The first question put forward to the panelists was about how they have managed to incorporate a gender and rights based perspective in their teaching and in their practice.   

Dr, Bhate responded by saying that there were a lot of struggles she had to undergo before she was able to incorporate gender into her teaching and practice.  In 2003-04, it was very difficult to implement such things because “gender” as a concept was not really heard of or discussed much. Before she really started analyzing texts from a gendered lens, she herself didn’t feel the like there was anything missing in the way she was teaching or what she was learning. It was only when she reviewed two PSM textbooks (Park 17th edition and Mahajan 3rd edition) along with the Achutamenon Centre that she realized what was being overlooked and misinterpreted. For instance, since the Park textbook mentions gender as a determinant of health, it was thought that it is a gender sensitive text. However, other issues such as a mere cursory mention of the PCPNDT Act or the language being biased towards boys and men only came up during the review. 

Secondly, Dr Bhate felt that being a PG teacher gave her the advantage of teaching subjects or giving her students projects which have a strong gender component. For example, one of the projects was done in collaboration with StreeMuktiSangathana where they looked at the health conditions of male and female rag pickers. Here, they found that the women had less health problems since they were less addicted to substances (owing to lesser access) in comparison to their male counterparts. She felt these projects gave the students important perspectives. 

Next, Dr Jagtap spoke of her own experiences as the casualty Medical Officer Rajawadi hospital. In the 4-5 years she had been there, she came across a lot of women coming in with exposure to Domestic Violence, women facing violence during pregnancies or old women being beaten up by their sons. She never felt that she could do something about it till her senior called her for a gender sensitization training in Pune. It was then that she realized the different ways in which she was being insensitive to her patients. For instance, a lot of times doctors get irritated with hysterical patients who come for help at 2 a.m in the morning. But it is important to consider why a woman would try to reach out at such a time unless she was facing some form of violence at the time. Another example of insensitivity often seen is in the gynecology or general OPD. When doctors find out a woman from a lower socio- economic background has a lot of children, they make prejudiced statements like “these people are like this” (yeh log tohaise hi hain). It doesn’t occur to them that she may not have had any choice in the matter. 

Subsequently, she joined the Dilaasa committee where they conducted gender sensitization programmes for all the staff members working at various levels. This is where the need to be sensitive and non judgmental was emphasised upon. As a result, the staff can now recognize victims of domestic violence and are able to send these women immediately to a doctor at Dilaasa. 

Another important learning for her was assuring privacy for patients. Earlier, she used to just make records of the various injuries on the woman’s body. Now, she takes the women aside, gives them space to take off their clothes if necessary and record all the injuries in a very scientific manner. Not a lot of women confess to being victims of violence but even talking to them sweetly is helpful.

Ms. Khanna reiterated that the introspection and the change in attitude and behaviour it leads to is very important to keep in mind. She also asked them to talk more about the importance of not just working on themselves but also creating change as a team. 

Dr Jagtap said this was very important since it is not just helpful for the patients, but also for the staff. The staff if also able to recognize resource persons they can go to in case they have problems.

Dr Samant said that in her case, there were two platforms she got to work through on the issue. One was  her own field of Obstetrics and Gynaecology.  The second was the field of Medical Humanities which her college runs as a programme at both under graduate and post graduate levels. While Obs-Gyn had a structured curriculum where she tried to incorporate gender sensitivity however and wherever she could, the other had no fixed curriculum and therefore had a lot more scope for awakening students’ curiosity though various projects. She also said that in the under graduate curriculum, it was most easy to talk about gender biases through the topic of contraception and fertility. These are usually issues which are only talked about to/focussed on women. The partner and the family are always missing from these conversations, even though, in most cases, the power of what needs to be done in her interest lies with the partner and his family. 

She also claimed that she was fortunate to have a very co-operative HOD who was supportive of her decision to incorporate gender sensitivity into her lectures. This gave her space to talk about issues of gender, masculinity, age, sexuality etc through topics like contraception (Should children be given sex education? Does sexuality determine what kind of contraception can be used?). Additionally, because there are trainings done on examination of sexual assault survivors, she was able to incorporate those teachings at the post graduate level. She also encouraged students to work on gender based issues for their research projects. Students chose topics like access to health care facilities for pregnant women with disabilities or connections between reproductive health and gender based violence. However, there were objections from the institution review board who felt that working on gender based violence could cause several issues like conflict between the husband and wife, insensitive handling on the part of the students and making the women respondents uncomfortable. Simultaneously, for medical humanities, short films on various gender based issues were screened for both undergraduate and post graduate students and these opened up a lot of space for discussions. 

Ms Khanna then asked the panellists to reflect upon the value additions of incorporating gender into medical practice. 

Dr Jagtap responded by saying that it’s not a value that can be judged purely in terms of quantity. Butthe qualitative impact is substantial. To begin with, it instils positive feelings of having done something right. She gave the example of a woman who was brought to the hospital in an unconscious condition. Her history had been provided by a relative who had said she had a history of hanging. Dr Jagtap realized that the psychiatrist in charge had put in the relative’s account in the form. When the women eventually recovered, she stated that she had not tried to hang herself and that the entire family had ganged up against her and tried to throttle her. This information changed the course of the entire case. The woman was referred to the Dilaasa Centre where she was counselled and eventually they were able to get a conviction for the husband. This positive result also uplifted the morale of the entire hospital. 

Dr Bhate added that gender sensitive care was an integral part of quality care at a hospital. She shared her experience of working on resource materials for prevention of sexual harassment at workplace. A lot of discussions and cases came up during this process which challenged her notions of KEM being a safe workplace for women. When patients would complain of sexual harassment earlier, their grievances would rarely be addressed. But now they had developed awareness raising posters and put them up for all women to see and know about their rights in a hospital. These posters have now been adopted by all hospitals across the municipality. 

Dr Samant said that knowing about and detecting a problem is the first step towards solving it. For instance, realizing the discrimination faced by HIV patients made them start a sub OPD which would provide post natal care only for HIV+ mothers and exposed babies. While multiple units should have been held collectively accountable for the health of these mothers, it usually came down to doctors sensitive gender issues to work with them. However, these issues are becoming more of a reality today than they used to be. 

The discussion was then directed towards the effect of such teachings on the students. 

According to Dr. Samant, post graduate students don’t usually respond very positively to this initiative. They feel that they would rather learn about the surgical aspects of a problem rather than ask questions around disabilities, gender or other social determinants. She also observed that students are less interested in knowing only about data, definitions and outcomes but become more involved when topics like masculinities and sexualities are discussed. Additionally, since undergraduate students are less preoccupied than the post graduate students, they are able to process these discussions better. 

Ms. Khanna then asked the panellists to elaborate upon the challenges faced by them and talk about the lessons they learnt. 

Dr Jagtap responded by saying that the first major challenge to overcome was that of logistics. Being a hospital running round the clock, getting people to take time out of regular shifts and attend three hours of gender sensitization training is a difficult task. Secondly, there was the factor of constantly keeping the staff to feel motivated enough to come for the trainings. In between epidemics of swine flu, malaria etc, it is a lot to ask both staff members to attend trainings. Additionally, it is also important to keep the trainers motivated so as to prevent boredom and monotony from setting in. Lastly, scepticism from male colleagues also proves to be challenging. 

According to Dr. Samant’s experience, almost all doctors have a uniform view of looking at women and their problems. Even female colleagues behaved in a manner similar to male colleagues.  She recounted a time when none of the women faculty attended a session that discussed gender based violence with the surgery department. Similarly, there were a lot of disturbing and condescending questions asked by male colleagues. It seemed that people felt threatened about having to confront issues around violence. That is what helped her realize that it will take time before we can openly talk about such issues. However, she added that her best experiences have been while working with PSM, Obs-Gyn and Paediatric departments. She also talked about having to work on developing a gender sensitive curriculum beyond her regular working hours, after her primary responsibilities had been taken care of.  

Dr Bhate agreed with the other panellists about having to face scepticism from colleagues. She added that any letter from CEHAT or Achutamenon Centre would be immediately dismissed as “non scientific nonsense”. The other major challenge she had to overcome was examination of sexual assault cases. HODs then were resistant to accepting the readymade protocol already prepared by CEHAT. However, this sort of resistance and scepticism is now reducing with the changing times 

All three panellists agreed that the primary way to overcome the challenges was by finding other likeminded people. This helped them share their work load as well as the stress they were undergoing while trying to implement a gender sensitive curriculum.