How the Gujarat government backed out of its promise to doctors on COVID-19 duty

Resident doctors shout slogans during a strike at Byramjee Jeejeebhoy Medical College inside the government civil hospital campus in Ahmedabad on 7 August 2021. PTI
24 September, 2021

About two thousand resident doctors working in government medical colleges and hospitals across Gujarat went on strike at the beginning of August 2021. The doctors were protesting a state government order reneging on a policy that allowed doctors who served in COVID-19 wards to serve a shorter period of mandatory government service. This policy reversal was at the centre of the protest but the doctors also raised other issues such as recognition of the sacrifices made by doctors during the pandemic, payment as per the seventh pay commission, postings in their parent academic institutes to compensate for the experience they missed while on COVID-19 duty and for their senior residency to be recognised as bond duty. The doctors called the strike off after 10 days even though the state government made only a minor concession on one of their demands. 

Medical students in government institutions in Gujarat are required to serve a year of bond service, mostly in rural postings, after completing their three-year post-graduation courses. Students can opt out of this bond service only by paying Rs 40 lakh. Many doctors return to the colleges they graduate from for a one-year senior residency after their year of bond service. This qualifies them to assume teaching roles at their respective institutes.  

During the peak of the second wave of coronavirus in April and May 2021, the Gujarat government devised an incentive for post-graduate students to remain on campus and help with the COVID-19 patient load. Jai Prakash Shivahare, the health commissioner of Gujarat, issued an order on 12 April which said that each day of COVID-19 duty by junior resident doctors would be counted as two days of their compulsory bond service. COVID-19 duty included attending to COVID-19 patients as well as working in the testing and triage areas of the hospital. Each graduating batch of doctors would be allowed to stay at their medical colleges for three extra months to ensure that the hospitals were not understaffed while dealing with the coronavirus surge.

As the second wave subsided, the Gujarat government withdrew its 12 April order. It issued a fresh directive on 31 July for recent graduates to serve at rural postings for a period of one year as required by the terms of their original pre-pandemic bond contracts. This new order did not mention the 12 April directive of bond service time being counted in the 1:2 ratio, that is, each day of COVID-19 work being counted as two days served. It only stated that each doctor would have to serve the complete bond period of one year. On 4 August, resident doctors across medical colleges in Gujarat went on strike. 

By 12 August, the doctors officially called off their strike. The Gujarat government issued a written order on that day stating that the year of senior residency of students of the 2018 batch would be counted as part of their bond service. This meant that students from that single batch who completed their senior residency in 2021 at a government medical college would not have to serve another year in bond service as previous batches had done. In effect, the doctors would have to compulsorily spend the year of senior residency at their colleges or pay to get out of their bond service. “This does bring some relief to us, but of course we are disappointed in the government as well, because they didn’t even comply with our foremost demand, that is the 1:2 ratio bond service,” a resident doctor from the Bhavnagar Medical College who is from this 2018 batch, said. He wished to remain anonymous. “But we had pressure from the government, and some of us were scared we’ll lose our job or pay so this is fine for now.”

The 12 August order stated that the special provision was only for the 2018 batch, due to the circumstances thrown up by the pandemic. This order did not apply to previous or subsequent batches even though doctors across batches had been on COVID-19 duty. Many doctors from the 2018 batch withdrew for the strike. “This was a pity, because perhaps if all of us had continued to show our strength in numbers and gone on with the strike, the government might have conceded to more demands,” a senior resident from the 2017 batch of Ahmedabad’s Byramjee Jeejeebhoy Medical College who took part in the strike said, on the condition of anonymity. “But people got scared and some came back to duty by 10 August because they were intimidated by the administrators of our colleges.” 

A day before the doctors began their strike a delegation of junior doctors from six government medical colleges in Rajkot, Vadodara, Surat, Ahmedabad, Bhavnagar and Jamnagar met Jai Prakash Shivahare, the Gujarat health commissioner, at his office in Gandhinagar. The delegation claimed that they were met with hostility and dismissed from his office. Hossain Gulam Kolsawala, a doctor who recently graduated from the government medical college in Bhavnagar and was part of the delegation, said, “He said we are in no position to make these demands. He said ‘tumhari aukaat nahi hai mujhse aise baat karne ki’”—You don’t have the status to talk to me like this. Kolsawala continued, “He dismissed us and called police officials to escort us outside.”

The Federation of All India Medical Associations, an organisation of representatives from resident doctors associations from across the country, expressed support for the protesting doctors. FAIMA had been working closely with Gujarat Junior Doctors Association, the body that represents  junior doctors associations from the six government colleges. In a letter to Nitin Patel, the health minister of Gujarat, FAIMA alleged that in his meeting with the delegation, Shivahare demanded “proof of work done in three years of residency, implying that we doctors are asking for our basic rights without doing any work in the hospital.” Kolswala told me that the doctors sought a formal apology from Shivahare for what they described as his misbehaviour. Shivahare did not issue an apology and did not respond to The Caravan’s queries regarding the incident.

The protesting doctors also had three major demands in addition to the government fulfilling its 1:2 promise. First, that all recent graduates from government medical colleges on bond duty be paid according to the seventh pay commission. Second, that senior residency for all batches henceforth be considered part of the compulsory bond service. Third, that recent graduates be posted back to the institutes that they graduated from so that they could work in their specialisations. 

On 12 August, more than a week into the strike and after a meeting with resident doctors, the government stated that senior residency would be considered equivalent to the bond service. This is the norm in most states across India. Government officials did not give the doctors any written assurance and so the junior doctors association from Ahmedabad’s Byramjee Jeejeebhoy Medical College continued their strike. They refused to perform any emergency or COVID-related duties until a written order was circulated amongst staff at the hospital. The hospital issued such an order on 13 August after which the doctors called the strike off. 

Meanwhile, residents and junior doctors from the other five medical colleges resumed their duties by 11 August, despite the government’s refusal to give in to their demands. “In some way the government has won, what can we do now?” Gaurang Khadiya, the vice president of the Junior Doctors Association at Jamnagar Medical College said on 11 August. “How long can we ignore our duties, it is only affecting our patients' health and the government does not seem to care.” 

As the protest lost momentum, only doctors at the Byramjee Jeejeebhoy Medical College in Ahmedabad continued to strike. “The others have been pressured and they have been promised that demands will be met in the future, but we have heard nothing from the officials yet. There is no guarantee,” Vishwajeet Raj, a recent graduate from the department of medicine, said when we spoke on the morning of 12 August. Khadiya said that senior doctors from his college in Jamnagar claimed that they spoke with officials from the Gujarat health department who assured them that their demands would be met if they called off the strike. “We are not very hopeful, but we don’t want our careers to be affected so we see no choice but to give in,” he said. 

Kolsawala did not want to be deployed to a rural posting where there were no operation theatres. He hoped to learn more from his seniors and professors in the surgery department. He wanted to get at least six months of extra training at his medical college because he had been exclusively on covid duty for the past year and a half. “How can I learn surgery in a primary healthcare centre with no resources to conduct advanced surgeries?” he asked. “In the future, we are going to be the specialists that all of you are going to consult and put your faith in. Shouldn’t we get more experience and be better trained?” 

The senior resident from Byramjee Jeejeebhoy Medical College in Ahmedabad also wanted access to the resources needed for specialisation. “It is the government’s duty that we learn all this,” he said. “That is the education they promised us.” Despite these demands remainign unfulfilled, all the doctors resumed their duties after the 12 August order.

The doctors had to face several pressures while they were on strike. Khadiya told me that when students from the Jamnagar hospital sat in protest outside the campus, police officials threatened to arrest them. On 3 August, just after the Junior Doctors Association representatives declared that they would be going on strike, the health commissioner sent letters to the deans of all six colleges asking them to ensure that everyone participating in the strike be marked absent and their salaries be deducted accordingly. On 6 August, the dean of the Vadodara Medical College wrote to hostel wardens, asking them to evict junior doctors on strike from their rooms. Kolsawala told me that deans of other colleges issued similar orders.

Doctors from both Bhavnagar and Jamnagar said that electricity supply to hostels was temporarily cut to force resident doctors to vacate the premises as soon as possible. At the Jamnagar Medical College, both electricity and water supply was cut from hostels on the night of 6 August. “Some of us head to leave the hostel in the middle of the night, imagine how unsafe that is for us, especially the women,” Khadiya said.

On 6 August, Gujarat Health Minister Nitin Patel also threatened the doctors on strike with punishment under the provisions of the Epidemic Diseases Act, if they did not join their postings or duties by 10 August. According to a reportpublished in the Indian Express, Patel deemed the strike “illegal” and claimed that the demands were “totally unreasonable”. Kolsawala reacted to Patel’s statement saying, “On one hand they want to pretend COVID-19 is a thing of the past and they don't need us anymore and on the other they threaten to invoke the Epidemic Diseases Act. If there is no COVID-19, how come they can use that act to punish us?” 

The Indian Express report quoted Patel saying that the 1:2 benefit was given as an incentive during the second wave of the pandemic but could not be applied to students who graduated in August. Doctors I spoke with were unsure whether the three months of COVID-19 duty that some of them performed would be doubled and deducted from their bond period. “It doesn't seem to be the case because when our posting order came they mentioned the full one year period and didn’t say anything about a cut off time for the 1:2 benefit,” Kolsawala, who graduated in May, said. 

Organisations like the Gujarat chapter of the Indian Medical Association, a national voluntary organisation of physicians, and junior doctors associations from across the country supported the doctors on strike. Darshan Shukla, a critical care specialist and the head of IMA Jamnagar told me that the government’s dismissal of the doctors’ demands showcased their apathy. “Why turn back on your word? Why make the promise in the first place? This shows that they wanted to appeal to them when they needed them and now they think they can treat the young graduates any way they want,” he said. 

Khadiya, the doctor from Jamnagar, recalls that during the peak of the second wave, the government housed some doctors in hotels where they could quarantine safely in the periods between their duty in the COVID-19 wards. “And now we have spent a night kicked out of our hostels. They have shown us how much they really value our work,” he said. 

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this reportage.