Since Wednesday, thousands of patients across Nepal had been deprived of regular healthcare services as resident doctors nationwide skipped duty to protest Monday’s assault on doctors at Manipal Teaching Hospital in Pokhara.

This was not the first time healthcare services have been affected due to doctors’ strikes in Nepal. On September 18, the Nepal Medical Association, an umbrella organisation of medical doctors, called a nationwide strike to protest the assault on doctors at a Hetauda hospital.

The association’s record shows at least seven incidents of misbehaviour and physical assault on medical personnel over the past four months. The latest strike in the healthcare facilities is the third in the intervening period.

Incidents of physical assaults, threats against medical staff and vandalism at healthcare facilities have been increasingly reported.

Here is all you need to know about growing incidents of violence against medical personnel and allegations of medical negligence during treatment.

Resident doctors on strike

The resident doctors serving in teaching hospitals nationwide refused to work since Wednesday demanding security and action against the culprits.

As senior doctors are generally more involved in academic activities and in direct patient care at big hospitals, thousands of patients across the country, particularly those seeking care at teaching hospitals, suffered badly. When resident doctors shun duties, patients who seek care at both out-patient and in-patient departments and those waiting for surgeries are deprived of essential services.

“How can we continue our services when we are under constant threat of physical assault and violence?” said Dr Arun Upreti, a member of the National Resident Doctor Association. “We cannot serve patients until we are assured of our safety and security.”

Growing conflicts between doctors and patients

Frequent incidents of manhandling, assault, threats against healthcare professionals and vandalism at healthcare facilities suggest that conflicts between doctors and patients are rising.

When something goes wrong, patients or their relatives often accuse doctors of negligence and even resort to violence, as happened on Monday. They argue that had the doctors treated the patient properly, they would not have died, or their ailments would not have deteriorated to the point of becoming fatal.

Most doctors, however, are not ready to accept that mistakes could have happened at their end. They instead argue that the growing frequency of violence against healthcare professionals is an indication of a failed state and that the incumbent government, which failed to enforce the law strictly, is solely responsible for it. Violence against doctors has made providing medical care more challenging.

Stringent law

In an attempt to cut down on incidents of assault on healthcare professionals and institutions, the government amended the Security of the Health Workers and Health Organisations Act-2010. The amended law provisions a fine between Rs300,000 and Rs500,000 and a jail term of two to five years or both for anyone violating the law.

But the amendment hasn’t put the brakes on incidents of attacks on healthcare professionals. The incident in Hetauda shows that relatives of patients don’t necessarily pour out their ire at losing a loved one immediately, taking even a month, as in this case. What is particularly worrying about the Manipal incident is that even security personnel were seen on the side of patients’ relatives.

“The two recent incidents of assault on doctors indicate that only a stringent law can stop these attacks,” said Bishnu Timalsina, general secretary of the Forum for Protection of Consumer Rights. “Time has come to contemplate on what we are doing wrong and also evaluate the kind of lapses that happen at the doctors’ end.”

Is the Nepali society becoming more intolerant?

The medical sector, particularly the doctor’s profession, is considered among the most sacred professions across the world. However, growing conflicts between doctors and patients show that something has gone wrong in the doctor-patient relationship.

“Our society is getting intolerant by the day, and people have started taking the law into their own hands,” said Dr Bhagawan Koirala, chairman of the Nepal Medical Council, the national regulatory body of medical doctors. “Due to violence against doctors and health workers, the risk of hundreds of thousands of patients across the country not getting timely treatment increases.”

Other doctors the Post talked to echoed similar sentiments. They said the society is getting more intolerant and the impunity promoted by the government by withdrawing cases related to heinous crimes is responsible for the frequent attacks on doctors.

“The incumbent government has promoted impunity by freeing those involved in heinous crimes, which has emboldened people with criminal mindsets,” said Dr Kedar Narsing KC, former president of the association. “Effective implementation of the law is a must to discourage frequent assaults on healthcare professionals.”

They argue that people have vented their anger at doctors, even in cases unrelated to the treatment of a patient. Those frustrated due to social anomalies such as black marketing, inflation, unemployment and the growing cases of corruption, too, have poured their anger on doctors, they said.

“Those not associated with the cases are also getting involved in the assaults on doctors,” said Dr Baburam Marasini, a public health expert. “This shows that our society is becoming intolerant.”

Communication gap

Doctors’ inability to communicate properly with patients and their relatives also leads to conflicts at healthcare facilities.

First, doctors often do not bother to inform patients and their relatives about the worst outcomes of ailments. Second, many doctors the Post talked to agreed that they do not speak the language that people from downtrodden communities understand.

“Most medical colleges in Nepal do not teach communication skills to doctors,” said Marasini. “Nor do the concerned agencies think it is necessary to amend the syllables or to include a chapter on effective communication skills.”

Most patients are not given sufficient information by doctors on their health conditions. Even if doctors commit mistakes accidentally, no doctor owns them up.

Experts say one must understand that adverse outcomes and deaths could happen in any case and it is not necessary that a doctor’s negligence is responsible. Assault could demoralise doctors, which could adversely affect the treatment process of other patients.

Burned out

Doctors are often burned out due to excessive workload. Some doctors have to attend to hundreds of cases every day, which raises their stress levels.

“Vacant posts at the health facilities have not been filled for years, which has exhausted healthcare workers, including the doctors,” said Dr Prakash Budhathoki, spokesperson at the Health Ministry. “This could be among the reasons for the growing conflicts between doctors and patients.”

Ill-equipped and understaffed hospitals and their trend of not referring serious cases on time also create conflicts, experts say.

Experts’ take

Many doctors the Post talked to agreed that the growing conflict between healthcare professionals and patients is a matter of grave concern, whatever the reason.

They agreed that the acrimony and the ensuing protests have deprived many patients of timely care, which is their constitutional right.

Lack of awareness among the patients and their relatives of the limitations of the doctors, plus a paucity of trust in the justice system, could also have promoted violence.

Experts say it is the responsibility of the government and media to make people aware and increase confidence in the justice system. They add that doctors, too, should communicate with their patients properly about the disease they are suffering from.

Meanwhile, agitating resident doctors have agreed to resume services from Sunday following a six-point-agreement with the government on Saturday evening. The agreement includes provisions for the safety and security of health professionals and health institutions and action against those involved in the assaults.