to healthcare settings, this means protection for women who are not just doctors but also nurses, receptionists, janitorial staff or patients.
Demands from the protests have been misguided for various reasons. For one, by seeking the death penalty for perpetrators of sexual violence in healthcare settings, they fail to account for whether such measures will address systemic issues. They have also skewed the focus away from the main issue of sexual violence and the underlying systemic injustice that allows vicious crimes against women, towards the safety of healthcare workers.
While it has been conveniently conflated by the Indian Medical Association and other vested interests, the issue of violence against healthcare workers is an entirely different one. It cannot be said enough — the brutalized person was not ravaged because she was a doctor; it was because she was a woman.
This is not to say that violence against healthcare workers can ever be condoned. This community’s committed service in government hospitals during Covid-19 should never be forgotten. Even when the state went silent during the Delta phase, this community did all it could to help. A vivid image of that time is of one of our more deplorable human traits — the prejudice we demonstrated against the frontline responders who returned to their homes in building societies, where they were threatened and shunned.
Demands have been made to legislate a central criminal law to prevent and deter violence against healthcare workers. They have, fortunately, been rejected by the Union government — so far. After all, the criminal law, as it is, is sufficient to cover such instances. By demanding a new law for healthcare worker protection, we overlook poor implementation of existing legal frameworks and fail to seek institutional accountability.
Not introducing new legislation does not absolve the responsibility of private and government healthcare to take measures to ensure the safety of frontline workers like ASHAs and ANMs and those in institutions like nurses and doctors. These measures must also address the sexual and gender-based violence that women healthcare workers face. Yet, demands of the IMA, such as a panopticon of airport-like security standards, including surveillance towers, armed guards and sniffer dogs, are hardly conducive to a wholesome healthcare experience. Such reactions also suggest that there are larger questions at play, which need to be answered.
We live in times where healthcare institutions are increasingly unfeeling and intimidating, mammoth corporate mazes where the user is disempowered. Their motives are so profit-centric that one enters them with cynicism, but also abject need. Resembling the stereotypical government department, when something is confusing or goes wrong it becomes almost impossible to articulate grievance, find a remedy, or pin accountability. We also live in a time where the public health system has received no attention from the state, weakening what should be the most accessible architecture to decrepitude.
In such times, the effort of all — the healthcare community, public health experts, policymakers, governments, affected communities — should be to find solutions that make healthcare an experience that is informed, competent, empathetic, affordable, resilient, transparent, hygienic, efficient. But when attempts to legislate the right to health are compromised due to the lobbying of doctors’ associations, as in Rajasthan recently, the message sent is one of hostility. The same can be said about the resistance to implementing the Clinical Establishments Act. When medical education continues to be devoid of any substantial focus on ethical practice, or linked to a larger understanding of public health and public good, values-based medicine will remain a pipe dream.
In a context such as this, the vortex we will be swallowed in is one where patients and their families are not communicated with, corporatisation and privatization become the dominant impersonal and avaricious character of healthcare and health insurance, and the disempowered become even more so, lashing out the only means they have left.
Much needs to be done to address the insidious nature of sexual violence. To stem that rot, an honest reckoning must take place: How we raise boys, the token and surface adulation we give women, our inability to make accountable the misogyny in our institutions, and the hypocrisy with which we approach sex and gender education.
Much also needs to be done to ensure that the healthcare system is sensitive to the needs of its users. Government budgeting to ensure a doubling of investment in healthcare is an essential start. It will lead to improved infrastructure at primary health and other levels, and more competent, sensitive and well-trained personnel. Along with this is the need for better accountability of health systems, which can only be achieved through robust monitoring, and making these systems participatory and transparent sites of engagement, feedback and improvement through community involvement and oversight.
At the heart of all of this must lie the unhindered ability to question authority and make it accountable, to feel safe in complaining of violations, and to dissent against a stagnant system.
The writers are at the Center for Health Equity, Law & Policy, ILS Pune