By Nisha Susan
If you haven’t been living under a rock, you have heard women asking each other for the numbers of non-judgemental gynaecologists. Non-judgmental gynaecologists is what they ask for, not women gynaecologists. The medical system makes it amply clear that women doctors can be as emblematic of the horror-movie patriarchy that is the medical system. You have met them. Now imagine the three senior doctors who reportedly bullied and tortured Dr Payal Tadvi all the way to suicide in BYL Nair Hospital, Mumbai as your doctors. Imagine Drs Hema Ahuja, Antika Khandelwal and Bhakti Mehar who seem to be on the run after Tadvi’s death on May 22, treating you and operating on you. Imagine asking one of these doctors for their opinion and trusting that she is recommending your uterus be removed for your health. And not because she took a quick peek at your surname and decided that someone from your caste is not worth a thoughtful diagnosis or worth reproductive rights at all.
Tadvi’s bullies certainly seemed to have decided that the bright young doctor from an Adivasi family didn’t deserve her career, telling her that they wouldn’t let her finish her MD, do surgeries or even meet her mother when she was visiting. According to her family the bullying was severe enough for her husband and mother to lodge complaints, for her to be transferred out of the unit where she was deeply unhappy (only to be transferred back again). Severe enough that a few months ago, Tadvi’s family had approached the superintendent of police in Jalgaon where she had completed her MBBS to complain about the bullying that extended to the Whatsapp group the doctors were part of.
This is not the first death from casteism in a medical college, of course. As recently as January 2018 Dr M Mariraj in an Ahmedabad college attempted to commit suicide reporting a very similar pattern of casteist bullying from the establishment which asked him to serve tea and kept him out of surgeries. Insight Foundation’s three-part documentary Death of Merit was conceived after the tragic death of Balmukund Bharti, a final year student in All India Institute of Medical Sciences, New Delhi, who committed suicide in March 2010. The title is heavily ironic but ‘merit’ continues to be discussed with all seriousness year after year, after every death. Even today, there are folks responding on Dr Tadvi’s friend Dr Simin Khan’s Twitter timeline saying mindboggling things such as ‘they didn’t torture her because she was from an OFFICIALLY backward classes. But because she was well off economically and still used reservation quota to get things right… Find it crude but this is what happens when government’s schemes stretch too far.’ It doesn’t matter that no one knows whether Dr Tadvi did access reservation. It doesn’t matter because savarna guardians of merit and the quality of medical care are only inflamed by the presence of Bahujan students. The presence of savarna students who got in only by paying gigantic donations (after highly capital-intensive education and coaching classes and lives) never seems to worry those po-facedly saying there should be no reservation in medical college. If you ask medical students they will tell you about all that they need to do and what it costs (sometimes in actual rupees) to stay in the good books of professors, seniors, external examiners and ethics committees. Still, savarna doctors like to behave as if their place in medical school is, to use a medical term idiopathic — a condition that arises spontaneously or for which the cause is unknown.
While the Indian Medical Association has issued a deafening silence the Maharashtra Association of Resident Doctors (which has suspended the three doctors) seems to think the solution lies in an orientation programme for young doctors that will improve communication. Anyone who has seen screenshots of the Whatsapp chats of the absconding doctors will know that communication wasn’t their problem. Long before the professional education stage, schools should be talking about casteism. We should be talking about caste beyond a paragraph in history textbooks in that chapter about the Vedas. We should be talking about the complex, blatant and subtle ways in which caste affects our everyday behaviour, from our access to resources all the way to the transfer of pain across generations. Our schools and colleges need to be unsqueamish places where you have to confront the ridiculous word that is merit and kick it. And then when you get to medical college or law school you should have to attend further classes where you confront your flawed humanity or else you will be that south Bangalore Brahmin doctor who told my colleague who had cysts and ulcers that her chronic stomach pain was because she ate mutton curry the previous evening.
I once knew a kind and brilliant young medical student. He had sweet endearments for his girlfriend, was crushed like an eggshell when she broke up with him, worked hard to understand how public health can be improved. When we spoke about the first few weeks of college and ‘ragging’ he told me a horrifying story that ended with all the first years having to jump into a pit of pee. What was doubly horrifying was his beatific smile as he told me that he thought it had been a good bonding experience. I don’t know what he feels about it now but when my skin still crawls at the memory. Ragging is only the highlights of the full-on dehumanised medical college experience. Modern medicine and medical education around the world is highly alienating, and needs a permanent mirror in its face to show its power-hungry face. But in India we have a perfect storm of gender, caste and class that produces the majority of our doctors. On the other hand if the Twitter account that I found did indeed belong to Dr Payal Tadvi this was a young woman with a deep interest in ecology, in public health and the world much, much wider than her. Mostly though we have Savarna doctors who are squeamish about touching patients, too used to thinking well of themselves to consider speaking to patients, too used to discounting the pain of others to inconvenience themselves in any way.
In the last decade women around the world including in India have begun to talk about what it means to be a woman patient. Pain, heart attacks, dosage, contraception, conception — feminist critiques of medicine helps us understand that the male body is not neutral and the body is not just a body, it lives in the world as a social being. But while we talk, medical colleges continue to function as grinding mills. Untroubled by any political critiques they continue to work towards producing people who will be able to monetise every 15 minutes they are awake. Teenagers who have spent their childhood in tuitions and coaching classes get in and leave as adults who still don’t know how to talk or listen. Their education doesn’t educate them. And in the five years of their sentence they turn on each other and the most vulnerable among them. And then when they graduate we have a situation in which human beings at their most vulnerable having to seek treatment from people whose education has taught them to show no kindness, understand no weakness. And if you are still worried about merit let me give you a tip. When the student parking spaces of medical colleges accommodate SUVs that’s when patients should worry about the future of medicine.
Co-published with Firstpost.com