Islamophobia: It may be hard to stomach but it does exist in the medical profession
The last few years have been marked by the increasing polarisation of Indian society along religious lines. Islamophobia has been growing in many sections of society, and the Indian healthcare system is not immune to this.
Islamophobia is creeping into medical schools and colleges, and some doctors have openly started pedalling it. Prof Aarti Lalchandani, the former Principal of Kanpur’s Ganesh Shankar Vidyarthi Medical College, went on a nearly five-minute-long rant blaming members of the Tablighi Jamaat sect for spreading COVID-19, calling them terrorists and wanting them to be thrown into the jungle. “Send them to jungles, throw them in dungeons. Because of these 30 crores, 100 crores are suffering. There is a financial emergency because of them,” she complained.
The pandemic brought out the ugly head of Islamophobia amongst even healthcare professionals. Dr Apurva Sastry, the author of the Medical Microbiology textbook, had to retract his unsupported allegation that the Tablighi Jamaat was responsible for the cluster of cases and explosive spread of Covid-19 across India after he faced backlash for his unscientific ramblings. Another Microbiologist, Dr Sumit Rai from AIIMS Mangalagiri, mentioned on his LinkedIn profile that if one has to stay in Bharat, one must chant Jai Shri Ram.
This year’s Oxfam Inequality Report noted that over a third of Muslims reported having been discriminated against in hospitals or by a medical professional. This ranged from being denied the release of the dead body of their relatives by the hospitals to women patients being treated by male doctors without a female attendant. Such discrimination is not only a human rights issue but also has a deleterious effect on healthcare outcomes. While discrimination against Muslims is hardly new, the past few months have seen calls for genocide go unpunished. With immensely skewed power dynamics in the doctor-patient relationship, the bias must be addressed.
At the crux of this discrimination lies some doctor’s bias – both implicit and explicit. The bias has led to instances where Muslims and Hindus were put in separate Covid wards and, in some cases, patients complained that they were denied care. Such discriminatory treatment does not only lead to worse outcomes but also leads to inequitable access to healthcare. At the core of a doctor-patient relationship lies trust. The trust not only erodes but also metamorphoses into fear when one hears of such incidents. As a result, the doctor-patient relationship crumbles, leaving cynicism in its wake. While little is known about how bias affects healthcare outcomes, a study of literature shows that discrimination resulted not only in poorer physical health outcomes but also poorer mental health aftereffects and can lead to a public health disaster. So, it is important to address this bias, both in medical schools as well as in those that practice medicine.
Islamophobia is not limited to India but is widespread even in the Global North. It is spread far and wide, from the NHS in the UK to Medical journals in North America. What’s welcome, though, is how it is acknowledged and dealt with there. Recently Canadian Medical Association Journal retracted an Islamophobic article that insulted hijab-wearing Muslim women; it further issued an apology to its readers. In India, Islamophobia in the medical education system, healthcare systems, and policies is neither acknowledged nor dealt with. While there has been some discussion on discriminatory treatment of members of oppressed communities like tribals, Dalits, women, and queer communities, religion is a taboo topic and often not taken into consideration in understanding our biases and such partisanship in healthcare profession is hardly addressed. In the West, while the discourse on medical bias has heavily been around people of colour, post 9/11, there has been an acknowledgement of Islamophobia in Medical systems.
It was hence a pleasant surprise when Karnataka Medical Council, in April this year, issued a circular informing medical practitioners not to participate in spreading communal disharmony through social media and that any such act will be regarded as professional misconduct. It is important to understand that doctors are also part of the same society we live in and are hence affected by campaigns of misinformation and hate that are prevalent in society. Not long ago in Nazi Germany, the well-meaning doctor did not realise when the cancer of eugenics and hatred metastasised to make them into monsters who not just conducted unethical experiments but helped Nazis devise efficient methods to kill Jews. The noble profession, which demands high levels of integrity and equal treatment of all irrespective of their intersectional identities, must constantly vigil for early signs of islamophobia.
Healthcare providers swear an oath to treat all patients equally when they take the medical oath. The draft – National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022 – has included The Physician’s Pledge as per the World Medical Association’s Declaration of Geneva. The Physician’s oath from the Declaration of Geneva that doctors take makes them swear to “…not permit considerations of religion, nationality, race, party politics or social standing to intervene between [their] duty and [the] patient”. Interestingly, the Charak Shapath, which the National Medical Commission recommended, is silent on discrimination based on religion.
The right to health has been held to be a part of the right to life under article 21 due to the expansive judicial reading of the Constitution of India. Addressing structural barriers in access to care and healthcare settings is essential to realise this right and ensure human flourishing. The minimal investment in public health infrastructure thus far and the reduced healthcare budget has only worsened the situation, according to the Oxfam Inequality Report. This islamophobia in medicine and medical schools must be addressed as an urgent measure because not only does this deter minorities from seeking care, but it also leads to worse outcomes once they get to hospitals. It must be addressed by the Ministry of Health and Family Welfare, state governments, medical associations, and the private sector working in tandem with each other as soon as possible.
It might be pertinent at this juncture to talk about how biases can be addressed in medicine. We propose to adopt a three-pronged approach that has been used to address cognitive biases. The first way of doing that would be to introduce bias and sensitivity training that has to be undertaken by doctors as a part of their continuing medical education as well as in medical schools. While most of us will deny having any explicit bias towards our patients based on religion, most of us do suffer from implicit biases. Tests like Implicit Association Test can help us discover our implicit biases and reduce them. It has been proposed to introduce such tests in the foundational year of medical school. India’s competency-based medical education system aims at creating an empathetic, self-reflecting doctor. However, the aspects of discrimination based on patient characteristics, including religion, are not discussed. Education and training thus will form the first part of bias mitigation.
The second leg of such mitigation should be using reflection. Doctors, residents, and medical students should be incentivised to report biases and given safe spaces to reflect on what brought on the bias and how it can be mitigated in the future. The introduction of devices like The Theatre of The Oppressed as part of Medical Humanities, Reflection, Narration, and Graphic Medicine can help achieve this aim.
The third and final leg of such a mitigation strategy would be mental checklists and decisional processes that aim to reduce bias and introduce sensitivity in medical training. Finally, suppose the concern around bias is not addressed, in that case, there should be a reporting system with the hospital as well as the NMC with penal provisions in place, including fines and cancellation of medical registration if the doctor is a repeat offender. In addition to professional organisations, the National Medical Commission and various State Medical Councils need to put forth clear guidelines to define and address religious discrimination issues.
Globally, religious extremism and hatred toward religious minorities are increasing. This is slowly getting normalised in our society, and it has already made headway in the medical system. It is crucial to tackle and cure this disease before it becomes too widespread. Proactive measures are needed in the medical education system including training of in-service doctors, and guidelines of government bodies and medical associations to control Islamophobia in medicine. It’s time doctors remember the first principle of Medicine – Primum non-nocere – First Do No Harm.
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