A nurse looks forward to the day when the broken window of her changing room at a government hospital is fixed. In a faraway primary health centre (PHC), the hope of her colleague to see a metal grille gate installed for the building’s main door gets dimmer with each passing day. At a top healthcare institution in Chennai, a postgraduate medical student on a 24-hour shift looks for an empty patient bed for a few minutes of rest at night as there are no separate rooms nearby for duty doctors. In a neighbouring district, a doctor on night shift at a Comprehensive Emergency Obstetric and Newborn Care Centre feels the need to stay cautious as the three-storey building where she works is manned by a single security guard.
Tamil Nadu, which pumps huge funds into hospital infrastructure, seems to have let slide some of the most basic necessities to ensure the safety and security of the women in its health workforce. Today, the question is whether women feel safe at its 11,000-odd government health facilities, including medical college hospitals, taluk and non-taluk hospitals, and PHCs. According to official sources, women account for at least 60% of the total health workforce in Tamil Nadu. This includes doctors, residents, nurses, village health nurses, accredited social health activists, women health volunteers, and housekeeping staff.
Though the Kolkata incident has sounded the alarm for the health authorities to step up safety and security on hospital campuses, several women healthcare providers and workers feel that the problem goes much deeper. It starts with the most basic of needs remaining unaddressed such as absence of separate duty rooms with toilets and proper water supply for postgraduate students, where they exist, they are poorly maintained and inadequate, nil security personnel at night hours, and dimly lit corridors. There are graver concerns of sexual harassment, verbal abuses, attempts to assault by the irate families of patients, and complaints of molestation/sexual assaults not taken seriously.
Lack of safety
A resident doctor of the Madurai Medical College, who did want to be named, says that only after the Kolkata incident have hospitals begun to think about the safety of their doctors at duty hours. Though this is a positive development, it is sad to see such an important issue being raised only after the occurrence of a horrific incident. “A government hospital is a place where thousands of persons enter and exit daily, and in such locations, some of the basic safety measures such as monitoring by security personnel and installation of closed circuit television (CCTV) cameras should be carried out,” the doctor adds. Recently, a 23-year-old man attempted to sexually harass a house surgeon at 8.30 p.m. at the two-wheeler parking lot of the Coimbatore Medical College Hospital. House surgeons, who staged a protest, alleged that the place was poorly lit at night. They also accused the hospital administration of failure to ensure security at night, including deployment of an adequate number of guards.
Such incidents serve as a wake-up call for the authorities but there are several complex issues that have become an intricate part of the healthcare system. Long working hours is one of them. This has become the norm with postgraduate students narrating tales of working for 36 hours (once a week) at a stretch and 48 hours (once in six weeks). A woman postgraduate student, who had been posted on 48-hour duty, says that attending ‘call-overs’ (when doctors of a particular speciality are called to another department for an opinion) at late night hours is scary. “At night, no security guards are deployed on the floors. We have to walk alone from one building to another. What is more problematic is that anyone can walk into the hospital at night as entry is unrestricted,” she points out. An alarm mechanism to indicate any emergency is lacking and intercom connections in the wards aren’t full-fledged.
A nurse in her early 40s points to how shortage of manpower has put them at more risk. “The PHC where I work has four sanctioned nurse posts but only two of us are here for morning and night shifts. At night, while one of us is on duty alone, a woman worker keeps us company. As the PHCs do not have security guards, we are left to manage on our own. We keep the main door locked after 10 p.m. and open it only if somebody knocks. There is no separate space to rest; so, we lie down in the outpatient area,” she says.
Trouble at night
A number of nurses narrated how men under the influence of alcohol have caused trouble at night at PHCs. “This seems never-ending. Many of us have faced harassment and verbal abuse from men who are drunk and seek treatment for injuries caused by fights at night. A number of PHCs do not have compound walls. Nearly a year ago, two persons entered a PHC pretending to be patients and snatched a chain from a nurse. Though the Public Health Directorate recently issued instructions to engage night guards, no step has been taken so far,” says another nurse working in a southern district. Emergency units and labour wards are among the most critical areas on a hospital campus where emotions could run high. Families of patients could turn aggressive at any moment, and there are several instances of women staff having faced angry mobs, several doctors and staff nurses say.
Newer troubles keep cropping up for women doctors. As one of them points out, “We have had patients and attendants taking videos of us during rounds. If there are any shortcomings in the basic amenities like water supply, these days we have irate patients threatening to post the information on social media. Recently, a man, in an inebriated condition, entered a female ward at night and kept staring at the patients. We got jittery and called the security for help. Why aren’t visiting hours regulated or attendant passes issued at government hospitals? Most of us are already experiencing burnout owing to workload, and such security lapses are taking a further toll on us,” a doctor says. Some hospital departments are havens for toxic work culture and patriarchal mindsets, another doctor says, adding, “In some places, availing maternity leave is treated like a crime, and snide remarks are passed.”
Complaints of sexual harassment aren’t taken seriously by the authorities, a student in her pre-final year of MBBS claims. “In a particular incident of a student being molested on campus, the authorities started with blaming the victim. Only after the information spread outside the campus did they act. Through our inquiries, we found that Vishaka committees are inactive at nearly 90% of the medical colleges. There are neither helplines nor grievance redress mechanisms on the campuses,” she says.
“Moving forward, we demand more awareness of and transparency in the functioning of the Vishaka committees, as well as an assurance that our grievances will be addressed in a timely and impartial manner,” says a postgraduate student of K.A.P. Viswanatham Government Medical College, Tiruchi.
At many hospitals including the ones in Chennai, women raise issues of dimly lit corridors and parking lots, poorly maintained duty rooms, absence of metal grille gates in duty rooms, and lack of security guards at night. There are not even bins to dispose of sanitary napkins in many toilets, according to a postgraduate student.
Consider this: women house surgeons in Coimbatore stay on the top floor of a block in the centenary building, which houses various departments and wards, unlike a hostel. The mess is on the other end of the vast campus. There are very few restrooms on the campus for them; hence, they depend on the ones in their accommodation and a few others in select departments, they say. In another medical college hospital, postgraduate students on 36-hour duty have no place to rest and go to their hostels to use the toilets. Despite the rapid growth of the healthcare sector, basic facilities like clean toilets for the women workers remain an issue, says Tamil Selvi, secretary, Indian Medical Association, Tiruchi chapter. “We have always had to go looking around for safe toilets during duty hours. We must work harder to improve basic amenities for the coming generations,” Dr. Tamil Selvi says. Yogeshwaran Elangovan, State organising secretary, Tamil Nadu Medical Officers Association, says there is no protection for staff nurses, postgraduate students, and house surgeons on hospital campuses. “The police force at the outposts is minimal. Except for the casualty ward, many places on a campus, like that of the Government Stanley Medical College Hospital, are blind spots that need to be taken care of. For instance, resident doctors have to go to the Government Raja Sir Ramaswamy Mudaliar Lying-in Hospital at Royapuram if called for opinion at night. The subway and the stretch leading to M.C. Road are deserted and no transport is arranged. In many instances, women postgraduate students get the help of male house surgeons to reach the hospital on a two-wheeler,” he says.
Doctors point to low awareness of the Hospital Protection Act among the police, with a senior gynaecologist noting that only stringent punishment for violence against women can serve as a deterrent. The Hospital Protection Force that was planned some years ago should be revived and ex-servicemen should be engaged as security guards for hospitals, says A. Ramalingam, State secretary, Service Doctors and Post Graduates Association.
‘Safety measures reinforced’
A. Arshiya Begum, vice-principal and dean (full additional charge), K.A.P. Viswanatham Government Medical College and Mahatma Gandhi Memorial Government Hospital, Tiruchi, says that after the West Bengal incident, the hospital has reinforced safety measures, but women professionals should be bold enough to register complaints in case of being abused. “They should not suffer the stress or emotional torture they feel at the workplace alone. Separate grievance committees are here to help them find a solution. It is our individual responsibility as women and professionals to see to it that these things do not happen to us, or others,” she says.
Health Secretary Supriya Sahu says that among the key areas identified after the joint security audits conducted by police and health officials at medical college hospitals and government hospitals is the need to make the CCTV cameras functional at some places, while more are required at a few other places. “These audits have identified areas where lighting should be improved, and most importantly, we need to put in place measures to manage the visitor flow into hospitals,” she adds.
(With inputs from C. Palanivel Rajan in Madurai,<QR> Wilson Thomas in Coimbatore, and Nahla Nainar and Ancy Donal Madonna in Tiruchi.)
Published – September 15, 2024 01:28 am IST