Nurses look forward to the day when broken changing room windows in government hospitals are repaired. At a far-flung primary health center (PHC), his friend’s hope of seeing the metal grill gate attached to the building’s main entrance is fading day by day. In Chennai’s top healthcare institution, post-graduate medical students on 24-hour shifts find empty patient beds during a few minutes of rest at night as there is no separate room for doctors on duty. In a neighboring district, a doctor on the night shift at the Comprehensive Emergency Obstetrics and Neonatal Care Center has to be careful because the three-story building where he works is monitored by a single security guard.
Tamil Nadu, which is pumping huge funds into its hospital infrastructure, seems to have dropped some of the most basic necessities to ensure the safety and security of women in the health workforce. Now, the question is whether women feel safe in the 11,000 government health facilities, including medical college hospitals, taluk and non-taluk hospitals, and PHCs. According to official sources, women constitute at least 60% of the total health workforce in Tamil Nadu. These include doctors, residents, nurses, village health nurses, accredited social health activists, women’s health volunteers, and household staff.
Although the Kolkata incident has raised alarm for health authorities to step up security and safety on hospital campuses, some women health providers and workers feel the problem runs deeper. It starts with the most basic needs that are still not addressed such as the absence of a separate duty room with toilets and adequate water supply for postgraduate students, where there are, unguarded and inadequate, no security personnel at night, and dimly lit corridors. There are more serious concerns about sexual harassment, verbal abuse, attempted assaults by angry patients’ families, and complaints of sexual molestation/assault not being taken seriously.
Lack of safety
A resident doctor at Madurai Medical College, who did not want to be named, said that after the Kolkata incident, the hospital started thinking about the safety of doctors during working hours. While this is a positive development, it is sad to see such an important issue only after such a terrible incident. “Government hospitals are places where thousands of people come in and out every day, and in these locations, some basic safety measures such as monitoring of security personnel and installation of closed-circuit television (CCTV) cameras should be implemented,” he said. the doctor added. Recently, a 23-year-old man tried to harass a resident surgeon at 8.30 am at the two-wheeler parking lot of Coimbatore Medical College Hospital. The resident surgeon, who staged the protest, said the place was dark at night. He also accused the hospital administration of failing to ensure night security, including adequate deployment of guards.
The incident is a wake-up call for the authorities but there are several complex issues that have become a complex part of the health system. Long working hours are one of them. It has become the norm when graduate students tell their work stories for 36 hours (once a week) and 48 hours (once in six weeks). A female postgraduate student, who has been on a 48-hour assignment, said attending ‘calls’ (when specialist doctors are called to another department for an opinion) late at night is terrifying. “At night, there are no security officers stationed on the floor. We have to walk alone from one building to another. What is more problematic is that anyone can enter the hospital at night because entry is not restricted,” he said. The alarm mechanism to indicate an emergency is low and the intercom connection in the ward is incomplete.
Nurses in their early 40s show how labor shortages are putting them at greater risk. “The PHC where I work has four sanctioned nursing positions but only two are here for the morning and night shifts. At night, when one of us is on duty alone, the female worker stays with us. Since the PHC does not have a security guard, we have to arrange We keep the main door locked after 10 o’clock and only if someone knocks. There is no separate place for us to rest,” he said.
Trouble at night
Some nurses told how people under the influence of alcohol cause problems at night in the PHC. “This seems to have no end. Many of us have faced harassment and verbal abuse from people who were drunk and sought treatment for injuries caused by fighting at night. Some PHCs do not have compound walls. Almost a year ago, two people entered the PHC pretending to be patients. and seized the chain from the nurses. Though the Directorate of Public Health has recently issued instructions to engage the night watchman, no steps have been taken so far,” said another nurse working in the southern district. Emergency units and labor wards are among the most critical areas on a hospital campus that can cause emotional distress. The patient’s family can become aggressive at any time, and there have been several incidents of female staff getting angry, several doctors and staff nurses said.
New problems continue to arise for female physicians. According to one of them, “We have patients and officers who take videos while playing. If there is a shortage in basic facilities like water supply, now there are angry patients who threaten to post this information on social media. Recently, people, in Drunken condition, entered the female ward at night and kept staring at the patients. Why are the visiting hours not issued in the government hospital? Most of us have experienced burnout, and security it is increasing,” said the doctor. Some hospital departments are havens for toxic work cultures and patriarchal mindsets, another doctor said, adding, “In some places, maternity leave is considered a crime, and a harsh word.”
Complaints about sexual harassment are not taken seriously by the authorities, students in the pre-final year of MBBS claim. “In certain cases of students being harassed on campus, the authorities started blaming the victim. Once the information spread outside the campus, they took action. Through our inquiries, we found that Vishaka committees are not active in almost 90% of medical colleges. There is no channel help or grievance redress mechanism on campus,” he said.
“Moving forward, we demand more awareness and transparency in the functioning of the Vishaka committee, as well as an assurance that our complaints will be dealt with in a timely and impartial manner,” said a postgraduate student of KAP Viswanatham Government Medical College, Tiruchi.
In many hospitals including the one in Chennai, women have raised issues of dimly lit corridors and parking lots, unguarded duty rooms, absence of metal grill gates in duty rooms, and lack of security guards at night. There are not even bins to dispose of napkins in many toilets, according to graduate students.
Consider this: a female resident surgeon in Coimbatore stays on the top floor of a block in a centenary building, which houses various departments and wards, not like a hostel. The mess was in another corner of the vast campus. There are very few toilets on campus for them; therefore, they depend on those in the accommodation and some others in choosing the department, he said. In other medical college hospitals, postgraduate students with 36-hour duties have no place to rest and go to the dormitory to use the toilet. Despite the rapid growth of the health sector, basic facilities like clean toilets for women workers remain a problem, said Tamil Selvi, secretary, Indian Medical Association, Tiruchi chapter. “We must always find a safe toilet during working hours. We must work hard to improve basic facilities for future generations,” said Dr. Tamil Selvi. Yogeshwaran Elangovan, secretary of the state organization, Tamil Nadu Medical Officers Association, said there was no protection for staff nurses, post-graduate students, and resident surgeons on hospital campuses. “The police force at the posts is minimal. Apart from the casualty ward, many places on the campus, like the Government Stanley Medical College Hospital, are blind spots that need to be guarded. For example, the resident doctor has to go to the Raja Sir Ramaswamy Mudaliar Government Hospital Lying- in Royapuram if asked for an opinion at night. The train and the road leading to MC Road are deserted and there is no organized transport. In many cases, female post-graduates seek the help of male house surgeons to reach the hospital on two wheels,” he said .
Doctors pointed to low awareness of the Hospital Protection Act among the police, with a senior gynecologist noting that only strict punishment for violence against women could act as a deterrent. The Hospital Protection Force planned a few years ago should be revived and ex-servicemen should become hospital security guards, said A. Ramalingam, state secretary, Medical Services and Postgraduate Association.
‘Safety measures strengthened’
A. Arshiya Begum, vice-principal and dean (full additional charge), KAP Viswanatham Government Medical College and Mahatma Gandhi Memorial Government Hospital, Tiruchi, said that after the West Bengal incident, hospitals have strengthened safety measures, but women professionals should be brave enough to register a complaint if harassed. “They should not suffer the stress or emotional abuse they feel at work. A separate grievance committee is here to help them find a solution. It is our individual responsibility as women and professionals to ensure that this does not happen to us, or to others,” he said.
Health Secretary Supriya Sahu said that among the key areas identified after a joint security audit conducted by police and health officials at medical college hospitals and government hospitals was the need for CCTV cameras to be operational in some places, while others were required in others. apart. premises. “This audit has identified areas where lighting needs to be increased, and most importantly, we need to implement measures to manage the flow of visitors to the hospital,” he added.
(With input from C. Palanivel Rajan in Madurai,
Published – September 15, 2024 01:28 IST