Language Barriers

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With doctors at the receiving end of violence, their skills should also extend to knowing three languages so that there is no miscommunication about their diagnosis

Recently, an altercation took place between activists of the Karnataka Rakshana Vedike and a postgraduate student at the Minto Ophthalmic Hospital in Bengaluru over language. The student did not respond in Kannada to their demand for compensation for patients blinded during a cataract camp simply because he did not speak Kannada. The matter has taken a political turn, with doctors going on strike and demanding enhanced security and action against the activists. The incident has sparked a national debate on the issue of language barriers in medical education in India.

Admission to medical colleges in India is based on common admission tests. The centre allocates seats to students in various colleges from an all-India quota. Unlike Ayurveda where the medium of education is Sanskrit, in allopathic medical colleges, it is in English. Even in the Supreme Court, the language is English. No one should expect students to learn the local language as soon as they enter a medical college. It could be a language they are completely unfamiliar with.

I did my undergraduation and post-graduation from the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, in Maharashtra where the local language was Marathi. I learnt Marathi during my college days but only as much as was needed for patient care. Ward boys and other staff would be our interpreters if we got stuck on any word.

However, some European countries such as Sweden have made it mandatory for doctors to learn Swedish if they want to practise there and many Indian doctors have done so by taking a course to demonstrate that they have reached C1- level Swedish. In 2010, the Eastern Mediterranean Health Journal touched upon the perspectives of students and staff on language barriers in medical education in Egypt and their attitude towards Arabization of the medical curriculum. In a survey of 400 medical students and 150 staff members, it was found that 56.3 percent of students did not consider learning medicine in English an obstacle, while 44.5 percent of the staff considered it an obstacle only during the first year of medical school. Some 44.8 percent of students translated English terms into Arabic to facilitate studying and 70.6 percent preferred to learn patient history-taking in Arabic. While Arabization in general was strongly declined, teaching in Arabic was suggested as appropriate in some specialties.

Thankfully, India does not have strict rules on language. Dr OP Gupta, my Professor of Medicine at MGIMS narrated what a colleague had told him. “I was examiner in one of the colleges of MP where I found that some students could not communicate well in English. But when I explained the questions in Hindi, they answered them with ease,” he said. So should language be a barrier for treatment? No.

Gupta further said: “I had a similar experience when I used to go as an examiner for final-year students. Even when I have a bedside discussion about a patient with students, sometimes I have to explain in Hindi. With English as a medium of instruction in medical education, a perceptible gap in communication is noticed. If a learner cannot understand the language of instruction, it becomes difficult, if not impossible, to grasp the content.”

In a sign of changing times, the National Eligibility Cum Entrance Test (NEET) 2018 examination was conducted in 11 languages. While 80 percent of the students wrote the exam in English, 11 percent did so in Hindi, 4.31 percent in Gujarati, 3 percent in Bengali and 1.86 percent in Tamil. About 20 percent of the 1.1 million students who appeared in NEET wrote in regional languages. NEET 2019 rules stated that the exam would be conducted in English, Hindi, Urdu and eight regional languages (Bengali, Assamese, Gujarati, Telugu, Marathi, Tamil, Oriya and Kannada). The regional language question papers would be bilingual.

However, it would be a good idea for all doctors to study one international language. As medical tourism is on the rise, that international language should be English. As it is also the medium in books and for teaching, they might as well learn it. To promote medical tourism, the government is also making it compulsory to have interpreter assistance at all levels. Recently, when I travelled to Japan as president of the Confederation of Medical Associations in Asia and Oceania, an interpreter was provided so that I could talk to my Japanese colleagues. For domestic medical tourism too interpreters should be made available in the hospital set-up in every state to facilitate communication between doctors and patients.

The second language for doctors to learn is the one most commonly spoken in the country. In India, it will be Hindi. The third language should be the local language where one is practising. The students themselves should learn it. That will be difficult unless the student devotes a full year to language learning or there are interpreters in hospitals.

These measures are necessary in order to stem disputes and arguments between patients/their families and the doctor. It is also needed to prevent deficiency in medical treatment due to wrong interpretation of symptoms. This may lead to wrong diagnosis and wrong treatment. The National Medical Commission should take these points into consideration and mandate local interpreters in the hospital setting.

Coming back to the violence against doctors, no one has the right to attack them for not knowing the local language. Doctors on duty are akin to pilots and flight attendants and any distraction from work can affect the pilot and jeopardise the lives of passengers. Similarly, any distraction in the treatment provided by doctors because of unlawful elements should be strictly prohibited and they should be arrested.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Supreme Court To Hear Pil Seeking Protection For Doctors Today

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The Supreme Court has agreed to hear a petition on 18th June filed seeking security for doctors in government hospitals across the country.

In the wake of strikes called by doctors across the country to protest the attack on a doctor in West Bengal, PIL has been filed in Supreme Court seeking protection for doctors.

The PIL seeks a direction to the Central government to deploy uniformed security personnel at every government hospital to ensure the safety of doctors. PIL has also prayed for a direction to the government to formulate guidelines for the safety of doctors and for the same to be implemented in “letter and spirit”.

Additionally, the petition also seeks a direction to the State of West Bengal to take stringent action against those who assaulted the junior doctor in NRS Medical College and Hospital, Kolkata.

The matter was mentioned today i.e. 17th June 2019 for urgent hearing by Advocate Alak Alom Shrivastava. The Vacation Bench of Justices Deepak Gupta and Surya Kant agreed to list the case on, June 18.

The furore was caused by an incident at the NRS Hospital, in which a junior doctor, Paribaha Mukhopadhyay, was severely injured by a mob of people angered by the death of a 75-year-old patient. Junior doctors at the hospital then led an agitation protesting the incident.

Later, West Bengal Chief Minister Mamata Banerjee criticised the agitation and urged the doctors to resume work. This sparked protests in other Kolkata hospitals, and eventually spread to other parts of the country.

The matter had even reached the Calcutta High Court, which last week urged the State government to take measures to resolve the grievances raised by the striking doctors, Further, the Bench also appealed that the doctors take up a reconciliatory approach in the larger interest of their patients.

However, the Court refused to grant any interim relief in the PIL. The matter in the High Court is scheduled to be heard on June 21.

In the Year 2017, when I was National President of Indian Medical Association, the Honble Delhi High Court had suo moto taken cognizance of the issue of incidents of doctors in public hospitals being subjected to extreme violence at the hands of the patients and/or their attendants. In the said case, the Honble High Court of Delhi had suo moto made Indian Medical Association a party. The said writ petition WP(C) 3903/2017 is still pending and the next date of hearing is 20th August, 2019.

National IMA is also likely to implead in the case in public interest.

With inputs from Advocate Ira Gupta

No politics with doctors please

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Doctors are and will remain next to God. The medical profession is and will remain a noble profession.

In an All-Dharma Gurus spiritual meeting, gurus from all religions participated, and I too spoke on medical profession as also a religion or dharma.

Whether it is doing your duty with devotion and discipline, unconditional love, compassion, nonviolence, unity in diversity, detached attachment and selfless service, all these components of any religion are also the duties of a doctor.

Medical profession should not be politicized. The current strike in West Bengal should be taken up as a national emergency.

Recently, an Indian businessman was sentenced to life in prison for a fake hijack threat on a domestic flight in 2017 that resulted in an emergency landing. Birju Kishor Salla, a resident of Mumbai, was arrested and charged for posing a threat to the safety of passengers and crew on board a plane. He was also fined 50 million rupees ($720,000), which a special NIA court ruled would be given as compensation to the crew and passengers. The 2017 incident, on a flight from Mumbai to New Delhi, resulted in the grounding of the plane belonging to the now-defunct Jet Airways airline.

Each pilot will get compensation of 100,000 rupees out of the fine amount, while each member of the cabin crew will receive 50,000 rupees, and each passenger will be paid 25,000 rupees for the “misery” the incident caused, according to a statement released by the National Investigation Agency (NIA).

Is the case of a hospital different?

When a doctor is beaten or assaulted, the situation is the same. The safety of all the patients in a hospital is at stake.

The number of patients in a hospital may be larger than the number of passengers in a plane. In this case it not the threat but the doctor (the pilot) was actually beaten.

Opportunities lost

Instead of playing politics

  • The BJP central government should immediately announce the central Act against violence on doctors and medical establishments in the forthcoming Parliament session or by an ordinance.
  • The West Bengal Chief Minister should announce a stringent action against all the accused and announce a compensation to all hurt.
  • Rahul Gandhi and all opposition leaders should side with the doctors and appeal for a central law in the coming parliament session.

But do politicians really care about the doctors?

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

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