Open Letter

To the Indian Medical Association, here’s why I am not marching with you today

This doctor and IMA member is not joining a Chalo Dilli march and Pen Down protest against violence and other persecution of doctors.

Dear Dr Aggarwal (President, Indian Medical Association)

I am a practicing surgeon and a long-standing member of the Indian Medical Association. Over the last few weeks I have received multiple messages from you to participate in today’s protest events termed the “Dilli Chalo” and the “Pen Down” campaign against what you call “atrocities” faced by the medical profession. Whilst many of the issues you highlight do affect me in my work, I am writing this open letter to explain why I have consciously decided not to participate in today’s campaign. By doing so I also hope to stimulate discussion amongst your members.

Physical violence against doctors needs condemnation. I have very early in my career been roughed up in the casualty of one of Mumbai’s teaching hospitals when a Member of Legislative Assembly was brought in shot dead. I have written publicly on this issue to state that whilst the problem is genuine the solution of offering security and protection is superfluous and symbolic.

I work in a large public hospital in Mumbai where my own resident doctors recently faced the ire of relatives because seriously injured accident victims have to be ferried to other CT scan facilities because the hospital’s CT machine closes down at 4 pm for lack of staff. Public anger is often misdirected against junior doctors when the problem is of huge deficits in basic emergency care, which are visible to patients’ families.

Past protests

Way back in 1986 as young doctors in Mumbai’s KEM Hospital, we led a protest hunger strike demanding that the emergency medical ward be improved. Our protest was supported across the board by hospital workers and nurse unions, public organisations, political parties and, of course, the medical profession including the IMA. Three newspapers wrote editorials congratulating us on taking up an issue in the interests of our patients. It would be interesting for you to know that some of us were served termination notices on the charge of leaking sensitive information to the press. This termination was later overturned by the Mumbai High Court which observed that we had actually acted in public interest.

In 1984, as a young intern I participated in the leadership of a strike in Maharashtra to protest the opening of the state’s first private capitation medical college. Amongst the many events during the strike, I particularly remember a massive march on the streets of Mumbai where students, resident doctors, senior teachers and even members of the public including trade unions, student organisations and political parties participated. And yes, we also marched hand in hand with the then IMA state leadership.

I refer to these incidents to point out that historically young doctors in India and even the IMA has a tradition of participating in issues of larger interest beyond the narrow confines of professional demands. Unfortunately, I cannot say that of today’s IMA. For that matter I would suggest that you have become extremely sectarian, sometimes even at the cost of the interest of patients.

In whose interest?

For example, last year I was a part of a committee formed by the state in Maharashtra to formulate a local draft of the Clinical Establishments Act. One of the terms of reference of the committee was to “rationalise” fee structure. Some of us thought that this was a good opportunity to come out with broad guidelines on charges and improve transparency in the billing process in big hospitals. In my view this is one of the single biggest trust deficits today between our profession and the people. The IMA representatives in the committee opposed us tooth and nail, and with other medical associations scuttled this provision from the final draft of the bill. This in my view was also due to the fact that your leadership in many states is essentially from nursing home owners whose financial interests seem to determine your stands.

I would also like to remind you of a letter I wrote to you in February 2016 . This was in the context of the incident at Jawaharlal University where a group of students were charged with sedition. You and your colleague had written a letter to the Home Minister of India on the letterhead of the IMA congratulating him for the action they had taken against the JNU students and warning medical students not to participate in such activities. I wrote to you asking whether this was a view of the entire IMA and whether the issue had been discussed before the letter was issued. I still have not heard from you though you acknowledged receipt of the letter.

Whilst you showed instant concern over the events in JNU, the IMA has been silent over several issues related to public health problems in the country. Whereas you include the demand for a fair conduction of the NEET exam, the association has never openly attacked the very idea of private capitation medical colleges and deemed universities controlled by powerful politicians that have played havoc with India’s medical education system. In my view, your letter to the Home Minister was nothing but an attempt to curry favour with the new power centre.

There are indeed many serious issues involving working conditions of medical professionals in India. Whether it is the pathetic working conditions of resident doctors, the pressure faced by doctors in large private hospitals for reaching “targets”, the browbeating of honest doctors by threats of transfers in the public sector, the IMA does not have any substantial record of taking up these issues. On the other hand your demands like stopping “unscientific mixing” of various systems of medicine are hypocritical given the fact that many of your members employ doctors trained in alternative systems of medicine as resident doctors. Or are lay people to understand that you make an exception to your stand when you get cheap labour?

Finally, I wish to suggest to you that whilst you articulate the narrow problems of allopathic doctors through such protests, you are not likely to reach far without the support of a section of public sentiment. When, in the spirit of medical associations across the world, including the IMA of yesteryear, which have a glorious history of defending the interests of patients as they defend their own, you decide to hold a march for affordable and accessible health care, you can count on me to be there.


Sanjay Nagral

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