Our healthcare institutions need more women at the helm

How can a woman doctor be raped, brutalised and murdered in a busy hospital in a metro city? We have gone terribly wrong somewhere. We need to search for the answers and do something urgently, before another heartbreaking story is created.

I go back to my own residency 30 years ago in a busy pediatrics hospital in Jaipur. The duty rooms were next to the wards and were common for women and men. The doors did not have a latch. While a guard was present, he would often nap at night. We were lucky nothing happened to us but many other women were not so fortunate.

Can we ever forget Aruna Shanbaug? The case that traumatised the medical world for four long decades after the 25-year-old nurse from King Edward Memorial hospital, Bombay was sexually assaulted and choked with a dog chain in 1973. Suffering brain damage, paralysis, cervical cord injury, she remained in a vegetative state for 41 years.

But from those days in the 70s when the nurse was brutally assaulted to now, nothing much has changed in most hospitals. And certainly not in the pediatrics hospital in Jaipur referred to earlier. Despite this hospital having grown in size substantially, the duty rooms have not changed. There are also not enough toilets for women doctors, who travel to the hostel, even for changing their sanitary napkins.

There are several situations and cases. For instance, that of a colleague in another city. She was “sad and depressed” for a long time before being confronted by her father who wanted to know the problem. It turned out that her professor and his friend, both senior doctors, were forcing her to meet them in private, and also making sexually explicit remarks. It took threats from her father for their unwelcome attention to stop.

A young colleague who completed her residency in Gynecology from another busy government hospital recently had this incident to share: the duty room next to the labour room doubled as the examination space for pregnant women. One night she was woken up by the husband of an admitted woman, with his face barely inches from her own. Another wealthy woman’s brother would come and sit with her repeatedly in the labour room. He kept calling her and asking her out for coffee, till she blocked his number.

“There were five of us friends from medical school who went to different hospitals across the country. All of us had such experiences”, she says. She did not share this with anyone - there was some embarrassment at the idea of sharing such experiences. Besides, she also did not know where to go to complain. She did not know about the Prevention of Sexual Harassment (POSH) Act, or if a committee existed in the hospital.

A senior doctor, now in her eighties recounts her training- “No unpleasant incidents happened ever, no one dared do anything. There were also fewer doctors and students, and we all knew each other personally”. This has changed now: the number of doctors has grown, that of students/ residents much more than that of their teachers. Earlier the teachers were around and present in the hospitals, now they spend less time here and a lot more in their own practices. Where then is the time or mind space to think of the safety of women residents, the condition of their duty rooms and toilets?

Women colleagues also talk about their repeated requests regarding hospital conditions to the administration, including duty rooms, canteens, places where they can sit and have their meals. They anyway spend so much of their time in the hospital. All of these seem to fall on deaf ears. Who are these administrators? We share the situation in Rajasthan, which may not be different across many States: 90% of the district health officials and hospital administrators are men. This includes the Reproductive and Child Health officers, who as the name indicates are responsible for the health of women and children.

There are some bright spots. Colleagues who have studied at premier institutions like the PGI in Chandigarh speak of separate duty rooms for women and men, labour rooms with guards at several entrances, and a well-functioning canteen. Such examples though are very few and far between.

If we move from cities to towns and villages, and from hospitals to CHCs and PHCs, the absence of women doctors is striking – for 8 male doctors, you will see 2 women. Concerns for their safety seem to influence their choices of where to work and this is something we need to know better. For our nurses and ANMs, harassment is not uncommon: in a study conducted 20 years ago, several nurses spoke about harassment at the hands of community members, and also reported a gruesome case of rape and murder. Even now, the women in the workforce do not know about POSH or any complaints committee. Neither is this information displayed in any public health facility.

Through running primary healthcare clinics and a government PHC, we have seen these threats first hand: women nurses receiving calls from drunken men, who are sometimes senior panchayat members. At times these men visit the clinics at night for trivial conditions and demand their services. By creating a safe space, many such incidents and cases of sexual harassment have come to the fore and been promptly acted upon. But it needs to be acknowledged that not all incidents see the light of day. A tolerance for such acts, fears regarding confidentiality, keep many of these under wraps - a situation that can become explosive anytime.

A message from the Kolkata case is to rebuild our healthcare workplaces with the intent of making them safe and gender inclusive. In addition to enhancing security, building more duty rooms and toilets, women must be brought to the decision-making table, life must be infused in our internal committees and the POSH Act. Till then, our work is only half done.

By: Sanjana Brahmawar Mohan

The writer is a doctor and co-founder of Basic Healthcare Services, a Rajasthan-based non-profit that runs primary healthcare centres. Views are personal) (Syndicate: The Billion Press)