A social sickness beyond the reach of doctors

March, 01/2018 - 09:00

Statistically speaking, it might or might not qualify as an epidemic, but it was not too long ago that we talked about violence against doctors and other medical staff.

by Thu Vân

Statistically speaking, it might or might not qualify as an epidemic, but it was not too long ago that we talked about violence against doctors and other medical staff.

We are forced to confront the issue again, now, and that is too soon for comfort.

In just one week, two cases of doctors and nurses being assaulted have been reported. The first incident happened in the northern province of Yên Bái where two doctors were attacked for refusing to let a family member of a pregnant woman take photos of her caesarean section last Monday.

The second one, last Saturday, saw doctors and nurses in Bố Trạch District, Quảng Bình Province, beaten up after receiving two patients injured in a traffic accident. The patients had apparently died before they reached the hospital.

This facile resort to violence, that too against people entrusted with the task of treating and curing sicknesses and saving lives, is deeply worrisome, but public responses on the lines of “they had it coming” are even more troubling. They hint at a toxic cynicism that is inuring us, as a society, to irrational violence.

As we revisit the issue, a more sober, deeper reflection on the problem entails an acknowledgement at the outset that even such irrational violence does not occur in a vacuum.

The many grouses, grievances and frustrations of Vietnamese people with the national healthcare sector’s numerous shortcomings are well known. There have been instances of doctors making mistakes, including abusing their position of privilege vis a vis patients. But no matter how many medical horror stories we get to hear, we know for a fact that there are many doctors in the country who are not just a credit to the profession, but people that we can take pride in and be grateful to.

The problem, therefore, lies beyond errant individuals on either side. There are systemic issues with our healthcare sector, and these are not particular to Việt Nam. The problem of violence against doctors has been studied in nations with big populations like China and India, and many structural issues with the healthcare industry identified.

But first, we should look at some of the symptoms at home.

Public trust is something that is in short supply, as far as our healthcare sector is concerned, but a fairer look is essential.  

Research shows that a basic psychological principle is that bad emotions have more impact than good ones. Bad impressions and bad stereotypes are quicker to form and more resistant to disconfirmation than good ones. But one person can’t be a representative for thousands. It’s just unfair to assume all doctors are heartless and mercenary.

Everyone wants an ideal healthcare environment where healthcare is cheap and the doctors always smile at you. But this requires investment, meaning adequate budget allocation and proper working conditions.

While Việt Nam’s spending on healthcare is relatively high compared to other developing countries at around 7 per cent of the country’s GDP, healthcare facilities and working environment for doctors leave much to be desired.

According to the World Health Organisation, there is only an average of 7 to 8 healthcare workers and 25 hospital beds for every 10,000 Vietnamese citizens. This is much lower than the global average of 15 healthcare workers and 30 beds per 10,000 people.

There’s no official survey – but many doctors have to work up to 80 hours a week, receiving up to 100 patients a day. They face many occupational hazards. They are at risk for communicable illnesses, both common and rare; workplace violence; abuse and assault, both physical and verbal. Then there is the stress that leads to burnout, depression, substance abuse and even suicide. 

Given this context, doctors in Việt Nam have made impressive achievements.

Last year alone: Vietnamese doctors successfully performed for the first time a lung transplant from two living donors. The transplant was conducted at the Military Hospital 103, in co-ordination with doctors from the Vietnam Military Medical Academy and Japanese experts. We have made great strides in the application of robotic endoscopic surgeries. In April, the National Hospital of Obstetrics and Gynecology announced successful testing of the new technique, which involves using a “catheter” to broaden the internal orifice of the uterus via an endoscopy through the womb and abdomen. After more than 10 years of study, the technique was successfully deployed on two women diagnosed with secondary infertility.

Also for the first time in Việt Nam, 3D technology has been successfully applied in cardiovascular endoscopic surgery at E General Hospital in Hà Nội. 

These achievements have to be communicated more effectively to the public at large.

But we should also be aware that editorials and correspondence on the issue have been carried by the prestigious medical journal Lancet over the last six years at least.

Once such editorial last year, referring to violence against doctors in China and India, noted: “However, violence against doctors perpetrated by patient escorts is a superficial sign of a deeper systemic failure. Reactionary measures, such as enhanced security at government hospitals or harsh medical negligence laws, are unlikely to boost the flagging morale of the medical workforce or represent sustainable solutions for the delivery of safe, effective, low-cost, and truly universal healthcare in the long term.”

Truly universal healthcare must be juxtaposed against the universal healthcare aims envisioned and articulated by our own policymakers. Only then can we accurately diagnose the ills that plague our healthcare system, and only then can we find the medicine for a social sickness that lies beyond the reach of doctors. — VNS