Demanding a minimum guarantee: safety for women in health workforce in Tamil Nadu Premium

Tamil Nadu healthcare facilities face safety concerns for women staff, highlighting the need for improved security measures.

A nurse looks forward to the day when the broken window of her changing room at a government hospital is fixed. In a faraway primary health centre (PHC), the hope of her colleague to see a metal grille gate installed for the building’s main door gets dimmer with each passing day. At a top healthcare institution in Chennai, a postgraduate medical student on a 24-hour shift looks for an empty patient bed for a few minutes of rest at night as there are no separate rooms nearby for duty doctors. In a neighbouring district, a doctor on night shift at a Comprehensive Emergency Obstetric and Newborn Care Centre feels the need to stay cautious as the three-storey building where she works is manned by a single security guard.

Tamil Nadu, which pumps huge funds into hospital infrastructure, seems to have let slide some of the most basic necessities to ensure the safety and security of the women in its health workforce. Today, the question is whether women feel safe at its 11,000-odd government health facilities, including medical college hospitals, taluk and non-taluk hospitals, and PHCs. According to official sources, women account for at least 60% of the total health workforce in Tamil Nadu. This includes doctors, residents, nurses, village health nurses, accredited social health activists, women health volunteers, and housekeeping staff.

Though the Kolkata incident has sounded the alarm for the health authorities to step up safety and security on hospital campuses, several women healthcare providers and workers feel that the problem goes much deeper. It starts with the most basic of needs remaining unaddressed such as absence of separate duty rooms with toilets and proper water supply for postgraduate students, where they exist, they are poorly maintained and inadequate, nil security personnel at night hours, and dimly lit corridors. There are graver concerns of sexual harassment, verbal abuses, attempts to assault by the irate families of patients, and complaints of molestation/sexual assaults not taken seriously.

A resident doctor of the Madurai Medical College, who did want to be named, says that only after the Kolkata incident have hospitals begun to think about the safety of their doctors at duty hours. Though this is a positive development, it is sad to see such an important issue being raised only after the occurrence of a horrific incident. “A government hospital is a place where thousands of persons enter and exit daily, and in such locations, some of the basic safety measures such as monitoring by security personnel and installation of closed circuit television (CCTV) cameras should be carried out,” the doctor adds. Recently, a 23-year-old man attempted to sexually harass a house surgeon at 8.30 p.m. at the two-wheeler parking lot of the Coimbatore Medical College Hospital. House surgeons, who staged a protest, alleged that the place was poorly lit at night. They also accused the hospital administration of failure to ensure security at night, including deployment of an adequate number of guards.

Such incidents serve as a wake-up call for the authorities but there are several complex issues that have become an intricate part of the healthcare system. Long working hours is one of them. This has become the norm with postgraduate students narrating tales of working for 36 hours (once a week) at a stretch and 48 hours (once in six weeks). A woman postgraduate student, who had been posted on 48-hour duty, says that attending ‘call-overs’ (when doctors of a particular speciality are called to another department for an opinion) at late night hours is scary. “At night, no security guards are deployed on the floors. We have to walk alone from one building to another. What is more problematic is that anyone can walk into the hospital at night as entry is unrestricted,” she points out. An alarm mechanism to indicate any emergency is lacking and intercom connections in the wards aren’t full-fledged.

A nurse in her early 40s points to how shortage of manpower has put them at more risk. “The PHC where I work has four sanctioned nurse posts but only two of us are here for morning and night shifts. At night, while one of us is on duty alone, a woman worker keeps us company. As the PHCs do not have security guards, we are left to manage on our own. We keep the main door locked after 10 p.m. and open it only if somebody knocks. There is no separate space to rest; so, we lie down in the outpatient area,” she says.

A number of nurses narrated how men under the influence of alcohol have caused trouble at night at PHCs. “This seems never-ending. Many of us have faced harassment and verbal abuse from men who are drunk and seek treatment for injuries caused by fights at night. A number of PHCs do not have compound walls. Nearly a year ago, two persons entered a PHC pretending to be patients and snatched a chain from a nurse. Though the Public Health Directorate recently issued instructions to engage night guards, no step has been taken so far,” says another nurse working in a southern district. Emergency units and labour wards are among the most critical areas on a hospital campus where emotions could run high. Families of patients could turn aggressive at any moment, and there are several instances of women staff having faced angry mobs, several doctors and staff nurses say.