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Many Uncomfortable Truths, And My Appeal

Disclaimer: These are my personal views surrounding the tragic death of my student.

Yesterday, I attended the funeral. There was a large police contingent and media presence. Everything was controlled by the police and other officials. Everybody who was somebody came to pay their last respects. However, many attended the funeral for optics. Their priority was being in the media coverage and making public statements of condolence and sorrow.

The parents were inconsolable, yet were unable to grieve in private. Cameras recorded every moment as part of a live stream. There was no dignity in death also. I felt disgusted by what I saw and deliberately stayed away from camera view. I was not there for self-promotion or publicity. What should have been about the deceased had been hijacked to be about others.

Since the time of the event, several narratives have emerged. I cannot vouch for the veracity of any claims as I have only second-hand information. However, I have had time to think about the incident in some detail and will attempt to articulate my thoughts below as responses to claims.

Claim: The attacker was addicted to ganja (marijuana) and received treatment from a de-addiction centre.

Response: How did he develop this addiction? Where did he obtain the contraband from? Who are all involved in the supply of drugs? Why is no action taken against the drug mafia? How many more are affected by this menace?

Claim: The attacker was not in police custody, and had been brought by police for treatment since he had an injury to his lower limb. In fact, the attacker had himself contacted the police and complained that he was being attacked.

Response: The police is expected to have a high index of suspicion at all times. Whenever they receive a complaint they are ordinarily expected to conduct a preliminary enquiry before taking action. If, as claimed, there was nobody with the attacker when the police arrived, how did the police verify his claim that he was being attacked before (in effect) granting him protection?

Claim: The attacker was behaving normally and suddenly became violent.

Response: The police is expected to identify those who behave suspiciously, including those under the influence of alcohol or drugs. Why was the police unable to suspect the attacker of substance use when his appearance (from visuals in media) is clearly abnormal?

Claim: Several policemen were unable to restrain the attacker.

Response: If true, how was it possible for a single intern to pull the attacker of the deceased?

Claim: Policemen fled the scene when they were attacked.

Response: Aren’t policemen given training on how to control aggressive or violent persons? Isn’t the police expected to use its training to subdue miscreants to protect innocent civilians? If the primary duty of the police is to protect citizens and maintain law and order, did the police discharge its duty in this case?

Claim: The Casualty Medical Officer (CMO) and other staff were present during the incident.

Response: What was the role of the CMO in assessing and resuscitating the deceased? What first aid was provided to the deceased at the government hospital? Why was the deceased shifted to a nearby private hospital? Who authorized the transfer and on what basis? Was it not possible to stabilize the deceased at the government hospital?

Claim: The deceased had a pneumothorax that resulted in her demise.

Response: Why was this not detected during medical assessment either at the government or at the nearby private hospital? Why was this possibility not considered especially since the victim had multiple stab injuries including on her torso? Examination of the respiratory system could have revealed abnormality before and after intubation even in the absence of radiography.

Uncomfortable truths

The police was neither prepared nor trained for such a situation. Even if they were, it must have been a long time ago else their training would have kicked in instinctively. To ensure preparedness, regular training/ refresher sessions are necessary.

The majority of medical students, doctors, and healthcare workers are women. The physical differences in size, strength, muscle mass, etc. between men and women make it highly unlikely that they will be able to defend themselves against attacks by one or more violent/aggressive men. Martial arts training may be helpful in certain situations, but will be a poor substitute to systemic changes resulting in safe working environments.

There is a shortage of resources in both public sector and private sector healthcare institutions. These include funds to install CCTV cameras, barricades; manpower to ensure round-the-clock presence of skilled personnel capable of dealing with such situations; and appropriate equipment for crowd control among other things.

There is widespread use of alcohol, drugs, and psychotropic substances. However, there is limited awareness on how to identify individuals experiencing withdrawal symptoms/drug-induced psychosis, or methods to restrain/control them to prevent harm to self and others. Law-enforcement agencies, and healthcare workers must be able to identify and manage the entire spectrum of drug-related behaviours.

There is a decline in clinical skills among medical graduates. Students do not invest in acquiring clinical skills (history-taking and physical examination), so depend on external sources of information (monitors and sensors to obtain blood pressure, pulse rate, etc; and laboratory investigations to arrive at a differential diagnosis/diagnosis). Faculty encourage and promote such behaviour by failing to strictly insist on skill acquisition, and permitting incompetent students to progress. Coupled with an overall erosion of values, we now have students and graduates who do not possess the necessary skills to clinically assess patients, and simultaneously fudge patient details without assessing the patient. As hardly anybody seems willing to insist on either skill acquisition or integrity, we are now producing medical graduates who are both incompetent and untrustworthy. In the long term this will result in avoidable loss of lives.

My Appeal

To everybody: This incident is the result of systemic failure. We are all responsible (I hope my responses to various claims establish that adequately). Therefore, please do not indulge in blaming others. For one, it will not solve any of the issues mentioned. Secondly, it will vitiate the atmosphere. What is needed is humility to accept our shortcomings and failings, and a willingness to cooperate and collaborate with others to bring about meaningful changes so that such an incident does not repeat itself.

To the medical fraternity: Please offer practical and actionable suggestions to address concerns, instead of only pointing out issues. Please do not disrupt medical services or training activities as doing so will be counter-productive. Please utilize the expertise available within the medical community to develop guidance documents, protocols, and other tools to deal with such instances (of substance use, violence, psychosis, withdrawal, etc.). Share these with policy makers and help with implementation at all levels. Be a part of the solution.

To the media: Please help spread awareness about substance use. Employ the tools available at your disposal to obtain statistics related to substance use, implementation of laws, etc. Serve as a watch-dog and speak truth to power, exposing lies and deficiencies. Please ensure that media coverage does not invade someone’s privacy or insult their dignity.

To leaders: Please use the inputs received and make meaningful changes to existing legislation. If necessary, enact new legislation. Please do whatever is necessary to provide a reasonably safe working environment to healthcare workers.