An editorial in The Lancet & reactions to it by the IMA has set off sharp criticism from doctors
The poignant story of how a journalist in Kashmir got to know about the miscarriage that his sister suffered in a hospital has substantiated the argument of a large group of doctors who have taken up cudgels against the Indian Medical Association (IMA) and the Indian Psychiatry Society (IPS) over their stand on an editorial in The Lancet.
Adil Akhzer, Senior Correspondent of The Indian Express, describes the trauma of his sister when the junior doctors at the maternity hospital could not make that one phone call to their senior colleague, a gynaecologist, to save her new-born son. And how the family could not inform him for eight hours because the phones had been disconnected.
“The drop in the heartbeat of my sister's baby couldn't be communicated, on time, to the senior doctor as the cell phones were dead. My brother told me that the hospital had to send a vehicle to fetch her and when she arrived in the evening, she could only reconfirm that the baby is no more,” wrote Adil.
“Our case was not the only one at the hospital. Every patient has his or her own story. One has been trying desperately to reach his family members in Pulwama because he has run out of money; an attendant from Bandipore, who had to send a message to her family about the critical condition of the baby through an ambulance driver. Tabish (Adil's brother), who stayed in the hospital all these days and nights, told me many more stories - of despair, agony and helplessness,” Adil said in his report.
Adil's report appeared on Wednesday and a group of doctors, largely public health professionals, psychiatrists and social scientists, from different parts of India and abroad had issued a statement late last week warning about the need to have a good communication system in place to attend to “ensure both mother and neonate have access to blood bank, ICU and neonatal facilities.”
The statement said: “The Federation of Obstetric and Gynaecological Societies of India (FOGSI) is well aware that obstetric emergencies can be rapidly fatal requiring urgent intervention and follow up. Good communication facilities are required to ensure that both mother and neonate have access to blood bank, ICU and neonatal facilities. Women may deliver at home or be forced to walk long distances to access health facilities. Women who develop pregnancy related complications such as obstructed labour, foetal distress, antepartum haemorrhage, premature labour, ectopic pregnancies, twins etc. often have to be carried to health facilities by relatives in the absence of functioning transport and healthcare. This increases the risk of morbidity and mortality in both mother and baby.”
Referring to Adil's report Dr Sylvia Karpagam said: “Such incidents are bound to happen when communication lockdown happens. Only if the doctors are connected to the social determinants of health and the issues that patients face while accessing healthcare, will they learn to anticipate such situations. But they are also taking offence when others point out the issues about patients.”
Dr Sylvia is one among the two dozen doctors who have protested against the Indian Medical Association (IMA) and the Indian Psychiatry Society (IPS) being critical about the editorial in The Lancet, the medical journal.
The controversy arose because The Lancet had commented about the decision of the Union government declaring the state of Jammu and Kashmir as two union territories and abrogating Article 370. Its editorial said that the suspension of communication and the presence of 28,000 security forces “raises serious concerns for the health, safety and freedoms of the Kashmiri people.”
The Lancet went on to point out that a study in two rural districts that were affected by the conflict between India and Pakistan and that nearly half of Kashmiris rarely felt safe. “Therefore, it is unsurprising that people in the region have increased anxiety, depression, and post-traumatic stress disorder.”
The IMA took strong exception to the editorial and considered it as a “breach of propriety by the comments on this political issue. It amounts to interference into an internal matter of India. The Lancet has no locus standi on the issue of Kashmir. The Kashmir issue is a legacy that the British Empire left behind.”
The IMA also felt that The Lancet was reacting to an internal administrative decision of the Government of India under the “garb of concern for the health of Kashmiris.”
This was followed by the Indian Psychiatric Society also condemning what they called “this unsolicited intrusion into the affairs of the Sovereign Republic of India. Generations of Indians, especially the doctors and medical students, will carry the unpleasant memory of this act of commission by The Lancet.”
The IPS also said that the “Indian government has provided excellent health facilities in Kashmir.”
But the decisions of the IMA as well as the IPS came in for much criticism. Another signatory to the group of doctors who criticised the stand of the professional bodies, was Dr Mohan Rao, former Professor, Centre for Social Medicine and Community Health, Jawaharlal Nehru University, Delhi.
“The IMA has forgotten the role of the doctor. He is like a priest irrespective of the class, race, religious belief or gender. He has to provide succour. It is really appalling that the Indian doctors cannot comment on what’s going on in Kashmir. Very seriously, I believe the psychiatrists should question the mental health of their colleagues,” Dr Rao said.
The most unfortunate aspect of this statement war of associations against The Lancet is that there is no effort to deal with the problems that the patients are facing in Jammu and Kashmir.