The incident took place in June of this year in Delhi. Following a brawl over parking, two groups of people were brought to Acharya Shri Bhikshu hospital in Motinagar by police due to injuries. While the doctors on duty were treating the first group, people from the other group were brought into the emergency department. The second group of people attacked people from the first group while they were being attended by the medical staff. Guards at the hospital tried to intervene but to no avail.

The ensuing brawl led to broken furniture and medical equipment in the emergency ward. Several doctors, including the Chief Medical Officer (CMO), and other employees had to lock themselves up in a room to escape the violence. This incident came on the heels of a written request by the Health Minister to Delhi Police, seeking better security for doctors. A few days before this incident, nearly 15,000 doctors from 22 government hospitals in Delhi had gone on a two-day strike demanding increased security for hospitals, provision of medicines, improved work hours, an increase in stipend and the number of beds in all government hospitals. During the strike, Out-Patient Departments (OPDs) and ward services were suspended while emergency services continued.

At the beginning of July, 4000 doctors in Maharashtra also went on strike with similar demands. The Government of Delhi had to impose Essential Services Maintenance Act (ESMA) to force the doctors back on duty. Since 2006, doctors in Pakistan have also gone on strikes demanding similar provisions from the government. A Young Doctors Association was formed in Lahore during 2006 in response to incidents involving violence against doctors serving in Government hospitals. In different incidents, attendants of patients have attacked the medical staff physically, damaging hospital equipment. In 2012, the Punjab Government overreacted to strike by Doctors by attacking hostels in Medical colleges and arresting doctors who were not even involved in strikes and agitation.

In KP province, doctors have also demonstrated for their rights. The issue of a ‘Service Structure’ has been on the agenda for doctors during the strikes. Provincial governments in KP and Punjab have promised implementation of the ‘Service Structure’ but concrete steps have yet to be taken. Why are educated professionals in developing countries revolting against the governments? The pressures that one has to go through during pre-medical studies, during medical education and afterwards promote a sense of frustration with the system among doctors. The pressures of keeping a job, staying alert at all times during duty hours, getting adequate pay for the job and specialising in a particular field at the same time can break the strongest people.

Diane W. Shannon, a medical professional from the United States decided to leave clinical practice and wrote about the factors that drove her away in an evocative blogpost. She contemplated, “Why is there such a discrepancy between the public’s perception of what we [as medical professionals] are capable of, and what we [as medical professionals who are also human beings] are truly able to sustain? We are individuals who are driven to succeed, but in many cases this is because we have been told all along how difficult our paths would be. We are healers, trying to alleviate pain and suffering, but this often comes at the expense of our own best interests. We are persistent because we have endured years of educational training far beyond those of our friends, but this coms with the sacrifice of maintaining those same friendships.” The popular perception about doctors in subcontinental culture is that of white-collared professionals earning a decent sum of money and having an upper-middle class living. The reality is not that rosy. After cut-throat competition in pre-medical years and after the ‘Entry Test’, few of the aspirants make it to medical colleges. The number of students sitting for Entry Test in Punjab during 2006 was more than twenty thousand. Only about two thousand students passed the test and got admission in various medical colleges of Punjab. From the remaining, some opted for private medical colleges (that charge an arm and a leg in tuition fee) while the rest either tried again or went into other fields.

The class of 2006 graduated in the beginning of 2012. Almost half of the students had to do House Job without pay. The hours during House Job are longer than most jobs in non-medical sector, including 30-hour calls and 24-hour emergencies on a stretch. After House Job, there were two options available to the Graduating Class of 2006-12. They could either opt for further studies by taking the entry-level exam conducted by College of Physicians and Surgeons Pakistan or they could study for US or UK-based residency programs. Almost 30% doctors opted for the foreign route while the rest decided to stay. Their options included the local residency program or joining the government service through Public Service Commission. During the last two decades, interviews for posts through Public Service Commission have taken place only two or three times.

For people opting for residency route, the number of paid jobs in teaching hospitals are limited, forcing many to work without any pay for many months (even years). The proposed ‘Service Structure’ addresses many of these issues, making life relatively easier for the so-called ‘cream’ of the nation. In this system, people who graduated from foreign institutes (in China, Russia, Cuba etc.) or from private medical colleges in Pakistan, are at a disadvantage. The reality of being a doctor in Pakistan or India today is much different than the ‘image’. The strikes are going to continue till any workable solution is found.