Mahatma Gandhi (Young India, May 21, 1925)
Barua and Verma assess the role of caste in workplace bullying at Indian healthcare facilities in their recent Comment in IJME (1). They examine the possible role of caste in mental violence suffered by trainee doctors. They conclude with a call to address the issue of mental health needs of doctors. It is true that doctors work under tremendous stress, have to make rapid decisions, sometimes consider the death of a patient as a personal failure, and frequently wonder what more could have been done to save a life. I believe that should not be a pretext to shield habitual offenders of caste-based violence which, sadly, the authors appear to be doing in their Comment. Sylvia Karpagam correctly states that caste-washing the healthcare system will do little to address its discriminatory practices (2).
What I want to make the authors remember is that suicide resulting from caste-based harassment is to be looked at as a continuum. Every year, several students die by suicide for this reason, and this is conveniently dressed up as a mental health issue of the victim (3). The vested interests of the authorities and the desire to bail out their bullying colleagues do not allow them to accept the reality. In the section “The casteism-reservation intersection”, Barua and Verma write that “the problem of casteism in medical colleges is partly fueled by reservation in entrance examinations”. I want to remind them that caste-based discrimination is not a unique pathology of medical institutions. Last year, a report in The Print stated that of 89 Secretaries in the current Union government, there were just three from the Scheduled Tribes (ST), one from the Scheduled Castes (SC) and none from the Other Backward Classes (OBC) (4).
Another report in the Indian Express last year revealed that just 12.4% IIT- Madras faculty belong to the reserved category (5). I want to inform the authors that the malady of caste based discrimination is all pervasive and the examples are numerous. This author is privy to conversations with faculty members who have faced slights, innuendo and sometimes plain mockery when they inform their interviewers that they are applying for a reserved seat. There are no prizes for solving the puzzle of vacant faculty seats in these institutes of national importance, when all the facts are laid bare for appraisal.
It is a fact that sometimes undeserving candidates get the benefit of reservation in educational opportunities and jobs. And for that purpose, there is a rule excluding the “creamy layer” in OBC reservations (6). When a candidate keeps on getting the benefit of reservation at more than one level, again there is misuse of scant national resources due to which a more deserving candidate of the same group may be left out (7). But looking through this window, we find that all the laws are misused at some point: for example the SC/ST (Prevention of Atrocities) Act, 1989, the Dowry Prohibition Act, 1961, right to freedom of expression and now even anti-terror laws. But despite misuse, these laws remain in our statute books and constant collective efforts are being made to prevent misuse.
Positive discrimination under caste-based reservation is made to allow oppressed groups to access their rights in a democracy where none exist at baseline. If some individuals deny this opportunity to someone, what sort of healers such persons will amount to needs to be considered. Daily, we examine patients at their most vulnerable times, when they are suffering and desperately seek our help. If someone brings the culture of bullying into that environment, in my opinion he or she is the biggest perpetrator of violence, and has never understood the meaning of the art of medicine. And if the violence is directed towards the most vulnerable person in the hierarchy, who can’t even fight back, it is the biggest crime of all. The irony of our times is that such violent actors are seldom, if ever, brought to book!