Opinion
Dr Payal Tadvi could not have broken this system. It has never in a thousand years seen her as equal and never will – for the next thousand.

Dr Payal Tadvi wasn’t just killed. She was mentally tortured, humiliated, abused, ostracised…and THEN she was killed.

I wonder – what if Payal Tadvi’s murderers had not been from the social location that they are now in? What if they had come from her own community of Adivasi Muslims? What if they had been friends since childhood with other Payal Tadvis? What if they had shared meals together, played together, had similar crushes, lived in similar localities?

What if their parents had taught them to respect others irrespective of caste, religion, colour or class? What if their parents had said, “No matter what, you cannot be cruel and hurtful to people you don’t understand or like.” What if the family celebrations had more than just their own narrow caste and class groups? What if their parents had said, “We want you to be a good human being. Success is secondary.”

What if the people around Payal had objected to how she had been treated? What if they had challenged the murderers? What if they had lodged a complaint along with Payal, objecting to the treatment meted out to her?

What if the violence and humiliation meted out to people like her was unacceptable to society? What if deaths such as hers were followed by protests and boycotts? What if deaths such as hers were not followed by a string of character assassinations of the dead along with desperate protestations of the virtues of the accused?

What if laws against discrimination in schools and colleges and workplaces were strictly and unapologetically implemented? What if Payal’s family were influential and well connected? Would their daughter had been safer? Would her complaints have penetrated an unflinching wall of resistance?

After her death, has anything or anyone changed?

Maybe change happened to people from her own community and people ‘like’ her from the margins, struggling for everything, from money, education, healthcare, nutrition and more importantly, dignity. Maybe change happened to people ‘like’ her, who understand where she may have come from and where they themselves could be heading.

However, the one community that has doggedly refused to change is the one her murderers come from. This group has no natural inbuilt mechanism of introspection, or a sense of right and wrong. The only prevailing and all encompassing sense is that of ‘pure’ unadulterated entitlement over every privilege and resource.

Dr Payal Tadvi could not have broken this system. It is a heartless, soulless system without morals or compunctions. It sees people like her as aberrations, like a malignancy that has to be removed by poking, prodding, and disintegrating. It has never in a thousand years seen her as equal and never will – for the next thousand.

When she died, a group of public health people expressed anguish and outrage and put out a heartfelt press release demanding that such deaths never happen. At the same time, there were mails on the same groups by two doctors who had never, ever spoken earlier. They described clearly the caste based harassment that they themselves had experienced. The response from the group? Silence.

What is it about caste that make it so much more appealing after death? Is it because the dead don’t need any changes? They just need sympathy, sadness, mourning, and protests. The living need much more than that. What really changes after each death? No structure changes. No organisation bows its head in shame. No leaders make a call for reparations and atonement. Life, in fact, goes on as usual. Only people ‘like’ Payal become a little more fearful, wondering what is it about institutions that lead to suicide, and parents ‘like’ hers who feel at once elated and afraid about their children’s success.

India has the baggage of a colonial allopathic health system, biased towards the urban elitist dominant caste and class patients. The irritations of the doctors against the poor are visible in small interactions – the impatience, the sarcasm, the humiliation, the lack of sensitivity, the deliberate inflicting of pain.

I have seen patients being hit on the perineum during delivery because they haven’t ‘pushed’ hard enough. Patients who forget tablets or the correct dose or hospital cards are abused. There is a sense of entitlement over the patient, as though the patient who doesn’t understand a ‘simple instruction’ is not just sick but stupid. This ONLY changes if the patient has buying power. Then, the relationship changes to one of sickly sweetness and pretentious kindness.

Often doctors get angry at criticism directed towards them. They project themselves as hard working, caring persons. When specific examples of bad behaviour by doctors are presented to them, they say, “All doctors are not like that,” or, “Don’t stigmatise all of us because of a few ‘bad apples’.” And that becomes an end in itself. It doesn’t lead to introspection.

In India, during the five years of training that doctors receive, there is hardly any focus on ethics, primary health care, or social determinants of health. Most medical colleges, especially the burgeoning private colleges, have students from very elite backgrounds with quite some social capital. The idea that health is a social subject deeply connected with the social situation of the country is lost on these elite kids. It is almost impossible to expect them to understand, empathise or work with communities that have different trajectories from the urban elite. In this context, a Dr Payal Tadvi who dreamt of going back to set up a hospital in her Jalgaon, for her Tadvi Bhil community, cannot be replaced.

In a country that is seeing innumerable sadistic lynchings and hate rapes of little children, these deaths are often forgotten quickly. Very little changes at the level of the structure or the system. The responses always tend towards blaming the victim – why weren’t you smarter, louder, cleaner, more knowledgeable, more adjusting? Why did you not complain? Why did you complain? Why didn’t you speak sooner? Why didn’t you speak later? Why did you write? Why didn’t you write? Why this? Why not that? It’s a bottomless pit that one is thrown into.

Students from marginalised communities are not all poor. Some are extremely savvy, well read, smart, and also flaunt their wealth. But neither the well-off nor the poorly off are welcome into these insulated spaces. The only expectation from them is that they should disappear, and all efforts are made to, in reality, make them disappear from all spaces that the dominant groups inhabit. The hatred towards Muslims runs deep, with offensive Islamophobic comments from ‘well-respected’ doctors not being uncommon.

The medical profession refuses to acknowledge its casteist, communal, Islamophobic, elitist status. No amount of external ‘regulation’ can control the private relationship that a doctor shares with a patient. I have overheard doctors telling emaciated HIV positive patients to stop eating meat and to eat only vegetables and fruits. This is not the science of medicine speaking, but religion, superimposed by caste. How does it seep in? Five years of medical education does nothing to address these deep rooted prejudices. They affect the treatments that patients receive and cannot be ignored as ‘personal beliefs’.

Isn’t the need to address caste based discrimination so much more necessary in the medical profession? Don’t doctors need to have social qualities like kindness, compassion, caring, love, sympathy, empathy? Can medical colleges unleash doctors who practice blatant caste harassment – into the world where patients of all kinds and castes and religions seek medical care?

All that remains now is the memory of the beautiful, smiling, incredibly meritorious Dr Payal Tadvi, lying dead on a cold post-mortem table – with the words justice, equality, and fraternity reverberating endless in the corridors of an empty, lonely morgue. Nothing much else has changed.

The writer is a public health doctor and researcher, of inter-caste background, working on Right to Food and Right to Health, particularly of marginalised communities.