News
Serious security and safety issues for healers in state hospitals
View(s):- With feminisation of the medical force, AMS calls for hospitals to be
- places without fear and GMOA begins audit of facilities and quarters
By Kumudini Hettiarachchi
The strident wake-up call in Sri Lanka’s state hospitals has regrettably followed a heinous crime, even though security and safety issues have been dogging the state health sector for decades.
A woman doctor at the Anuradhapura Teaching Hospital was sexually assaulted on Monday night in hospital quarters, eliciting major protests not just from doctors and other healthcare personnel but also from all rational men and women. As condemnation of the incident and conditions within hospitals for staff went viral on doctor groups, the suspect was nabbed in Galnewa, about 45km from Anuradhapura.
Many reiterated that this incident was a serious aspect of a widespread issue in the country with regard to women which goes unaddressed by the legal system inclusive of enforcement authorities and is also ingrained in the societal mindset.
The Government Medical Officers’ Association (GMOA), the Sunday Times learns, has begun taking stock of facilities and quarters available for doctors and other healthcare staff in every state hospital.
A hardly-lit corridor without a soul and stray dogs at a hospital very close to Colombo
There are a little over 20,000 doctors in the state health sector, inclusive of about 2,000 specialists, while there are around 42,000 nurses. These doctors and nurses ‘man’ and ‘woman’ 120 hospitals with specialists which range from base hospitals, district general hospitals, teaching hospitals, national hospitals to specialized hospitals and also 1,000 primary care hospitals which include divisional hospitals and primary medical care units. There are also 360 Medical Officer of Health (MOH) units.
The serious lapses with regard to safety and security are not limited to remote hospitals but are also evident even in huge and sprawling tertiary hospitals.
The issues include –
When staff are moving from ward-to-ward, to areas such as ward-to laboratories or ward-to-quarters within the hospital.
When walking to and from the respective wards to doctors’ quarters which may be located outside the main hospital premises.
When in their quarters, whether within the hospital building or premises or outside the main premises
Doors and windows without locks in ‘on-call rooms’ within hospital buildings even in major cities such as Colombo are the norm, it was found, as also dark or dimly-lit, shadowy corridors without a soul in sight in the dead of night; quarters having to be accessed along unlit pathways with security personnel hardly to be seen; and quarters too without proper locks on doors and windows.
Numerous doctors, senior and junior, the Sunday Times spoke to said this was a volcano waiting to erupt.
Reiterating that doctors both female and male and also other health staff are vulnerable, the President of the Association of Medical Specialists (AMS), Dr. A.D.K.S.N. Yasawardene, pointed out that more than those on normal duty, those on ‘on-call’ especially at night were doubly vulnerable. They were compelled to go to and from wards to their rooms at all odd times, unlike those who were on night duty who would stay put in the wards and in rooms close to the wards.
He looked closely at the medical workforce, the face of which has changed with an exponential increase in females. Two-thirds of students in the medical faculties are women, but the systems have not evolved with this change. Whereas decades ago most night-time House Officers (HOs) and post-graduate trainees would have been males, now they are females who are doing an excellent job.
“They are very duty conscious and when they are walking to snatch a few hours of rest, would be exhausted and thinking about their patients, rather than worrying about their surroundings,” said Dr. Yasawardene.
Currently a specialist who had been a Registrar in the early 2000s recalled how she would walk to her room in Hantane through scrub jungle, from the Kandy Hospital in the middle of the night, without a thought for safety. “We were under the false belief that we were safe and no one would get hurt as we were health staff.”
In an outpouring of appreciation, many female doctors went public on social media to thank their male colleagues who accompanied them to their quarters in the night or even when travelling to far off places in the night for duty the next morning. It is now that they had realized how vulnerable they had been. A major flaw pointed out by many doctors was that many big hospitals did not have quarters for post-graduate trainees, which was a shortcoming in the planning, as these trainees had to work extended hours into the night.
The Sunday Times found that in a Colombo hospital, the on-call room which had been meant for one, now accommodates three, while the door-lock does not work and a chair has to be propped up against it to ensure safety and privacy.
Another eye-opener was that a premier institution, once again in Colombo, had tiny rooms for staff to rest, and many doors could not be locked, while the hospital premises were being used as a short-cut by three-wheelers not to bring in patients but to cut across from one main road to another through a different gate, as if it were their private property.
“All sorts of unsavoury people including drug addicts roam the hospitals, while packs of stray dogs also have a field day, in some cases biting staff and patients,” another doctor said, pointing out that the locks on doors of quarters do not work and doctors sometimes bring their own padlocks. “This is not a satisfactory situation.”
He also spoke about the time he was at Tambuttegama Hospital a while back, when his quarters were across the road and in the night there was the imminent danger of meeting a herd of wild elephants.
Others recalled how they were nearly-bitten by venomous snakes including cobras in the night when rushing from their quarters to see a very-ill patient. Their remedy was to carry sticks to ward off these creatures.
Harking back to the years before the late 1990s, AMS’s Dr. Yasawardene said that in those days on-call doctors were provided an ambulance or hospital vehicle along with a minor-employee chaperone. A call book was also maintained. With the advent of mobile phones all this has vanished along with measures of safety, he said, insisting that no one is asking for an ambulance to pick them up, but security has to be ensured.
“The need for security is not limited to sexual assaults but also physical assaults and robberies linked to healthcare staff within hospitals. Such acts of violence against the staff invariably have an adverse fallout on patients and the care provided to them,” he said.
He urged that in keeping with the feminization of the medical force, systems have to evolve, while also making sure that the security personnel on duty at hospitals do their job properly.
Echoing all these concerns, GMOA Executive Committee member, Dr. Shivantha Fernandopulle, labelled the accommodation in most hospitals as “dilapidated” and below par, requiring much to be desired. In contrast, the Ampara Hospital had dedicated quarters for doctors along with facilities like a gym and badminton court due to the efforts of the Director who is no more.
He said that specialists including himself need to re-think their impression that hospitals are “sacred and safe”.
“We are sometimes annoyed and reprimand juniors when they are late but there is a dilemma – now we realize that their lives should not be put in jeopardy. The House Officers’ quarters are poorly-lit and these young doctors in their 20s and 30s have to walk through quarters of other staff. Thought must also be given to the nursing staff which is 99% female,” he said.
Raising another valid point, Dr. Fernandopulle said that hawkers and three-wheel drivers have a field day, roaming freely within hospitals and in their vicinity. This needs to be halted immediately.
“The responsibility of making sure that the staff is safe, lies squarely with the hospital Director along with the Housing Committee which includes trade union representatives, the Administrative Staff and the Planning Unit,” he said, adding that indirectly this issue is also linked to the Health Ministry and line ministries.
The AMS, meanwhile, underscores that dedicated and committed female doctors have to attend emergencies and other hospital work even in the middle of the night especially during their post-graduate training and in after hours on call duty period. They need safe accommodation and other facilities, to perform their duties without fear and frustration.
Calling on the government, law enforcement agencies and hospital administrators to implement stringent security protocols including enhanced surveillance, restricted access to on-call rooms and increased police presence to protect healthcare staff, the AMS points out that if not, the current 24/7 health service coverage by medical personnel would be adversely affected, causing severe inconvenience to the public.
“Hospitals must remain ‘sanctuaries’ of healing, not places of fear,” the AMS adds.
The consensus is that in the wake of this crime, permanent measures to ensure the safety and security of all healthcare staff should be implemented forthwith and not just a temporary and fleeting knee-jerk reaction.
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