Trigger warning: mentions of suicide, workplace sexual harassment and caste-based discrimination
In 2019, after Dr. Payal Tadvi tragic death by suicide, more than seven different committees were formed to probe what led to her death, ranging from the anti-ragging committee at BYL Nair Hospital, where she was a second-year postgraduate student pursuing gynaecology. While a few committees acknowledged the caste-based discrimination she endured during her residency, most dismissed it by attributing it to her 'inability to cope with stress.'
Even four years after her passing, the lopsided focus remains only on the student’s ‘inability to cope with the academic pressure’ rather than demanding accountability from institutions.
According to recent Lok Sabha data, Maharashtra finds itself in the unfortunate second position in the nation alongside Gujarat for medical student suicides after Karnataka. What's alarming is the surge in suicides among post-graduate students, many of whom serve as resident doctors in medical colleges. Out of the 14 medical students who died by suicide in Maharashtra in the past five years, 11 were post-graduate students who fulfilled the crucial role of resident doctors in their respective medical institutions.
But what is pushing the medical students to take such drastic steps? A stark truth emerged as I spoke to these resident doctors within the campuses of Maharashtra's top medical colleges. The frontline warriors of these institutions describe how they endure gruelling shifts, grapple with workplace harassment and more. This intricate mix of pressures is further aggravated by the burden of their social identity, and this is driving them dangerously close to a mental health crisis.
When teachers cross a line
Resident doctors often walk on a tightrope while balancing the need to learn practical skills and academic learning in classrooms. For some, this gruelling schedule means going without sleep for three to four consecutive days. It is then obvious for them to seek support from their professors. What do they get? Toxic behaviour and unrealistic deadlines.
“Once an (overworked) resident doctor from a medical college (in Mumbai) faced scolding from a professor who questioned his decision to eat a meal during the outpatient department (OPD) hours. Such dehumanising treatment naturally leads to immense pressure and distress.”, Dr Abhijit Helge, President of the Medical Association for Resident Doctors (MARD), tells me. MARD works on addressing the concerns of medical students with government authorities to initiate change.
A major part of a resident doctor's duty hours is devoted to patient care. While the environment should prioritise supporting the medical students as they often work in unfamiliar surroundings, they often receive verbal abuse and harsh criticism from professors, including yelling and mistreatment. A resident doctor from Mumbai’s JJ Hospital, who requested anonymity, says, “We do acknowledge the need to speak out, but fear holds us back. Subtle threats of failing in examinations and not assigning important duties are often used as intimidation tactics by some professors that deter us from raising our voices.”
The letter written to MARD in 2019 by the three accused in the case of Dr Tadvi’s suicide, in fact, points out how harassment at the level of institution begins at the workplace, which is later internalised by the residents to the extent that it becomes the norm.
Instead of encouraging the students to know how it feels to work in a high-pressure environment, some professors subtly assign additional tasks to discourage participation in activities beyond academics. A student from one of Mumbai's biggest government-run medical colleges who requested anonymity says, “Some professors also question our dedication towards our work and ask us, ‘Is this why you have come all the way (from your village) to the city (Mumbai) leaving your parents?’.”
In February this year, an anonymous letter highlighted how public humiliation and mental torture are meted out on the resident doctors by the department heads of KEM Hospital, Nair Hospital and Sion Hospital. The letter did not name the professors but termed them as ‘worst psychopaths’ causing mental distress to the resident doctors placed under them.
In June 2023, over 750 resident doctors from JJ hospital went on strike, alleging harassment by the former dean and head of the Ophthalmology department. An inquiry later pointed out that the faculty was at fault, leading to the resignations of 9 medical staffers. Issues of sexual harassment also plague the student-teacher relationship. In May 2023, a medical college professor was booked after a 22-year-old medical student lodged a police complaint alleging sexual harassment by her teacher.
Shortage of faculty, Stagnant hostel accommodation
If regular intimidation from a few professors wasn’t enough, several departments within some medical institutes do not have enough faculty to teach. In the last 6 years, there has been a 50 per cent jump in the availability of MBBS seats in Maharashtra as the state government had sanctioned approvals for building several new medical colleges to address the state's doctor shortage.
But it’s easier said than done. According to the latest report in August 2023 by the Hindustan Times, the five medical colleges run by the Brihanmumbai Municipal Corporation (BMC) face a shortage of 439 doctors.
And despite the substantial increase in medical seats over the years, hostel capacity remains stagnant. As a result, the junior resident doctors are forced to live in cramped living conditions, with more than four students sharing a single room. Earlier this year, more than 7000 resident doctors from the medical colleges staged a protest demanding better hostel facilities, among a host of other problems.
The protest led by MARD was later called off when the Medical Education Minister Girish Mahajan immediately released Rs 12 crore funds to the Public Works Department (PWD) for the repair works. Dr Helge further adds that there is still a significant shortfall in available rooms. While MARD has met the Maharashtra Governor Ramesh Bais to propose a potential solution—leasing out hostels or buildings near campus to ensure that resident doctors remain close to their workplace, a norm mandatory for medical students—a lot remains to be done on this front.
Sweeping the conversation of caste under the carpet
When you add all these systemic issues to how identity worsens this discrimination, an even more glaring problem emerges.
A 2021 report titled Steady Drumbeats of Casteism found that medical students on the Maharashtra campuses from the dominant castes and tribes echoed a recurring sentiment toward the students from the marginalised communities. The report quotes several student testimonies of social discrimination. 'Tula kashala abhyas karava lagto Tu tar sarkarcha javai ahes [why would you need to study and read? you are like the government's son-in-law].' This hints at a negative outlook toward the affirmative reservation policy aimed at providing equal opportunity to individuals from the marginalised communities on campuses.
Unsurprisingly, students from the Dalit and Bahujan communities are often subjected to such humiliation under the garb of campus jokes. In the case of Dr Tadvi too, the investigation revealed that she endured bullying and several casteist remarks from the accused doctors despite complaining about it to the college authorities, who continued to disregard her plea for help.
In 2007, the government established a committee chaired by Prof. SK Thorat to investigate claims of unequal treatment towards SC/ST students at the All India Institute of Medical Sciences (AIIMS). As a result, several crucial findings and lapses on the part of the institute were brought to light. The committee had provided a detailed list of recommendations that could have been implemented by Maharashtra especially after Dr Tadvi’s case.
While a lot of medical colleges in the state have adhered to the recommendations, they seem to have conveniently missed out on the suggestion that emphasised the importance of establishing a SC/ST cell with an assigned liaison officer. As per this Indian Express report, a BMC official and a member of the Maharashtra State Scheduled Caste/Scheduled Tribe Commission stated that medical colleges are not mandated to form SC/ST committees. The Nair Hospital Dean, Dr. R N Bharmal, had gone on record to say that caste discrimination complaints are directed to the police, and the anti-ragging committee handles only the harassment and ragging cases in medical colleges. Even in 2023, no medical college in Maharashtra has a dedicated SC/ST student cell.
Why are students hesitating to seek help?
A recent research study conducted by Solapur’s Government Medical College points out that out of the 619 undergraduate students who participated in the study, nearly 358 medical students reported extremely severe anxiety, 103 experienced extremely severe depression, and 68 endured extremely severe stress.
In contrast, the on-campus counselling programmes have been mainly ineffective in gaining the students' trust. For example, the Student-Dosti Programme, an initiative by the KEM hospital, had invited students for on-campus counselling. However, as per their website, in 2022, only 94 students from 1st to 4th year of the college attended the session. Similarly, in July 2023, the Directorate of Medical Education and Research (DMER) started a 24/7 helpline number Sanwad 14499, for the resident doctors and medical students in coordination with the State government and the Maharashtra Institute of Mental Health (MIMH). In the last 3 months, it has received only 12 calls from medical students across Maharashtra, including districts such as Solapur, Pune and Mumbai.
I spoke to Dr. Shrikant Pawar, an Assistant Professor of Psychiatry at MIMH, and he said, “Medical students often think of themselves as doctors in the making. This makes them uncomfortable, and they hesitate to approach the counsellors. Many medical students live away from their families and lack support from their peers while bearing the weight of high expectations from their family members. To address these issues, institutional changes at the campus level by establishing a stronger student support system should be the priority for all medical educational institutes.”
Are the medical institutes really listening?
It is crucial to note that in the previous years students have fought the stigma against mental health issues. In 2016, after repeated protests by students, the Maharashtra University of Health Sciences (MUHS) had issued a notification making it mandatory for the medical colleges particularly the one that offers post-graduation, to conduct physical and mental health check up of all the resident doctors on campus. However, even after several years, several medical institutes have failed to screen vulnerable students who need physical or psychological help.
The NCRB's Accidental Deaths and Suicides in India (ADSI) reports 2021 report reveals that the most common reasons for suicides among those under 18 were family problems (30%), followed by love affairs (14%), illness (13%), and failure in examinations (8%). Notably, a significant portion of the "illness" category was related to mental health issues.
While addressing the issue of suicides in medical colleges in Maharashtra, the NMA had issued directives to medical colleges across India to prioritise the well-being of their students; for every 15 students, one faculty member shall be appointed who will oversee the progress of the student throughout their MBBS course. But what happened? Each life lost to suicide should set a reminder that only institutional change can protect these future doctors while upholding the sanctity of educational institutions as true second homes.
As we look into the challenges young medical students face, it becomes imperative to question the sincerity of the institutions entrusted with their education and well-being. In times of vulnerability, they may turn to their teachers for guidance and support. However, what happens when these very teachers and the institutions are the perpetrators of the issues these students are grappling with? When power dynamics are used to ‘put students in their place’, it creates an environment of fear and silence. Iit is the collective duty of all the stakeholders, particularly the institutes, to ensure that the students do not merely fade into statistical records.
Featured image is for representational purposes only.
This story has been written as part of the My City Writers’ Training Program.