By Dr. George Jacob

Kochi, May 16, 2023: Sandeep, undergoing deaddiction is an Upper Primary school teacher under suspension. He was taken into police custody on the night of May 9 from his house following a brawl with neighbors. The inebriated and injured Sandeep was taken by the police to Government Taluk Hospital in Kottarakkara in Kerala’s Kollam district for the mandatory medical checkup.

A 22-year-old house surgeon Vandana Das tended to Sandeep’s wounds. She was on duty that night, as part of 84-days compulsory rural posting students undergo after completing MBBS. While being treated, Sandeep turned violent abruptly. He stabbed Vandana several times with scissors available in the dressing room, injuring her seriously.

Five others including accompanying policemen, an ambulance driver on duty and a relative were injured while attempting to overpower Sandeep.

The seriously wounded Vandana was rushed to a private hospital in the same town. She was then taken to a hospital in the state capital of Thiruvananthapuram where she breathed her last.

A young doctor’s life and her aspirations to become a gynecologist were snuffed out by an alcoholic and a drug-addict. Dreams of her parents, to whom she was their only child, lay shattered.

Doctors in Kerala went on a flash strike exempting emergency services. Customarily, politicians cutting across party lines descended like corpse-eating vultures.

The state governor and health and cooperation ministers reached the hospital where the incident happened. If only their visits miraculously brought Vandana back to life.

The chief minister visited the hospital where Vandana’s body was kept to console her parents. He condemned the incident and promised strictest action against the assailant.

Opposition leader V D Satheshan blamed police negligence for Vandana’s murder.

Adding to the politicians’ crocodile tears, Kerala’s Health Minister reportedly did a faux pas by stating that Vandana’s inexperience in handling such situations and resultant fear led to her murder. Opposition politicians heckled the minister for her insensitive remarks, which the former journalist later denied saying she was misquoted.

Ironically, a young doctor was heinously murdered in Kerala, which boasts of superlative health indices comparable to Scandinavian nations, unlike rest of India. It is doctors like Vandana who made that possible.

Vanadana isn’t the first doctor to be attacked in Kerala. Police have registered 469 cases of attacks on medical staff including doctors, and 70 attacks on hospitals since 2012, confirming the fall from grace of doctors and hospitals.

What caused the patient-doctor estrangement?

• Privatization of medical education has given a wrong start to making of doctors. Private medical colleges offer seats from undergraduate medical courses to super-specialization at exorbitant ‘donations’ and/or fees. The public accuse qualifying doctors lacking aptitude and attitude of attempting to reclaim money spent for their education by drawing huge salaries impacting hospital bills.

• Pharmaceuticals-doctor liaison. Doctors are accused of liaising with pharmaceutical companies through the latter’s representatives, who ‘visit’ them in hospitals and homes. Pharmaceutical companies are called to sponsor medical conferences, and travel and hospitality bills of doctors attending them. Doctors are accused of accepting ‘rewards’ from these companies for prescribing drugs they manufacture, which patients buying them have to bear. This trend has waned significantly lately.

• Corporatization of healthcare. This has unequivocally derailed healthcare. Patients are fleeced big money as ‘advance’ on approaching Emergency Departments of corporate hospitals. Even accident victims and those with life-threatening emergencies aren’t spared. ‘Temples of healing of old have made way to “wayside burglary centers”’ as a patient once told me! Here, Staff especially doctors are paid flashy salaries, than their counterparts in public hospitals. Patients are charged exorbitant bills in corporate healthcare centers, while the same treatment is provided free of cost from public hospitals with upgraded facilities.

• Inadequacy of public hospitals. Public ire against healthcare workers would be history if public hospitals gird themselves to provide healthcare of comparable quality, work ethics, and commitment at cheaper rates. Scarce government funding of healthcare retards modernization of public hospitals. Dr. Vandana herself was taken to two hospitals, loosing precious ‘golden hour’. The hospital where she was attacked couldn’t save her.

• Lack of honest communication. The Corner stone of patient-doctor relationship is honest and transparent communication between the two, beginning from outpatient consultation. Details of the disease including treatment, prognosis, expenditure and possible complications must be driven home to the patient and family realistically. In today’s crowded outpatient clinics manned by over-worked healthcare providers, this suffers, resulting in stunting of patient-doctor relationship. The communication must continue as treatment progresses.

• Inclusion of healthcare in the ambit of Consumer Services Act. Healthcare deals with one of the most unpredictable of commodities- the human body. Diseases it fall to and their treatment are too vagarious that they defy predictability. The science of healing for above reasons cannot ‘guarantee’ results. After all, politicians, advocates, engineers and teachers aren’t pulled up for ‘services that fall short.’

• Healthcare workers and centers are cannon fodder for antisocials, drug addicts and the inebriated like Sandeep for want of adequate security personnel to protect them, while politicians have armed security guards, and SPG forming human shields. An inebriated Sandeep wasn’t even handcuffed when he was taken to the hospital.
All these and many more have rendered the healthcare dispensation system sick. A crucial system which merits healing and restoration. Patient-healthcare provider estrangement must give way to intended sanctity of healthcare dispensation built on trust.

Doctors are considered a group drawing hefty pay checks leading cushy lives at the expense of the sick. Charges of ‘treating unnecessarily,’ and ‘ventilating dead patients’ fly thick and thin. While healthcare providers are considered punching bags for patients and families, healthcare centers are sitting ducks awaiting ransacking. This is resultant of the trust deficit people have for healthcare workers.

Vandana is a sacrificial lamp at the altar of a failed system. More might be murdered and maimed at that altar (God forbid) if the sick system isn’t nursed back to health.

(George Jacob is Consultant Surgical Gastroenterologist, Lakeshore Hospital, Kochi, Kerala)