Doctors’ safety in Bangladesh: A pressing concern

25-year-old Ahsanul Islam was injured in a traffic accident on his way from the airport to Mirpur on August 30, 2024. Initially taken to Combined Military Hospital (CMH), Kurmitola, he was later transferred to Dhaka Medical College Hospital (DMCH), where he allegedly died due to negligence. Following his death, Ahsanul's classmates and relatives rushed to DMCH and accused the doctors of medical negligence. Chaos ensued. The emergency department saw vandalism and brutal assaults on physicians, with doctors being dragged from surgery rooms and physically attacked. The director of DMCH, Brigadier General Md Asaduzzaman, confirmed that Ahsanul had sustained severe injuries and denied any negligence in his treatment.

A similar event unfolded at Cox's Bazar District Sadar Hospital on September 10, 2024, when a young man named Aziz, admitted to the ICU, also allegedly died due to medical negligence. His relatives claimed his death occurred after he was administered a painkiller injection, prompting them to attack Dr Kazi Sajib, the physician on call. The two incidents occurred within ten days of each other, underscoring the alarming frequency of such instances of violent outbursts and mob justice.

When asked about such incidents, Taim Ahmed Shaan, an intern doctor at Mugda Medical College Hospital, stated, "The actual rate of workplace violence against doctors is very high. There are hardly any cases where patients are admitted, and their relatives don't threaten the doctors. Sometimes, doctors defend themselves, but they often fall victim to these attacks, particularly in primary care settings where resources are limited. I firmly believe we need police protection, just as other areas like the railway do." A study titled Workplace Violence in Healthcare Settings in Bangladesh revealed that delayed treatment (26.8 percent) and power dynamics (26.1 percent) were the leading causes of violence, especially in under-resourced primary healthcare centres.

In a coordinated healthcare system, doctors aren't the only healthcare providers. Paramedics, medical assistants, nurses, and ward staff play a vital role in a patient's care and counselling. But, due to staff shortages, doctors are compelled to be the only healthcare professionals in many primary or even higher centres. In case of any treatment failure, be it for an iatrogenic cause or a divine one, doctors are the ones who have to face the rage of the patient's loved ones. Within the current medical and dental syllabi, little emphasis is given to practical training on counselling patients. Even if this is included in academia, there is still a lack of counselling rooms for patients' relatives, human resource officials to handle such delicate situations, and security personnel in our facilities.

Due to inadequate and ill-equipped security, mid-level or intern doctors often have no choice but to call in their juniors or medical students as reinforcement. At the time of writing this article, I (Mehrab) received a call from one of my seniors, an intern doctor who said that a patient's condition had been deteriorating in the emergency department. Despite counselling the family, they kept threatening the doctors. He instructed me to inform the others and be prepared. Unfortunately, phone calls like this have become too common across medical campuses.

An upsetting truth about the intensive care unit (ICU)/emergency department is that even when doctors follow protocol and do everything in their power, patients can still expire. The patients are often brought in too late with little or no first aid provided. The survival rate in emergency and casualty departments is, therefore, very low. Yet, for the family of the deceased, it's their loved one who has passed away.  The trauma of losing a family member is understandably overwhelming. The family deserves to be in a private setting when the news of their loved one passing away is delivered so they can process the information. The situation in most of our facilities is quite the contrary.

CCTV footage from Cox's Bazar District Sadar Hospital, widely circulated on social media platforms as well as numerous news outlets, recorded Dr Sajib doing everything by the book. He performed cardiopulmonary resuscitation (CPR) on the patient for several minutes and tried to revive him when he flatlined. Unfortunately, the patient didn't make it. Thereafter, the footage also captured multiple relatives being given access to the ICU.

Upon witnessing the death of the patient, the relatives assaulted the doctor, dragging him down an elevation ramp, all the while pounding him with punches and kicks. In the end, Dr Sajib is seen lying down on his face, beaten unconscious. Protests and strikes from doctors following the two incidents were met with consolation and assurances — a meagre band-aid on a profusely bleeding wound.

The problem here is: How did unaccustomed civilians get access to a controlled environment like the ICU? Medical professionals are trained to handle such life-and-death situations. But, in our hospitals, civilians often get access to these places, become overwhelmed, and assault healthcare workers. Entry into these vulnerable environments should be controlled much more carefully.

To discourage malpractice from doctors and ensure justice for patients, malpractice courts need to be strengthened and streamlined so cases don't pile up. Doctors and other healthcare professionals must also be given thorough training in patient counselling. Additionally, security staff need to be briefed about the scenarios they might face in a hospital setting.

All of these individual steps should be made coherent through additions or reformations in the existing laws and policies that do exist. At present, under Section 353 of the Penal Code, assaulting a government doctor, nurse, or staff causes a fine or three years of jail time. Non-government healthcare workers, however, can only file a civilian assault case. Yet, their profession puts them in dangerous situations with a genuine risk of being assaulted. Separate laws are necessary here. An expert committee should be formed to help combat the risks healthcare workers are exposed to. The inclusion of junior and mid-level doctors, who are often on the front lines and are subjected to most of these assaults, is essential to the efficacy of this committee. Otherwise, the changes required won't be properly addressed; it'll remain at risk of being reduced to bureaucratic jargon.

As doctors, we take the Hippocratic Oath and swear to put our patients' needs above all else. However, the ongoing brutality against doctors and other medical professionals is demoralising for both medical personnel as well as the newer generation who wish to enter the healthcare field. If we, as a society, fail to save the lives of our doctors, then who will be left to save our lives?

Purna is a second-year medical student at Shaheed M. Monsur Ali Medical College, Sirajganj. Send her e-mails at: ahnafpurna@gmail.com

Mehrab Jamee is an activist at Sandhani, a 5th-year medical student at Mugda Medical College, and writes to keep himself sane. Reach him at mehrabjamee@gmail.com