Trends of Violence Against Health Care Workers and Facilitie1

TRENDS OF VIOLENCE AGAINST HEALTH CARE
WORKERS AND FACILITIES
ABSTRACT
Abusement in health care organizations is a well-documented issue in the world. Workplace
violence is a common problem for healthcare employees occurring more frequently than in
private industry. Every year thousands of employees in health care organizations are abused
while at work. It is true that no occupation is absolved from work-related victimization but
according to researchers, violence in the health field is more than any other work places and
it is less talked about. Work-related victimization, includes acts of abusive language or
bullying, threat with a weapon, physical attack, sexual harassment, attempted rape, and
rape against healthcare employees. The group who is most affected by these activities are
emergency workers or nurses. The people who are involved in these acts are mostly
patients or relatives of patients. In many countries, certain measures have been taken to
avert violence in health care institutions and those who use violence will be accountable for
severe punishment.
The purpose of this study is to grow awareness among people about this major issue, and
draw attention towards the causes of violence against health care workers and facilities.
INTRODUCTION
Violence is a function of the dynamic interaction between a specific individual and a specific
situation for a given period. According to the World Health Organization [WHO], violence is
“the intentional use of physical force or power, threatened or actual, against a person, or
against a group or community that either results in or has a high likelihood of resulting in
injury, death, psychological harm, maldevelopment or deprivation (1)”
Violence that health care workers are exposed to in a workplace can be classified as follows:
1. Physical,
2. Psychological (emotional)
3. Harassment
4. Threats
https://steemit.com/violenceonmedicalstaff/@awaiskhan007/essay-the-growing-trend-of-violence-
committed-by-patient-relatives-against-medical-professionals
https://www.researchgate.net/publication/274298198_Violence_Against_Health_Care_Workers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520583/
http://blogs.jpmsonline.com/2016/01/05/violence-against-healthcare-in-pakistan-social-and-
humanitarian-implications/
Another classification divides violence into four groups:
 TYPE 1 : by intent crime

 TYPE 2 : violence from consumer to worker
 TYPE 3 : violence to worker from another worker
 TYPE 4 : interpersonal relations
However, the most common form of violence is the second type of violence.
Violence is progressively being used against doctors and other medical personnel. More
than 75% of doctors face violence during their practice. Almost half of the violent incidents
occur in critical care units. Anesthesiologists, especially those working in intensive care units
(ICUs), face it almost every day. There are regular reports of doctors being abused,
threatened, bullied, manhandled, and even killed.
Internationally, violence is the leading cause of death and disability. Over half a million
people die each year from violence worldwide. There are heaps of hospitalizations,
hundreds of emergency calls and thousands of doctor designations for deaths because of
violence. In addition, violence of casualty can have lifelong and psycho-social consequences
including physical and mental health problems leading to slow economic and social
development. There are many evidence based studies conducted that have apparently
proven that violence can be prevented but also to modify the individual, community and
societal factors that encourage or reduce violence.
An example of violence against health care workers is illustrated by the following incident
which occurred in Larkana, Pakistan. A 25-years old patient named Tasneem wife of
Abdullah Leghari, a resident of Miro Khan Taluka of Kambar-Shahdadkot district, a resident
of OPF Colony of Larkana was rushed to hospital in critical condition and the duty doctors
suspected that she had tried to commit suicide. Her stomach was washed immediately but
she could not survive. The attendants of the patient called their relatives. The relatives
around arrival ransacked office of Chief CMO, broke office furniture, windowpanes, fired
pistol shots and severely beat duty doctors at Accident & Emergency Center of the Chandka
Medical College Hospital, as they suspected that their patient died due to the negligence of
duty doctors. They tore clothes of one Dr. Mannan Bhutto and dragged him in the
emergency ward. Zahid Leghari, a relative of the patients, told media that she died due to
the negligence of duty doctors. Chief RMO Dr. Habib Soomro said that the accused also fired
straight pistol shots but fortunately no one was injured as all the doctors and duty staff had
already fled. Police arrived one hour late despite informing them well on time and they
played a role of silent spectator and not arrested a single accused. Assistant Commissioner
Masood Bhutto and DSP Yar Muhammad Rind later held talks with the enraged people and
the situation was brought under control. The Medical Superintendent of Chandka Hospital
has constituted a 3-member probing committee consisting of Prof. (Rtd.) Hafeezullah Abro,
I/C Accident & Emergency Center, Dr. Abdul Majeed Jessar and Dr. Ahmed Ali Brohi, both
Additional Medical Superintendents of the Hospital to report within three days. No case was
filed till filing of this report.
The purpose of citing the above story is not to show an event of violence that took place in a
rural area of Pakistan rather it was meant to show that incidents like that have become a
norm in almost all medical institutes of Pakistan; varying in intensity and damage inflicted.
The reasons for violence inflicted against clinicians are many and varied. Patients who feel
they have been physically and/or psychologically injured are at increased risk for committing
violence against clinicians, especially if their complaints are dismissed. Fear and helplessness
are risk factors for patient violence, especially when painful intrusive procedures are used.
SURVEYS CONDUCTED IN HOSPITALS OF PAKISTAN

Pakistani society is currently passing through political turmoil and political instability.
Poverty, unemployment, and political agitation have generated frustration, anger, and
impatience among mango people resulting in a spike in crime and violence trend in the
country. Among many communities, the medical community is also being immensely
targeted by this crime and violence. A study carried out in 2011 shows that nearly 77% of
675 doctors from 9 public hospitals in Pakistan had experienced violence — 65 percent
verbal and 11.9 percent physical. In another similar study in 2013, conducted on 164
healthcare professionals from a public health care facility in Lahore, 74% of the doctors
admitted that they experienced violence while working in the emergency department. The
offenders were mostly patients' relatives 71%. Both the reports concluded that "too many"
attendants, long waits, limited contact with the physician, resulted in chaos and mayhem
and in turn, led to violent incidents.
Many target killings are involving doctors who are serving mankind. Pakistan Penal Code
PPC accommodates a law that government has a political or legal duty to implement.
Section 153-A of the PPC ,which stated that:
“By words, either spoken or written, or by signs, or by visible representations or
otherwise, that promote or incite, or attempt to promote or incite, on grounds of religion,
race, place of birth, residence, language, caste or community or any other grounds
whatsoever, disharmony or feelings of enmity, hatred or ill-will between different
religious, racial, language or regional groups or castes or communities: or commits, or
incites any other person to commit, any act which is prejudicial to the maintenance of
harmony between different religious, racial, language or regional groups or castes or
communities or any groups of persons identifiable as such on any ground whatsoever, and
which disturbs or is likely to disturb public tranquility shall be punished with
imprisonment for a term which may extend to five years and with fine”.
If the government utilizes this law for the sake of public, we could see decrease in extremist
trend and well organized society would result.
SURVEY CONDUCTED IN HOSPITALS OF THE WORLD
Violence against health care workers is both a national and a global problem. In a study
conducted in Canada, the frequency of emergency service employees being exposed to
violence at any time is 60%; 76% of employees are exposed to verbal violence and 86% to
physical threat or attack. In the same study, 73% of the participants fear of patients because
they are exposed to violence, 49% participants are recognized by patients, and 74% of them
have less job satisfaction. In addition,67% of violence victims have reported violence; some
of them had a job change.
According to a survey conducted by the British Medical Association in 2008, in the last 1
year one-third of physicians were attacked physically or verbally; however, more than half
of the physicians did not report this.
According to a study conducted on emergency service workers in Iran, 71% of employees
were exposed to verbal violence and 38% were exposed to physical violence over the last
year. In addition, 4% of violent incidents resulted in serious injuries. However, according to
another study conducted on emergency nurses in Iran, 91.6% of the participants exposed to
verbal violence and 19.7% were exposed to physical violence last year.
A study conducted in Jamaica in 2005 in which 832 health care workers participated, 38.6%
were exposed to verbal violence in the past year and 7.7% were exposed to physical
violence.
n a cross-sectional study held in the US in 2011on the physicians working in the emergency
service, 78%of physicians were subjected to one or other act of violence in the past year,
21% were subjected to one or two types of violence, 75% reported verbal violence, and 21%
reported violence.
In a study conducted in university hospitals in Switzerland, more than half of the staff were
subjected to one or the other violence in the past one year, and11% of these violent
incidents took place in the last week.
In a study conducted in psychiatric clinics in Australia, violence was sorted out into eight
levels depending on the nature of damage, and the most frequently observed violence was
the low level of physical violence. In the same study, nurses were exposed to more violence;
most of the patients who used violence were the alcohol and drug addicts.
In a cross-sectional study held in Japan in 2011 on8711 people working in 19 hospitals,
36.4% respondents were subjected to one or the other kinds of violence in the workplace,
29.8% were subjected to verbal violence,15.9% were subjected to physical violence, and
9.9%were subjected to sexual violence. In addition, workers exposed to violence were
significantly higher in the psychiatric clinic and the intensive care unit.
According to a study conducted in Israel, at least56% of physicians throughout their career
were exposed to verbal violence and 16% were exposed to physical violence. Doctors,
psychiatrists, and nurses working in the emergency service were found to be the risk group
exposed to violence.
Table 1: The results of some research studies on violence against health care workers in the World.
RESEARCHER COUNTRY INSPECTED TOTAL EXPOSED VIOLENCE

PERIOD VIOLENCE TYPE
Physical Verbal
N % N % N %
Miedema et al. Canada Career 759 99.0 302 39.0 580 75.0
2010
Mayhew et al. Australia Last 1 year 400 100 131 32.7 400 100
2003
Palácios et al. Brazil Last 1 year 732 46.7 100 6.4 619 39.5
2003
To me v et al. Bulgraia Last 1 year 341 67.2 38 7.5 164 32.2
2003
Steinman 2003 S. Africa Last 1 year 619 61.0 172 17.0 609 60.1
Ferrinho et al. Portugal Last 1 year 209 60.0 12 3.0 177 51.0
2003
Sripichyakan et Thailand Last 1 year 589 54.0 110 10.5 520 47.7
al. 2003
Franz et al. 2010 Germany Last 1 year - - 87 70.7 110 89.4
Drabek et al. Poland Last 1 year - - 203 17.0 1046 90.0

2007
One of the most comprehensive studies in Turkey was conducted in Eskişehir, Ankara, and Kütahya
in health care institutions in 2002 (27). In this study, healthcare workers were asked if they had been
exposed to verbal, physical, or sexual assault in the last year and49.5% (39.5% for males and 60.4%
for females) stated that they had been exposed to violence. In the same study it was reported that
the ones who exposed to violence were most frequently primary care physicians and nurses—at
least the teaching staff. The study demonstrated that the ones who mostly exposed to violence
were the emergency service workers. A total of48.3% of the respondents were exposed to violence
between one and five times. In addition, prevalence of physical violence was 72.4%, verbal violence
was11.7%, and sexual violence was 0.025%. Gun, knife, or stabs were used in violence at the
frequency of 0.3%.The study also pointed out that usually during the act of violence, workers could
not get help. More than half of workers who were exposed to violence felt anxiety and restlessness
after the event.
In a study conducted in Samsun on 522 general practitioners in 2006, 82.8% of physicians reported
that they had been exposed to violence at least once in their professional life. The most common
type of violence was verbal violence. Women were exposed to verbal and sexual violence more than
men, and men were exposed to physical violence more than women. In addition, 91.1% of the
violence was used by the patients and their relatives. Physicians mentioned that they exposed to
violence while gathering information or doing physical examination; the reason for the violence was
that they rejected the demands that could not be accepted.
In a study conducted on staff working in the emergency service in Denizli in 2003, 88.6% of
participants were exposed to or witnessed one or the other kinds of violence in the past year, and
49.4%were exposed to or witnessed physical violence in the past year. According to the participants,
the most common reason of violence was the use of alcohol and substance of abuse by patients,
while the second reason was long waiting periods.
In addition,36.1% of the participants reported that they experienced psychological problems after
the incident. In a study conducted in Ankara in 2007 on 622nurses working in 8 hospitals, 91.1%
respondents mentioned that they had been exposed to verbal violence at least once in their working
life, while 33.0%reported to have been exposed to physical violence. In this study, the most frequent
verbal violence was from colleagues and most frequent physical violence was from the patients and
their relatives. In addition, the most common problems after the violence were as follows: mental
health problems, reduced job performance, and headache.
In a study in which 186 psychiatrists participated in Istanbul, 71% psychiatrists were at least once
exposed to verbal or physical violence during their professional life, 48.4% were exposed to both
types of violence,19.9% were exposed to just verbal violence, and 2.7%were exposed to physical
violence only. In addition, approximately half of the participants stated that violence was a normal
part of their profession, while only 5% of them reported this.
The results of some research studies investigating violence against healthcare workers in Turkey are
summarized in Table 2.
EXPOSED VIOLENCE TYPE
RESEARCHER INSPECTED TOTAL VIOLENCE PHYSICAL VERBAL

PERIOD
N % N % N %
Ergün et al. Career - - 13 9.7 65 98.5

2005
Erkol et al. Last 5 year - 87.1 - 19.5 - 46.9

2007
Adaş et al. Career 160 74.5 - - - -

2008
Aydın 2008 Last 1 year 142 45.0 - - - -
Gülalp et al. Last 1 month 109 100 42 8.5 109 100

2009
A survey of violence against general practitioners (GPs) in Birmingham found that 63% had suffered
abuse or violence in the previous year, with 0.5% suffering a serious injury. Another survey of GPs
found that over 60% of GPs experienced abuse or violence by patients or their relatives over a 1-year
period and nearly 20% reported some sort of abuse at least once a month
A German survey, published in the year 2015, reported that almost 50% of GPs were confronted
with aggressive behaviour, with 10% of them experiencing critical to violent attacks, such as criminal
damage to property and/or physical assault
A study from India reported that about 87% of violent incidents were verbal while 8.4% were
physical
REPORTS
In 2017, there were at least 701 attacks on hospitals, health workers, patients, and
ambulances in 23 countries in conflict around the world. More than 101 health workers and
293 patients and others are reported to have died as a result of these attacks
The year 2017 was also catastrophic in terms of access to medical and humanitarian aid, as
parties to conflict—both state militaries and armed groups—in several countries blocked
the passage of aid, putting the health of millions of people at severe risk. Fifty-six health
programs were forced to close directly or due to insecurity in 15 countries. That trend
continued in early 2018, with the siege and bombing of dozens of hospitals and health
facilities in eastern Ghouta in Syria.
The numbers are likely significantly higher, however, because some United Nations (UN)
agencies report aggregated data on attacks rather than information on individual incidents.
The violence against health in 2017 once again represents violations of longstanding norms
meant to protect the safe delivery of care to people everywhere without discrimination or
interference. States have made little progress to protect and respect the provision of and
access to impartial health care and to ensure proper investigation into and accountability
for violations.
The countries with the most reported acts of violence on health infrastructure and against
health workers and patients are Afghanistan (66), the CAR (52), the Democratic Republic of
Congo (DRC) (20), Iraq (35), Nigeria (23), occupied Palestinian territory (oPt) (93), Pakistan
(18), South Sudan (37), Syria (252), and Yemen (24).
At least 29 ambulances were damaged or destroyed and 21 hijacked or stolen throughout
2017. In total, 91 health workers were arrested. No breakdown of the figures is currently
available for Syria.
In addition, oPt had the most reported obstruction to the provision of health care, with 57
detailed cases.
In Ukraine, the parties to the conflict shelled health facilities, blocked the passage of
ambulances, and impeded patients from crossing the “contact line,” which divides Ukrainian
and separatist-controlled territories, to seek health care.
Severe and devastating obstruction of medical and humanitarian aid has deprived millions
of people of access to medicine and health care in Myanmar, South Sudan, Sudan, Syria,
and Yemen.
Although there were fewer reported instances of violence against vaccinators than in past
years, in 2017, vaccinators continued to be attacked in Afghanistan, Nigeria, Pakistan,
Somalia, and South Sudan for seeking to immunize children against polio.
For example, in Nigeria, an army plane dropped two bombs on an internally displaced
persons camp near the town of Rann during a vaccination campaign, killing at least 90
people, including at least six Red Cross aid volunteers and three MSF contract workers; the
army claimed that the bombing was accidental.
CONSEQUENCES:
Ø Violence against healthcare is a prevalent factor affecting human rights and public
health worldwide.
Ø Violence against healthcare has social, economic and multiple health consequences for
the individual, families, communities and societies.
Ø Damaging gender norms can continue violence against health care
Ø Cost of services incurred by victims and families (health, social, justice)
Ø Loss in workplace productivity and cost to employers
Ø Health complaints and physical injury
Ø Attempting suicide
REASONS OF VIOLENCE AGAINST HEALTH CARE WORKERS AND FACILITIES
COMMERCIALIZATION AND CORRUPTION:

Till the end of the 20th century, the medical profession was considered the most noble of
professions. As a mark of respect, in cinema, someone always carried the iconic satchel of
the doctors. The pendulum has now swayed the other way and the medical profession now
falls within the ambit of trade and the patient being considered a consumer. Doctors are
depicted as extortionists who extract money even for treating dead bodies. Unfortunately,
some black sheep in the profession have been caught on camera seeking
bribes/commissions, in exchange of favours for pharmaceutical companies, and the media
portrayed all doctors as commission agents. Nobility has gradually taken a backseat and so
has the respect accorded to the treating doctor. There is no doubt that there are corrupt
and unethical medical practitioners, but the general perception is that the entire profession
is corrupt and gold diggers. Corruption is a malady afflicting all professions, with the media
and judiciary are no exceptions. Patients are becoming more aggressive in their demands
and are much more likely to resort to aggression if not satisfied with health care.
ROLE OF MEDIA:
The news-hungry media regularly publish sensational stories of organ theft, medical
negligence, prescription of expensive branded drugs, and malpractice. Movies and television
are not far behind. The regular portrayal of doctors in poor light, with the objective of
sensationalizing news, has played a major role in painting the medical profession as Satan.
The media is the window of society. They should stop demonizing physicians and rather
report medical errors with a sense of responsibility rather than as scandal. The media should
be sensitive to the fact that medical science cannot replace the almighty God and make all
immortal.
ROLE OF POLITICIANS:
The doctors are the favourite bashing boys of the politicians. Doctors are regularly advised
publicly to perform the social duty of treating the needy free. For cheap vote-bank politics,
senior government ministers issue statements demeaning the medical profession and
painting the entire profession as corrupt. A court of law recently legitimized violence on
doctors and commented that those who cannot face violence should not practice medicine.
To overcome these shortcomings, governments need to be sensitive to the expectations of
the common man and improve/enhance the facilities in public hospitals. Doctors must, on
their part, sharpen their communication skills and should take time to clearly explain patient
prognosis to attendants as they may harbor unreasonable expectations. Counsellors for
emotional support should be available.
VULNERABLE AREAS:
Emergency wards/departments are the most vulnerable places to the threat of violence.
The sources of violence are Patient’s relatives; brainwashed by negative media reports;
irritated by personal socio-economical deprivations; agitated by an inhumane irritating
attitude of the staff.
OTHER CAUSES IN ED: The other causes that can trigger violence in Emergency
Departments include
l . Patient and relatives’ assumption that they are not provided proper treatment by the
staff.
ll . Fatality of patients can bring out the worst behavior in the relatives even though
appropriate treatment might have been given in serious cases.
LACK OF COMMUNICATION BETWEEN HEALTH CARE WORKERS AND PATIENTS :
Health care workers should provide accurate information to patients and their relatives
about the patient's condition and the approximate waiting period. Careless answers are
perceived as avoiding taking responsibility.
Lack of communication between Doctor and patients due to the difference in language,
social status, gender difference can also become a cause of ferocity.
Building a patient–physician relationship is essential to practice clinical medicine. This
mutual trust is crucial to ensure cure, apart from maintaining a respect for each other. The
doctor–patient relationship, historically defined as the legendary Hippocratic Oath, is now
unfortunately reduced to a commercial transaction. The notion that the practice of
medicine is a social service, and not a profession, aggravates the situation. Patient
perceptions of societal injustice and commercialization of medicine lead to patient–
physician mistrust. Physician training lacks core humanistic components that nurture
empathy and caregiving. The public at large feel that health care is a fundamental right and
they should not have to pay for it. On the other hand, governments have been shrinking
health-care budgets overtime and gradually want to shirk off this burden. Limited
government financial support to hospitals (about 4.4% of the overall budget in India)
encourages these structural distortions. Hospitals refuse care to poor patients and the
prolonged illness devastates families financially.
LACK OF SECURITY MEASURES :

The inadequate number of security guards and police, especially, in the public hospitals
needs to be solved. Security should be provided to health care workers during working
hours. Lack of staff training on the prevention and management of violence needs to be
solved
Insufficient security for medical staff makes them an easy target for an angry mob of
relatives.
Ever since the incidence of violence has increased, there has been a demand to boost up
security and to introduce martial personal protection training of doctors. The way to abet
this violence is not to hit back but rather prevent it. The need of the hour is to develop
better health-care facilities; develop crisis management teams; better patient flow
management; training of employees/security to defuse crisis; and analysis of potential
hazards and measures to control them. New laws need to be framed to deter the public
from indulging in such acts. While it is an offense to assault a public servant, there are no
laws for the protection and safety of the medical community. Assaulting medical personnel
on duty should be made a serious cognizable offense. Unconcealed closed circuit television
with video recording may serve as a deterrent, as well as be used to record evidence.
Hospitals and clinics must have panic alarms and all threats/episodes of violence should be
recorded in a critical incident book. There must be a zero tolerance policy for abuse. This
policy must be embraced as a universally applied core institutional value rather than an
imposed bureaucratic requirement.
VIOLENCE AGAINST LADY HEALTH WORKERS :

Lady Health workers (Nurses) are more vulnerable to violent incidents as compared to their
male counterparts. The reasons for this violent behavior are usually excessive waiting time,
shortage of staff and unmet patients demands. Verbal abuse was the most common and the
assailants were mostly the patient's relatives or friends followed by the patients themselves.
SOLUTION TO TACKLE CAUSES OF GROWING TREND OF VIOLENCE AGAINST

HEALTH CARE WORKERS AND FACILITIES :
RAISING STANDARDS:
Accreditation criteria for medical and dental schools should be made very strict in order to
maintain high quality and standards. Those institutes failing to raise their standard to the
prescribed criteria should be closed down.
AVOIDING NEGLIGENCE:
Doctors should avoid negligence and each patient should be adequately examined,
investigated and treated.
CONFIDENCE BUILDING:
Patients should be taken into confidence prior to any medical procedure is carried out and
should be briefed about all the possible complications and risks involved in the procedure.
Proper documentation should be prepared to record patient’s decision in order to prevent
any misunderstanding to occur in case of failure of the medical procedure.
PEMRA’S ROLE:
Pakistan Electronic Media Regulatory Authority (PEMRA) should educate Media, in

particular, to show responsibility while reporting health issues and avoid graphic details that
may stir the sentiments of the people that may incite the violence.
SECURITY:
Healthcare facilities should be secured with adequate security. The boundary walls of the
institute should be guarded 24/7. The entry point of the hospitals should be secured by
appointing physically capable security guards who should be well trained in peaceful crowd
control techniques. Security guards should be posted inside the hospital particular in most
sensitive areas like Emergency, Intensive Care Units, and Operation Theatres.
AWARENESS:
Seminars and social events should be organized to educate medical professionals on how to
deal with the public effectively and efficiently.
ONE GUEST POLICY:

Not more than one patient’s relative should be allowed to accompany the patient to the
hospital. This policy is very successful and has been adopted by many hospitals like Rehman
Medical Institute (RMI) and North-West Hospital in Peshawar; which helped in mitigating
the problem of overcrowding, violence etc. and keeping medical professional safe .
NO SYNDICATES POLICY:
An atmosphere of harmony should be created between the senior doctors and young
doctors. Recent cases of violence against senior doctors carried by young doctors
organizations have created a gang war like situation in the hospitals which caused uncertain
atmosphere in the hospitals where young doctor have hostile sentiments against their
seniors and vice versa. Patients are the most affected party in case of conflict between the
young and senior doctors rift. The government should pay heed to the demands of all
parties to ensure patients don’t suffer due to internal politics of the hospitals. All political
syndicates should be banned in hospitals.
HELP FROM TECHNOLOGY:

Help should be sought from newer technology advancements and equipment like closed-
circuit television (CCTV), and other intelligent solutions should be installed in hospitals and a
team of professional especially dedicated to looking after this equipment and keeping an
eye on the doctors; evaluating their performance and checking condition of the patients,
while not invading their privacy while carrying on this process. CCTV can also help to track
down the violators.
PROTECTION FOR AMBULANCES:

Even if medical professionals working inside the hospital are protected from the wrath of
the patient’s relatives, but structures like ambulances can be exposed to the angry mob and
can be damaged easily while also inflicting serious injuries to the ambulance staff like a
driver, nurse etc. The government should be responsible to provide extra mobile security for
the ambulances so that they can carry on their function uninterrupted. Special bulletproof
ambulances should be provided to hospitals in order to save the staff from an armed angry
mob.
INCREASED BUDGET:
A significant increase in capital in the annual budget for the health sector by the
Government of Pakistan can ensure that all the hospitals can have all the essential
equipment that they can utilize to treat the patients. In recent years the problems like load
shedding created a lot of problems for doctors, who were forced to carry on major
operations using flashlights. One can imagine how a little error in such situation can affect
patient. In such a scenario, the death of the patient can become justifiable for the violence
carried on by the relatives, in people’s eyes.
IDENTIFICATION:
All the patient’s relatives or guests should be issued entry cards after complete investigation
of their bio-data. This investigation record can later help the Hospital and Police
administration to track down people who might be involved in act of violence carried
against Hospital staff.
COMPLAINT CELL:
A complaint cell should be established in every hospital to pay heed to the patient and their
relative’s complaints. All the necessary actions should be carried out to satisfy them. Justice
should be provided to them.
CONCLUSION
Violence against health care workers is always a common problem. Violence in health care
institutions is more than other public institutions, and it is scientifically proved. Therefore,
penalties for these crimes in healthcare institutions need to be more deterrent.
In short, there is an urgent need to make the healthcare facilities a safe environment for the
healthcare professionals to work only then they can be expected to work with devotion and
dedication. Breaking News on the Television Channels regarding the death of patients due
to doctor’s negligence has only served to work against the patient’s own interest as now the
healthcare professionals are very reluctant to handle serious cases, hence many precious
lives which could have been saved are being lost. The blind pursuit of financial profits at a
systems level has eroded physician trust in Pakistan. Restructuring incentives, reforming
medical education and promoting caregiving are pathways towards restoring trust.
Assessing and valuing the quality of caregiving is essential for transitioning away from
entrenched profit-focus models. A number of effective measures can be undertaken by the
government, hospitals, and medical schools ensuring patient safety. However, it is essential
to sensitize the hospital directors to elevate their quality of medical services.

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TRENDS OF VIOLENCE AGAINST HEALTH CARE

WORKERS AND FACILITIES

 TYPE 1 : by intent crime

SURVEYS CONDUCTED IN HOSPITALS OF PAKISTAN

SURVEY CONDUCTED IN HOSPITALS OF THE WORLD

RESEARCHER COUNTRY INSPECTED TOTAL EXPOSED VIOLENCE

Drabek et al. Poland Last 1 year - - 203 17.0 1046 90.0

RESEARCHER INSPECTED TOTAL VIOLENCE PHYSICAL VERBAL

Ergün et al. Career - - 13 9.7 65 98.5

Erkol et al. Last 5 year - 87.1 - 19.5 - 46.9

Adaş et al. Career 160 74.5 - - - -

Aydın 2008 Last 1 year 142 45.0 - - - -

Gülalp et al. Last 1 month 109 100 42 8.5 109 100

REASONS OF VIOLENCE AGAINST HEALTH CARE WORKERS AND FACILITIES

COMMERCIALIZATION AND CORRUPTION:

LACK OF SECURITY MEASURES :

VIOLENCE AGAINST LADY HEALTH WORKERS :

SOLUTION TO TACKLE CAUSES OF GROWING TREND OF VIOLENCE AGAINST

Pakistan Electronic Media Regulatory Authority (PEMRA) should educate Media, in

ONE GUEST POLICY:

HELP FROM TECHNOLOGY:

PROTECTION FOR AMBULANCES:

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