The 1982 Hospital Movement: A Fight for Healthcare Reform in Calcutta
Primary health care centres in Bengal became horror stories symptomatic of all that was wrong with the way the front ran its government. The state government failed to create an effective primary and secondary health care infrastructure in Bengal. If there is one doctor for 2,083 patients in the country, there is only one doctor for 3,964 patients in Bengal. If at all doctors were posted in rural centres, absenteeism became an endemic problem.
With the aspiration of making changes to this terrible situation, in 1979 the students and junior doctors of Calcutta Medical College, under the leadership of the students’ union, launched a movement which became famous as the “Hospital Movement.” This pivotal initiative was not just limited to one institution; the students and junior doctors of R.G. Kar Hospital also launched a similar movement, demonstrating a collective urgency to address the dire conditions within the healthcare system. The movement of 1979 was a preparation for a bigger movement in the next decade, laying the groundwork for future activism. To further consolidate their efforts, the House-staff Intern Association (HIA) or Junior Doctors Association (JDA) was formed in different medical colleges across the region, each mobilizing support and resources to address common grievances. These individual HIAs or JDAs came together to form the All Bengal Junior Doctors’ Federation (ABJDF), representing a united front in their quest for reform. The charter of demands was meticulously prepared through extensive discussions, involving not only the voices of the student bodies but also insights from various stakeholders within the healthcare community. Some of these demands were of immediate nature, seeking urgent changes to improve working conditions and patient care, while others were long-term demands aimed at systemic overhaul with far-reaching consequences, such as better funding for public health and improved training for medical professionals, reflecting the deep-seated issues that plagued the healthcare sector at that time.
Immediate demands:
- The supply of essential and life-saving drugs should be regularized and be made available.
- X-ray, E.C.G., blood, and other essential laboratory tests should be made possible 24 hours a day.
- All the willing licensed, Junior Doctors should be offered Government jobs. The canard that Junior Doctors are unwilling to go to the villages should be stopped.
- The stipend for Junior Doctors should be increased and all post-graduate students should be given stipend.
- Maximum working of 48 hours a week should be ensured.
- The draconian Hospital Bill should be withdrawn.
- In the hospital management committee, representatives from all levels of health workers should be inducted.
- Irrational DCMS course which produces quacks should be scraped.
- Real security for health workers of all levels should be ensured.
The first convention of ABJDF was held in January 1982 (Jyoti Bose was Chief Minister). The charter of demands was placed before the Government. However, the Government refused to even recognize ABJDF.
After a few days, with the regret letters (inability to offer jobs) from the Public Service Commission in hand, junior doctors staged a protest march, and a memorandum was given. But the Government refused to accept the memorandum.
Junior doctor, Paresh Chowdhury, died in the office due to continuous 24-hour work without any break. The government refused to take any responsibility and failed to offer any compensation.
On 23rd March 1983, the ABJDF convention took place amidst an extensive campaign and leafleting efforts in the outdoor facilities of the hospitals, which fervently supported the pressing demands of the ABJDF. Despite the mounting pressure and the presentation of another charter of demands aimed at addressing critical issues within the healthcare system, the Government remained indifferent, showing little regard for the voices of the concerned junior doctors. In both hospitals and medical colleges, memorandums detailing the grievances and expectations were given to the Superintendents and Principals; however, they, too, chose to remain indifferent, contributing to a feeling of frustration and helplessness among the medical professionals. A deputation was organized to meet with the Health Minister on 23rd April, in hopes of sparking a change in the Government’s attitude. During this meeting, the Minister assured the delegates that the Chief Minister would meet and engage in discussion with the Junior Doctors within a promised timeline of 7 days. Prompted by this assurance, the proposed outdoor strike was subsequently called off in a gesture of goodwill and optimism for progress. However, despite the passing of the week, the Government remained silent, leading to increased skepticism among the junior doctors about the sincerity of the promises made and raising significant concerns about the future of their demands and the overall state of healthcare provisions.
On 3rd May more than 1000 junior doctors went in a procession to give deputation to the Health Minister but the Health Minister was so busy with the panchayet elections that he could not spare any time for them.
Between the 9th and 14th of May, an outdoor boycott programme was launched in different hospitals. Badges were worn to mark protest.
On 6th June, the Burdwan Medical College authority illegally dismissed two house-staff members on false charges. From 13th June both outdoor and indoor boycotts took place along with two days of hunger strike. But the government remained silent. Mass organizations of CPIM were asked to campaign in front of the hospital gates against the protesting junior doctors.
On 15th June, the functioning of the hospitals was paralyzed as junior doctors boycotted outdoor, indoor, and emergency departments, creating a significant crisis in the healthcare system. For the sake of the patients, emergency squads were hastily started in the hospitals, ensuring that those in critical need still received some level of care. In the midst of treating the patients in P.G. Hospital, the visiting faculty of the Orthopaedics department and State secretary of the government doctors’ organization (Health Services Association), Dr. Arun Banerjee, was violently attacked by the opponents of the protests. His only fault was that he had openly supported the junior doctors’ movements, advocating for better working conditions and resources. The situation escalated when junior doctors were confronted and attacked by members of DYFI and the Co-ordination Committee right in front of the police, who failed to intervene appropriately. This violent clash epitomized the tensions brewing between the protesting junior doctors and those opposing their strike. On 17th June, in an attempt to address this escalating conflict, a crucial meeting took place with the Chief Minister regarding the demands placed by the junior doctors, where issues of safety, working conditions, and patient care were discussed in hopes of reaching an amicable resolution.
On 7th July, the government announced an increase in salary for junior doctors, which was intended to recognize their hard work and dedication, but remained silent regarding the numerous demands concerning public health that had been raised by various medical associations and advocacy groups. On 8th July, terming the attitude of the government as a bribe to pacify discontent, a large protest march was organized in the capital city, where effigies of the Chief Minister and the Health Minister were burnt as symbols of their perceived indifference to the serious issues plaguing the healthcare system. Between 9th and 13th July, in a show of solidarity and frustration, junior doctors boycotted outdoor departments, instead running parallel outdoor facilities to ensure that patients continued receiving needed care despite the ongoing tensions. It was proposed that the recently announced increase in salary could be strategically allocated to enhance the services provided to patients, thereby directly addressing the expectations of the community. However, Land and Revenue Minister, Mr. Benoy Choudhury, expressed his discontent during a press conference, stating that conducting parallel outdoor clinics in hospitals is tantamount to an outright revolt against established medical protocols, which could undermine the integrity of the healthcare system as a whole and further exacerbate the ongoing crisis.
On 4th August, another meeting took place with the Health Minister but the government remained adamant and refused to accept the demands. From 5th till 12th August, junior doctors again went for strike.
On 27th August, the Health Service Association (HSA), Indian Medical Association (IMA) and ABJDF jointly organized a meeting of all doctors supporting the demands. The government was still silent. From the 15th to the 17th September, an Outdoor boycott was carried out in rotation in support of the demands concerning public health policies.
From 21st to 27th September, after giving an ultimatum, junior doctors went on a complete strike.
On 1st October, the government announced that junior doctors who were participating in the strike would not be given course completion certificate and their stipend would be stopped. This declaration of the government was protested by HSA and IMA.
On 4th October 1983 at SSKM Hospital and Nil Ratan Sircar Medical College, police ruthlessly lathi-charged the junior doctors who had stationed themselves in the offices of the Superintendents, creating an atmosphere of fear and unrest.
This escalation of violence sparked outrage among the medical community and their supporters, leading to heightened tensions across various healthcare institutions. Meanwhile, at National Medical College, an attack was carried out by members of the Co-ordination Committee, aiming to assert their demands for better working conditions. In protest, even at the stroke of midnight, junior doctors launched a spirited protest march, their voices echoing through the streets in solidarity.
On 5th October, ministers, attempting to justify their actions, defended the lathi-charge with statements such as Benoy Choudhury’s assertion that the police had acted in self-defense against an imagined threat. The reality was harsher, as at National Medical College, police had injured 28 doctors and arrested 14, showcasing a blatant disregard for the safety of healthcare professionals.
This prompted a widespread uprising, as more than 1000 junior doctors, students, nurses, and staff burst into action in protest, demanding justice and accountability. That night, overcoming all adversities, a determined sit-in was staged in front of the Raj Bhavan, where the protesting group vowed to continue their struggle until their voices were heard and their demands met, firmly standing against oppression in the healthcare system.
On 6th October, HAS and IMA organized a strike that resulted in the complete stoppage of activities in outdoor departments of 18 hospitals.
On 8th October, the government initiated a slanderous campaign that falsely claimed children in B.C. Roy Children’s Hospital were dying as a direct result of the strikes carried out by junior doctors. This alarming assertion quickly gained traction and caused widespread panic among the public. However, the hospital superintendent took swift action to clarify the situation, firmly stating that no child had died due to this strike, thus dispelling the misinformation. In a related incident at Bangur Hospital, the CPIM-led Nagarik Committee escalated tensions by launching an attack on the doctors, further complicating the already tense atmosphere. In light of these events, and in response to the call from the Indian Medical Association (IMA), thousands of concerned citizens, along with several eminent personalities from various fields, organized a peaceful protest march. This collective effort aimed not only to support the medical professionals but also to submit a memorandum addressing their grievances and advocating for the rights of both patients and doctors alike. The solidarity exhibited by the participants showcased the community’s commitment to standing up against unjust narratives and supporting the healthcare system.
On 9th October CPIM cadres carried out parallel attacks in B. C. Roy and Bangur Hospitals.
10th October, CPIM had gheraoed ABJDF president’s house.
11th October, the Chief Minister Joti Basu ill-behaved with the delegates invited for a discussion. In protest, two junior doctors left the room while the Chief Minister was adamant in his discussion with the remaining delegates.
On 13th October, the Government backtracked and withdrew punitive measures. Accepting some more demands, government urged the junior doctors to withdraw the strike.
On the 14th of October evening, IMA and HAS decided to withdraw movement and at night ABJDF decided to rejoin work and at the same time took vows to carry out struggle to realize other demands.
One ex-student reported: I graduated from Calcutta Medical College in August 1983 and thus became a junior doctor while the movement was on-going. As I stepped into my role, I could see the significant effects of this movement while working in the hospital. At that time, most of the beds available in the hospitals were free beds, a crucial aspect of the healthcare system that allowed many patients access to medical care without the burden of cost. I cannot recollect any instance where patients occupying free beds had to buy any medicine from outside, regardless of how expensive those might be, including costly antibiotics and life-saving cancer drugs. Laboratory tests could be conducted within the hospitals without any additional fees, ensuring that patients received comprehensive care without financial strain.
However, this beneficial condition did not prevail for long. As the political and social climate shifted, within three years, in 1986, junior doctors had to resort to another protest movement, highlighting the ongoing challenges in maintaining quality healthcare for the public and the need for sustainable solutions in the medical profession.
The government had also taken lessons from the movement, analyzing the dynamics and underlying motivations of the participating groups. Since the government doctors’ organization (HSA) had passionately supported the movement of the ABJDF, this support did not go unnoticed among the ruling party officials. In response, government doctors aligned with the ruling party decided to proactively form their own organization, named the Association of Health Service Doctors, in an attempt to counterbalance the influence of the HSA. This newly established association was designed not only to consolidate the loyalty of government doctors but also to serve as a platform for promoting the interests of those in favor of the ruling party. Utilizing the carrot and stick principle regarding transfers and promotions, where rewards were offered for compliance and penalties threatened for dissent, the majority of government doctors found themselves compelled to join this organization. This strategic maneuver by the government exemplified its intent to maintain control over the medical workforce while mitigating the impact of dissenting voices within the healthcare sector.
During the course of the movement, when the government doctors refused to act as “strike-breakers,” it led to significant repercussions for the healthcare system, as well as for the countless patients relying on these medical professionals. The refusal resulted in denying jobs to many highly qualified and experienced jobseekers, who had devoted years of their lives to rigorous medical education and training. Furthermore, the government sidestepped the convention of first posting in rural areas, which traditionally aimed to address the healthcare needs of underserved populations, and instead proceeded to appoint individuals who were far less qualified. As many as 87 doctors were appointed in hospitals and medical colleges of Calcutta, yet these appointments raised concerns about the standards of medical care being provided. The only notable qualification these individuals possessed was their status as SFI cadres, a distinction that overshadowed their lack of adequate medical education.
Over time, these appointees were made permanent, leading to a troubling scenario where some continued to occupy positions in government hospitals despite lacking higher educational qualifications; their primary function appeared to be serving as the “ears and eyes” of the government, collecting and reporting information rather than providing quality patient care. In this environment of compliance and loyalty, a new association of junior doctors, the Junior Doctors’ Council (JDC), was formed. This organization further solidified the government’s influence and control over the medical community, positioning itself as a subservient entity that prioritized governmental interests over those of the medical profession and public health, ultimately compromising the integrity of medical practice in the region.
About 30 years have passed since the movement of ABJDF, and during this time, the public health condition has steadily deteriorated with each passing day. This decline can be partially attributed to the introduction of new economic policies, including liberalization and structural adjustment programs in 1991. With these policies, the government has gradually withdrawn itself from essential areas such as health, education, and various welfare activities. In place of the government’s role, private capital has begun to spread its tentacles throughout the health service sector, leading to a growing concern about access, quality, and equity in healthcare.
As we reflect on the political landscape, it has now been 34 years of left-front rule, and with the new government in power, an additional year has passed. Although this new government brands itself as a government for change, many citizens feel that significant changes remain elusive. The expectations from this administration have not materialized into tangible improvements, leaving the public disillusioned. Yet, the political arena is not entirely devoid of representation from the ABJDF movement; one leader has managed to become a parliamentarian, while another member now serves as a Member of the Legislative Assembly (MLA).
In light of these circumstances, there remains a glimmer of hope that junior doctors will rise once again. Their commitment to advocating for healthcare rights has historically galvanized public support. It is anticipated that they will take to the streets once more, rallying under the powerful slogan, “health is not a matter of charity; the right to health is my fundamental right.” Such a movement could spark widespread engagement, potentially evolving into a mass protest that draws various segments of society into the fray, emphasizing the critical importance of health as a fundamental right rather than a privilege. With the collective might of the populace, there is the possibility of reigniting a movement that had previously captured the public’s imagination and demanded accountability from the authorities.
Described by Dr. Punyabrata Gun in Nov, 2012
