Worked to the bone, India's doctors fear for their safety, too

Exhausted doctors resting in crowded on-call rooms with no locks, two to a single bed. Frustrated relatives of patients angrily challenging a physician's diagnosis. Too few security guards to keep the peace.

These are everyday realities in Indian government hospitals. Young doctors describe multiday shifts and harrowing working conditions in rooms and wards often lacking in safety and hygiene, where learning is frequently interrupted by the crushing load of urgent cases.

Their plight has come to light in recent weeks after the rape and murder in Kolkata, India, of a 31-year-old junior doctor who had been resting after a grueling 36-hour shift. Last month, police arrested a man, considered a prime suspect in the killing, after he was caught on CCTV walking into the hospital late at night.

The case has prompted nationwide protests, with doctors, students and human rights activists demanding justice for the victim, as well as better protection and safer workplaces for doctors and women. Many doctors also went on strike.

"People protested because we identified with the victim," said Dr Susmita Sengupta, who graduated in 2020 from MGM Medical College & Hospital in Jamshedpur, a large city in the eastern state of Jharkhand, and worked there for a year before moving to private practice.

Between the lack of security personnel and the challenges many female doctors face to be heard, "any residency in India becomes toxic," Sengupta said.

The brutalized body of the Kolkata doctor was found August 9 in a seminar room at RG Kar Medical College and Hospital, a state-run institution where she was completing a residency. After the attack, India's Supreme Court set up a national task force to recommend workplace safety measures.

The New York Times interviewed more than a dozen Indian doctors, within India and abroad, who shared their experiences in the country's state-run hospitals and medical colleges. Many who practice in India spoke only on the condition that their names be withheld, fearing for their safety.

Some told of verbal or physical abuse from families of the ill whose patience had been exhausted. Many, having chosen the medical profession with a deep determination to save lives, said their resolve had turned into despair and then resignation as they went through their residencies in an overwhelmed system.

Some have left for private practice, others for foreign shores. Dr Richa Sharma, now an anesthesiologist in West Hartford, Connecticut, went to the United States in 2018 for a residency at Columbia University in New York. Sharma, who graduated from medical school in Delhi, said she was driven to pursue her training outside India partly because she was disillusioned with the Indian medical system.

Even though that system was set up with the welfare of patients in mind, it did not always function that way, Sharma said. She added that she had worried about losing compassion if she was "caring for hundreds of patients a day as if they were objects in a factory and not people."

The Kolkata rape and killing galvanized her to bring together a group of US-based alumni of Indian medical colleges to write letters to government offices demanding change. Sharma said she was in touch with a member of the Supreme Court task force to make recommendations based on the group's experiences.

One India-based junior doctor, who did not want to be identified talking about her employer, said those in her cohort who protested had to call patients to cancel appointments. "I received threatening messages, voice notes and calls after that from those patients," she said. "I now block the patient's number as soon as I make the call to them."

State-run hospitals are the main providers of health care for those at the bottom of the economic ladder in India. The public network consists of primary health care centers as well as top research and training institutes. Although there are thousands of private hospitals that typically have better facilities, they tend to be expensive and do not necessarily employ the best doctors.

Many young doctors who want to specialize in a certain field of medicine join government-backed medical colleges and teaching hospitals. In recent years, the Indian government has been trying to increase the number of such institutions to train more doctors.

However, highly trained doctors tend to cluster around cities and in states that have more medical colleges and teaching hospitals, which leaves large areas of rural and small-town India without easy access to health services, especially for complex diseases like cancer, studies have found.

City hospitals are left with many more patients than they are equipped to handle. Patients and their relatives, already agitated because of a health issue, often wait for hours to see a doctor.

"There was no system to attend to the most serious patients first," said Gunika Sehgal, who recently accompanied her father, who suffers from liver dysfunction, to the emergency room at the All India Institute of Medical Sciences in New Delhi, one of the country's top hospitals.

Sehgal said they were attended to within two hours only because her family pulled some strings. "I don't know how much longer we would have waited if not for that connection," she said.

The combination of overwhelmed doctors and irate patients can create a tinderbox.

While resident doctors around the world often work long shifts, since part of their training involves admitting patients and tracking their journey, the burden is heavier in India's under-resourced system. The frequency with which many resident physicians in India do demanding shifts wears them down, doctors said.

The sheer number of patients makes it incredibly tough, said Dr Dhrubajyoti Bandyopadhyay, a cardiologist. Bandyopadhyay worked at several state-run hospitals in India, including RG Kar (the hospital where the Kolkata doctor was raped and killed) before joining Massachusetts General Hospital, Harvard University's largest teaching hospital.

"People from villages and slums come to the hospital, so in a day in an OPD we used to see 400 patients, which is not possible for two to three people," he said, referring to the outpatient department.

Once during his residency, Bandyopadhyay administered CPR to an 80-year-old man in an emergency room after his pulse stopped, but was unable to save him. The patient's relatives then started accusing him of killing the man by pumping his chest for half an hour, Bandyopadhyay said, and refused to have a post-mortem done.

"All of a sudden, 50-plus people gathered and started shouting and verbally abusing us," he said. "There was no one to protect us."

Reflecting on the episode, Bandyopadhyay later said in a WhatsApp message that emotion and "impunity that nothing will happen if you abuse a doctor" were behind violent behavior toward health workers.

Dr Aditya Yadav, a surgeon, recalled an episode during his residency when a patient with acid burns on his face demanded that a consultant doctor do more to fix the damage. When the doctor was unable to do more, the patient walked around the hospital with a bottle of acid, threatening other doctors that he would "make everyone look like him," Yadav said.

Even doctors in private hospitals can be subject to patient abuse, and many keep guards on hand.

"Over the last few years, I have seen and heard so many incidents of family members of patients beating doctors that I have lost count of it," said Dr Shoborose Tantray, an associate professor at Santosh Medical College, a private hospital in Ghaziabad, near Delhi. "Male colleagues have been beaten blue and black; female doctor friends have been threatened. Some have thought of even finding jobs outside the country."

Sharma, the anesthesiologist who is trying to draw attention to the working conditions of her counterparts in India, reflected on the contrast between how doctors are viewed and treated: "They are either seen as supra-human, or not human at all."