Payal Tadvi's suicide: Marred by casteism, dominated by donations, medical education in India needs mirror to avoid dehumanisation

If you haven’t been living under a rock, you must have heard women asking each other for the numbers of non-judgemental gynaecologists. Non-judgmental gynaecologists is what they ask for, not female gynaecologists. The medical system makes it amply clear that female doctors can be as emblematic of the patriarchal horror-movie that is the medical system.Now imagine that your doctors are the three senior doctors who allegedly bullied and tortured Dr Payal Tadvi all the way to suicide at Mumbai's BYL Nair Hospital. Imagine doctors Hema Ahuja, Antika Khandelwal and Bhakti Mehar, who seem to be on the run after Tadvi’s death on 22 May, treating you and operating on you. Imagine asking one of these doctors for their opinion and trusting that she is recommending your uterus be removed for your health, not because she took a quick peek at your surname and decided that someone from your caste is not worth a thoughtful diagnosis or worth reproductive rights at all.Tadvi's alleged tormentors Hema Ahuja, Antika Khandelwal and Bhakti Mehar at Mumbai's BYL Nair Hospital certainly seemed to have decided that the bright young doctor from an Adivasi family didn't deserve her career, telling her that they wouldn’t let her finish her MD, carry out surgeries or even meet her mother when she was visiting. According to her family, the bullying was severe enough for her husband and mother to lodge complaints, for her to be transferred out of the unit where she was deeply unhappy (only to be transferred back again). The harassment was severe enough that a few months ago, Tadvi's family had approached the Superintendent of Police in Jalgaon, where she had completed her MBBS, to complain about the bullying, which even extended to the WhatsApp group the doctors were part of.[caption id="attachment_6713301" align="alignleft" width="380"]

A young Indian demonstrator holds a placard at a rally in Delhi. AFP[/caption]This is not the first death from casteism in a medical college, of course.As recently as January 2018, M Mariraj attempted to commit suicide at a college in Ahmedabad, reporting a very similar pattern of casteist bullying from the establishment, which had asked him to serve tea and kept him out of surgeries.Insight Foundation's three-part documentary Death of Merit was conceived after the tragic death of Balmukund Bharti, a final year student of the All India Institute of Medical Sciences, New Delhi. He had committed suicide in March 2010. The title is heavily ironic, but 'merit' continues to be discussed with all seriousness year after year, after every death.Even today, there are folks responding on Tadvi's friend Simin Khan's Twitter timeline making mind-boggling statements such as, "They didn't torture her because she was from an OFFICIALLY backward classes, but because she was well off economically and still used reservation quota to get things right... Find it crude, but this is what happens when the government's schemes stretch too far."It doesn't matter that no one knows whether Tadvi did access reservation. It doesn't matter because the Savarna guardians of merit and the quality of medical care are only inflamed by the presence of Bahujan students. The presence of Savarna students who got in only by paying gigantic donations (after highly capital-intensive education and coaching classes and lives) never seems to worry the po-faced who say there should be no reservation at medical colleges. If you ask medical students, they will tell you about all they need to do and what it costs (sometimes in actual rupees) to stay in the good books of professors, seniors, external examiners and ethics committees. Even so, Savarna doctors like to behave as though their place at medical schools is — to use a medical term — idiopathic, a condition that arises spontaneously or for which the cause is unknown.While the Indian Medical Association has maintained a deafening silence on the resident doctor's death, the Maharashtra Association of Resident Doctors (which has suspended the three accused doctors) seems to think the solution lies in conducting an orientation programme for young doctors to improve communication. Anyone who has seen screenshots of the WhatsApp chats of the absconding doctors will know that communication wasn't their problem.Long before the professional education stage, schools should discuss casteism. They should talk about caste beyond just a paragraph in history textbooks in a chapter about the Vedas. They should talk about the complex, blatant and subtle ways in which caste affects our everyday behaviour — from access to resources all the way to the transfer of pain across generations. Schools and colleges need to drop the squeamishness and confront the ridiculous word that is merit and kick it. And then, medical colleges and law schools should have students attend further classes to make them confront the fact of flawed humanity, or risk becoming that South Bangalore Brahmin doctor who told my colleague who had cysts and ulcers that her chronic stomach pain was because she ate mutton curry the previous evening.I once knew a kind and brilliant young medical student. He had sweet endearments for his girlfriend and was crushed like an eggshell when she broke up with him. He worked hard to understand how public health can be improved. When we spoke about the first few weeks of college and the 'ragging' students faced, he told me a horrifying story that ended with all the first year students having to jump into a pit of urine. What was doubly horrifying was his beatific smile as he told me he thought it had been a good bonding experience. I don't know what he feels about it now, but my skin still crawls at the memory.Ragging is only the highlights of the full-on dehumanised medical college experience. Modern medicine and medical education around the world is highly alienating and needs a permanent mirror held up to it to show it its power-hungry face. But in India, on one hand, we have a perfect storm of gender, caste and class that produces the majority of our doctors. On the other hand, if the Twitter account I found did indeed belong to Payal Tadvi, this was a young woman with a deep interest in ecology, public health and the world much wider than her, indicating that there is a possibility of having another kind of doctors.In the past decade, women around the world, including in India, have begun to talk about what it means to be a female patient. Pain, heart attacks, dosage, contraception, conception — feminist critiques of medicine help us understand that the male body is not neutral and the body is not just a body; it is a social being. But even as we speak, medical colleges continue to function as grinding mills. Untroubled by any political critiques, they continue to work towards producing people who will be able to monetise on every 15 waking minutes.Teenagers who spent their childhood at tuitions and coaching classes get admissions to such institutes and leave as adults who still don't know how to talk or listen. Their education doesn't educate them. In the five years of their sentence, they turn on each other and the most vulnerable among them. And when they graduate, we have a situation where humans at their most vulnerable have to seek treatment from people whose education has taught them to show no kindness, understand no weakness.If you are still worried about merit, let me give you a tip: When the student parking spaces of medical colleges accommodate SUVs, that's when patients should worry about the future of medicine.The Ladies Finger is India’s leading feminist magazine.