MARD strike : our reservations

The MARD strike raises several questions for the larger medical community.

There is some truth in grievances raised by MARD: insufficient pay, poor living and working conditions, long working hours, and insensitive or absent redressal mechanisms. This was the organisation’s 16th strike in as many years. Their frustration is understandable if conditions have not changed significantly even with several changes in government. But the larger concern is the grave consequences to the lives and health of lakhs of patients who have nothing against the doctors, and have little leverage with the government. In several instances emergencies were neglected, almost amounting to rights violation.

The problem stems partly from the over-reliance on teaching institutions, and the neglect of all other government hospitals including rural hospitals and health centres, forcing most patients to travel hundreds of kilometres and for several days for health care. Extra work pressures and poor hospital conditions are a direct result of this perennial neglect.

Second, there is lack of clarity on the status of resident doctors. Are they resident students or employees? What are their ethical and legal responsibilities if they abstain from mandatory work?

Third, what is the basis for their compensation? Are they given subsistence as a matter of goodwill, or are they paid on the basis of an accepted principle? Should residents in all the specialities be paid the same though those in some departments have a lighter workload than others?

Finally, does any reasonable redressal system exist, or must the battle be fought on the streets? No previous government has attended to this problem.

Still, we have two very definite reservations on the MARD stand. First, it is obvious that the strike hurt people in pain more than the state with whom residents had a grievance. This is not just an issue of profit or loss. It affects several families adversely, and for life.

Second, MARD should have started the settlement initiative rather than resort to a strike just when the new government came into power.

The larger issues go beyond the strike to the overall framework of our health care system. Even 50 years after the Indian republic was formed, we have aggrieved doctors in urban hospitals while the majority of villages don’t even have health workers, let alone doctors. The government has done practically nothing to help the matter. Most teaching institutes do not have adequate full-time staff, and depend on students, who usually manage most day-to-day work. Finally, the cost of medical treatment is rising beyond what ordinary people can afford. We all need to pay attention to these deeper maladies rather than react in the usual knee-jerk manner.