Doctors, Veterinarians & Psychiatrists Of India – First Do No Harm

The situation in Kashmir is no mystery these days when it comes to the international media, organisations of repute, and academics.  Kashmir is ‘normal’ when it comes to the Indian government and Indian media houses.  For Kashmiris who live in a total information blackout, day to day survival is the only thing which matters.  Being a psychiatrist who has trained and worked in Kashmir, I cannot stop thinking about the mental anguish, fear and uncertainty which the entire population is facing.  Not able to get through to loved ones locally or from outside the state, just makes the agony worse. I had numerous calls from people around the world, strong men and women, breaking down in tears, experiencing panic attacks and some deciding to go back into the unknown, just to be with the family, no matter what the consequences.  After all, is it not better to share the tears and pain than face the numbness on your own.

With all the major news outlets around the world talking about lack of access to healthcare, baby food and essential medicines, many reputed journals like the Lancet and the British Medical Journal (BMJ) wrote editorials urging and cautioning about the worsening of health of besieged population. Not only the physical health but the ongoing mental trauma people experience made worse by virtually living in an open prison with total information blockade.  As a doctor, I was relieved like many other likeminded professionals who understand the need for professional organisations to raise their voice and at times question politicians, when it comes to the health, safety and wellbeing of people.  Then came the time to face reality, that not all doctors who work under strict professional and moral code, no matter in which country they practice, writing scathing criticism of the Lancet and how dare it take a view on the ongoing suffering of millions of people.  The reality started hitting when in some of the WhatsApp groups; doctors started signing petitions and even planned on trolling the Lancet journal on social media, arguing that it will prevent others from following the Lancet.  The minute I questioned them, asking don’t you need to look at the evidence, the reports of looming health disaster, shortages of medication, the result was not different. National interest comes first; the mood of the nation comes first, no matter if eight million people are caged in their homes not having access to basic amenities necessary to sustain life.

Then came the open letters from Indian Medical Association (IMA), various other doctors organisations and even the Indian Veterinary Association (IVA), not only criticising the Lancet, but at the same time showing complete disregard for human beings and health concerns with total and complete lack of empathy. It would be hard to argue if this is in context of the totalitarian state policies which is taking root in India, racism, communalism or just mob mentality. After all I have trained, worked, debated, and argued with same clinicians for years now and we have always been humans and friends at the end. Did I question myself? Yes, I did. I went back into history, terrified how doctors in Nazi Germany assisted the state in most inhumane experiments and interventions using the same arguments of national interest as my current colleagues from India or Indian origin seem to put forth.   Looking at the letters they wrote to the Lancet journal, one does not have to be an academic or a professional to see that apart from jargon of interfering into the internal matters of a country, there is almost no scientific argument which could put the Lancet’s editorial concerns on the wrong side. 

If this was not enough, a news article published in the daily newspaper The Hindu published on the 22^nd August 2019, wherein the current President of the Indian Psychiatric Society (IPS) was planning to protest against the Lancet editorial at the International Conference of World Psychiatric Association in Lisbon. Not only that, he also claimed that IPS has thirty members from Kashmir and the Lancet should have contacted them first, arguing there are hardly any mental health issues and if there are they are due to the inference of a neighbouring country, a favourite of the current political disposition to dismiss any idea about welfare of Kashmiris.  He also questions why the Lancet didn’t publish something when as per him; there was a publication about mental health issues published in 2006. The official letter issued by the President of IPS looks like a dossier from ministry of external affairs talking about Pakistan, terrorism and Osama Bin Laden. In no way does it come across as a letter drafted by a professional body representing highly educated psychiatrists of a country. There is no evidence based argument, no references to any scientific research whatsoever which could have proved the Lancet wrong. The letter talks about coming generations of Indians especially doctors and students carrying an unpleasant memory. What about millions caged at gun point and children staying home trying to avoid the barbed wires?

As a Kashmiri psychiatrist who happens to be a member of IPS as well, I would like to know did IPS at any point try to contact their registered members in Kashmir or did they just splash their names on the letter used to criticise the Lancet. How does a national organisation representing almost all psychiatrists in the country makes videos, issues political statements and politicise about Pakistan, but at no point thinks of questioning the politicians about policies which are putting the physical and mental wellbeing of millions of people at risk. One does not have to be a scientist to understand that putting an entire population in siege, arresting their children, cutting off their all communication links will scar them psychologically forever, more so when the exposure to trauma is more than 70%. One out of ten people have lost a loved one directly to the current conflict and one out of three has lost someone in their extended families.  There are hundreds of publications in peer reviewed journals from local Kashmiri psychiatrists, orthopaedics, surgeons, sociologists, and other specialities talking about the mental and physical morbidity as a direct result of on-going war like situation in Kashmir. This will only get worse and no matter what professional jingoism will say, the reality of mental scarring is real.

Lastly, the members of any organisation have every right to question the decisions made by their representatives, may it be a country or a professional body.  Would the politically minded office bearers of IMA and IPS clarify if they had consulted their members before making sweepings statements, made fun of the scientific premise they claim to follow, shown utter contempt of their terms of reference and more importantly denigrated the pain and suffering of millions of people than becoming their voice. I am sure if there was a responsible body in the country, all these doctors would lose their licences to practice due to probity issues and not adhering to the code of conduct which no doctor should forget. Will the members of IPS ask their president to resign remains to be seen? When the siege is over, I am sure the Kashmiri psychiatrists will have a story to tell and many more scientific papers to write on the very trauma inflicted on them and their loved ones.

‘Dear Indian Psychiatry Society.... Psychiatry has come a long way from just using chains... !’ , wrote a friend to me who happens to be an Indian psychiatrist as well.