You never forget the day you give birth to your child. But 28-year-old Nabiha says she will also remember it for reasons other than just a mother’s joy.
“The ward where they took me for post-delivery care was filled to capacity. All the doctors and nurses were stretched to the limit,” she says. “I remember seeing a frail woman on a stretcher wheeled into the ward, demanding to see her husband. The nurses and doctors on duty were trying to explain that he would soon be in to see her but to no avail. The woman was unrelenting. Out of the blue, she sat up and pushed the nurse standing closest to her with such force that her body was slammed against a cart of medical supplies that she was carrying.
“Visibly shaken, the nurse again apologised to the woman who’d just hit her, reassuring her that the husband would be in soon. Then she quietly rushed out of the ward,” Nabiha recalls.
Unfortunately, such incidents are quite frequent in hospitals. Most of the time violence is directed at the healthcare staff and hospital infrastructure. The staff get attacked by family members or friends of patients and, in rare cases even by the patients.
What causes such behaviour and why no way has been found to stop it?
“This is a manifestation of increasing intolerance in our society. Hospitals are simply an easy target says Ashraf Nizami, president of the Pakistan Medical Association (PMA). “The concept of mob justice is now unquestioned. Those guilty of hospital violence often get away with it. We have the Punjab Healthcare Commission (PHC) to deal with complaints about healthcare officials or systems. But instead of approaching an authority, those with grievances often end up taking the law in their own hands.”
According to Nizami, violence against healthcare officials is one of the major concerns of the medical profession all over the world. It is alarmingly close to an emergency.
Salman Kazmi, of the Young Doctors’ Association of Pakistan (YDA), is of the view that this is a result mostly of the blatant exploitation of doctors at hospitals. “Doctors are overworked — some of them work 36-hour shifts — as well as underpaid,” says Kazmi. He says that the doctor-patient ratio is unsettling, and medics are simply not equipped to handle the resulting pressure. “In such situations, chances of negligence increase tremendously.” Moreover, he is not happy with the security situation in most hospitals. “Most hospitals are outsourcing security to small private companies and hiring retired guards at criminally low rates,” says Kazmi.
Another factor that might contribute towards violence at hospitals is an inherent mistrust in the delivery of justice by formal channels, says Aamer Waqas, the spokesperson for Punjab Medical Association. “Patients’ attendants do not understand the medical procedures or the patients’ chances. They resort to violence when they come across news that they can’t handle,” he says. “They seldom realise that their outbursts can cause difficulties for other patients. In extreme cases, they can be fatal.”
He is referring to the passing away of Noorul Hasan, a Sadiqabad-based taxi driver, who was a patient at a renowned hospital in Lahore. He passed away last month after he was allegedly left unattended owing to the chaos triggered by the protesting family of another patient who had earlier passed away at the same hospital.
The healthcare situation seems bleak due to many other reasons also. But every problem has the potential for a solution. For the healthcare industry, there may still be hope. On July 22, the International Committee of the Red Cross (ICRC) launched a countrywide Bharosa Karein (Trust Us) campaign to inform the public about the harms caused by violence at hospitals, and the impact it has on the patients as well as the staff.
According to Nizami, things will look better once the Health Protection Bill, currently pending with the provincial Assembly, is passed. “Also, people should be held accountable for their actions. If such behaviour is appropriately punished, the example will deter many. Thirdly, hospitals should show more responsibility in safeguarding their patients and staff,” he says.
Kazmi has a different take on it. “Doctors should have more reasonable duty hours; no more than eight hours at a stretch under any circumstances. More doctors should be hired, and given appropriate wages. Besides, hospitals should invest in better security.”
Tending to the concerns of their patients’ family is an integral part of a doctor’s job description. “If hospitals focus on this there will be a marked decrease in such incidents”, says Waqas. “Attendants should be explained the procedures in lay man terms. They should be constantly updated on the patient’s condition so that there is no confusion. They should be taken into confidence,” he adds.
What actual steps are being taken in order to tackle these problems? Many a time the strategies adopted by administrative bodies leave a lot to be desired. Sometimes, a lot is done but to no avail.
According to Dr Nayyar Toor, Assistant Medical Director (AMD) at Shalamar Hospital, the latter assertion has some truth to it. “It is not that we do not communicate with the attendants. We try to update them thoroughly on all the medical details but if they are bent upon showing aggression, we can’t do much about it.” He says that most patients and their families are usually very cooperative. In certain situations, some of them just refuse to listen.
Nearly all hospitals are secured, says a hospital security official, on the condition of anonymity. “But most of the time, the guards are hired to protect the premises, not to prevent attacks on people. Security guards do not have a legal cover so that if we try to control violent people physically and things go awry, we will be held responsible. We can only control them verbally, without any physical contact at all. It is not possible to control a mob by just politely asking them to stop.” According to him, the number of security guards at most hospital premises is appropriate for the duties that are assigned to them.
Usman Sulman, the Corporate Services in charge at Shalamar Hospital says, “oftentimes such attacks are unexpected… the hospital administration and security officials are taken aback. “We are here essentially to provide healthcare, not to anticipate violent attacks.” He says that security officials cannot be authorised to control people by force, as that might eventually increase violence rather than decrease it. “Currently, the hospital is working with its security officials to implement stricter rules to restrict the number of attendants accompanying a patient,” he adds.
As I start typing “violence against” on Google to read up on this subject, the first few suggestions to come up are, in fact: “violence against healthcare workers” and “violence against doctors”. This alone is enough to show the sorry state of affairs regarding security within our healthcare organisations. To minimise violence in hospitals, effective strategies need to be devised and put in place. More importantly, they need to be strictly implemented in order for some sort of change to actually take place.