The rape and murder of a doctor in RG Kar hospital in Kolkata on August 9 has led to widespread protests by doctors and medical students across the country. They are demanding that the management of hospitals and college campuses provide them with better facilities and security.
The crime has particularly horrified doctors because of where it occurred – in the hospital’s seminar room, where the victim was sleeping. “It could have been any of us,” said Dr Rohini Chandrashekar, a doctor working at a government hospital in Kanpur.
Some responses by institutions have only angered protestors further. On August 12, the principal of the Silchar Medical College and Hospital issued a circular instructing “female doctors, students and staff” to “generally avoid isolated, poorly lit and sparsely populated areas”.
It also asked them to “refrain from leaving hostels during the night hours”. Further, it said, “avoid associating with individuals who appear unknown or are suspicious in nature”. While on duty, it added, “you should be composed emotionally, remain alert and should graciously interact with the public so you don’t attract unnecessary attention of unscrupulous people”.
The notice came in for sharp criticism from doctors in the college, and elsewhere in the country, who said that the college was shirking its own responsibility to ensure the safety of those who worked and studied in it. “This is completely unreasonable, because the campus actually is in dire need of improvements,” a doctor working at the hospital said. “There is a dearth of security guards, on-call rooms. Some places did not have grills or gates.” There were “so many unlit areas in the college”, she added.
Doctors and students have also demanded that a police outpost be set up near the college. “But we were denied,” the student said.
She added, “There is a lot that can be done to increase safety, but the college management policing women instead reveals not just misogyny but also inefficient administration.”
In response the uproar against it, the college withdrew the notice.
No facilities for rest
A key problem, doctors note, is that very few hospitals had on-call rooms – rooms on hospital premises that are equipped with beds and other facilities to allow doctors on call to rest. Thus, it was common for doctors to sleep in rooms meant for other activities. “Most of the time we are just looking for a place to sleep,” Chandrashekar said. “We are burdened with so much work, we often don’t realise where we are going to sleep. Sometimes it is on a chair, sometimes a stretcher, or just in some corner in the ward.”
Government hospitals in India were not designed to allow rest for doctors, noted Dr Savithri B, who works at a government hospital in western India. “On-call rooms don’t seem to be part of the hospital plan,” she said. “Doctors usually have to just resort to a makeshift room.”
A doctor from Maharashtra said, “I have slept on trolleys and sometimes even standing because I was exhausted. I didn’t even spare a thought for my safety back then.”
Chandrashekar explained that even hospitals that do have on-call rooms usually do not have enough of them. The Jawaharlal Institute of Postgraduate Medical Education and Research in Puducherry, where she worked previously, had an on-call room on every floor, she recounted. But, she added, there were only two or three beds in the room, which was insufficient for the number of doctors in each shift. “At least 30 doctors are posted at night,” she said.
The hospital that she currently works in has only a few on-call rooms. Further, the management only infrequently posted women on night shifts because of the perceived risk to them. “There aren’t enough security guards, so the hospital doesn’t want to risk it by posting women during the night shift,” she said.
But this could be detrimental to women doctor’s careers. “I’m sure we miss out on some opportunities because of this,” Chandrashekar said. While she worked at the Jawaharlal Institute of Postgraduate Medical Education and Research, women “were posted at night, sometimes every alternate day, so I found it odd that women were not given night duty as commonly here”, she added.
Even where on-call rooms are available, there are rarely safety measures in place for those who use them. For instance, women are not usually allowed to bolt the doors to the rooms – while this ensures that nurses can wake them up any time they are needed, it also leaves them in an unsafe position. “Anybody can enter at any time because the doors remain unlocked,” said Dr Sylvia Karpagam, a public health doctor from Bengaluru.
The problem was not a lack of funds, Chandrashekhar argued. “When hospitals can afford to buy MRI machines, they should be able to build us on-call rooms with a few beds and a restroom,” she said.
Living in fear
Female doctors told Scroll that they worry constantly about their safety, even when using the restroom. “When I was in college, we would not go to the restroom alone during night duty,” Dr Sangeetha Sivaraman, a doctor based in Bengaluru said. “We would take someone along because it was often in an area which was isolated and we were scared.”
Chandrashekar explained that this fear was particularly acute during or after night shifts. “When you finish work at 2 am, there is always a fear – what if something happens, someone comes suddenly,” she said. “Even walking on long lonely corridors in the night is scary. It is eerie and silent.”
She added that parents of women doctors often told them to stay back in the hospital after their night shifts, “because that is seen as more safe than travelling at that hour”.
Savithri said that at the institution she works at, the road between the hospital and the student hostel was in very poor condition. “There were no streetlights, and after the night shift students have to travel alone for four kilometres to the hostel,” she said. “Nobody is asking how the student is going to get home. It is seen as the student’s responsibility, not the administration’s.”
Though hospitals are usually equipped with CCTVs, they did not always install a sufficient number of them. In the Kolkata case, when police asked for relevant CCTV footage, the administration is reported to have said that there were no CCTVs installed in the seminar room because “many women change clothes there”.
But Chandrashekar noted, “Even if not inside on-call rooms, CCTVs should be installed outside the rooms,” she said.
Doctors also observed that many hospitals did not have enough security personnel. Chandrashekar said that while at the Jawaharlal Institute of Postgraduate Medical Education and Research, there were a sufficient number of security guards, at her current hospital, there are not.
A student from RG Kar College who asked to remain anonymous told Scroll that there were not enough security guards in the campus. “There are already few security guards on campus, but there was nobody at the seminar room,” the student said.
A doctor from a hospital in Delhi, who asked to remain anonymous, said that sometimes security staff were themselves under stress. At one hospital she worked at previously, she recounted, when she asked a female security guard for help with controlling a crowd of patients, “she just burst into tears, saying, I don’t like my job, I want to quit. I did not know whether to laugh or cry. I just let it be. But that’s what it’s like in public healthcare sometimes.”
Security personnel were often inadequately trained. “Where I worked, there was a massive issue with the security guards,” she explained. “One is that they were all outsourced to an agency and were not directly under the hospital management. Most of them do not know what to do when issues arise.”
In some instances, corruption also crept into the security system. “Some take money from the patient’s relatives, saying they will get things done for them faster,” she noted. This, she added, leaves the personnel less likely to deal with the relatives firmly when needed.
Poor security can also present a major problem to doctors when large crowds visit hospitals. “Anybody can enter,” Savithri said. “Families of the patients get visitor passes if they want to meet patients outside of visiting hours, so there is some monitoring. However, during visiting hours, anybody can walk in.”
Doctors sometimes face physical violence and even sexual harassment and violence from the attenders of the patients – in some instances, families and friends procure a doctor’s number and call or message them. “People find the numbers from a register or somewhere else and then send inappropriate messages,” said Chandrashekar.
Dangers within the system
But sexual harassment also occurs within the hospital system itself. “Medical campuses and hospitals are highly hierarchical spaces and also inherently sexist,” said Savithri. “Female doctors and nurses are exposed to sexual behaviours and harassment from male doctors and administrators. Nurses have it especially hard because of the power dynamics between doctors and nurses.”
Harassment can affect almost every aspect of students’ work and lives. “When I was doing my MBBS, we had to wear name badges,” Sivaraman said. We were cautious about where we wore our badges because male seniors would use that as an excuse to stare at our breasts.”
One professor of surgery “insisted that interns wear sarees to work because he had a fetish for them”, a doctor in Bengaluru recounted.
Another senior would ask male and female students to stand on opposite sides of the table, and would “do and say things to make women uncomfortable – like sliding their hands on the women and touching them inappropriately”, she said.
Inappropriate behaviour can even extend to how doctors handle patients. “Sometimes the doctor will be treating a female patient, and if she is exposed, he will touch her inappropriately in front of female students and doctors in the pretext of teaching, but it would be completely unnecessary,” said Karpagam.
The risk of facing harassment is particularly high during procedures such as surgeries, which can carry on for many hours, and during which interns and doctors may have to stay in a confined space. During these times, some male doctors make inappropriate remarks and even molest students. “When I was an intern, I was asked to scrub in on a surgery. I was groped during that surgery by the main surgeon,” said Dr Subhasri, who is based in Kerala.
The doctor based in Maharashtra recounted one incident in which a male colleague of a female doctor “came into the room and tried to slash her jeans”. The woman “created a huge uproar”, after which the male student was suspended. But the suspension lasted for only six months, after which he “was poised to return to the same college”. She added that the woman doctor “had to exert immense pressure to get him transferred”.
Many hospitals had “well-known predators”, Savithri noted. “Female doctors and nurses warn each other about them. We just try to get by.”
Such measures were necessary, she added, because there was a complete absence of conversation about the problem of sexual harassment in the medical fraternity. “No discussion about the internal complaints committee and just no awareness about how or where to complain,” she said.
Karpagam recalled that even when she was a student two decades ago, teachers would make sexually explicit comments in the presence of students. They would also use occasions like the viva exam, when a teacher and student interacted one-on-one, to ask vulgar questions. “It is a boy’s club,” she said.
The fraternity was reluctant to even discuss it. “I once raised this issue in a WhatsApp group of healthcare professionals and they removed me from it because I did,” Karpagam said. “There is a lot of shame even talking about it.”
Students and young doctors who raised any kind of formal complaint against a doctor risked being seen as “trouble” and jeopardising their careers, Karpagam added. “They’ll say we are spoiling the name of the hospital,” she said..
They were also hesitant to complain, Karpagam noted, because complaints committees largely comprised people from the same institution – as a result, students did not feel confident that they would receive justice from the system.
Savithri echoed these observations. “Residents are at the mercy of the doctors for at least three years and so they don’t make any official complaint,” she said. She added that a more effective way to handle complaints would be to have them examined by independent bodies.
“Increasing security is important but there are systemic changes that need to happen,” said Subhasri. “Everyone working in health care needs to undergo gender sensitisation and we need to strengthen the internal complaints committees so those facing sexual violence can get justice.”
