Nurses are among the frontline health workers, working heroically to deliver essential medical services to people during the current COVID-19 outbreak. It is impossible to imagine any kind of medical service in the hospital without the services rendered by the nurses.
Mazdoor Ekta Lehar (MEL) spoke to RJ, a leading member of the United Nurses Association of India, about the conditions of nurses in our country in general and the particular difficulties they are facing at this time. We reproduce below excerpts of the interview:
MEL: What are some of the main challenges that nurses, doctors and other health workers in hospitals across the country are facing during the current COVID-19 outbreak?
RJ: When the current coronavirus epidemic broke out, majority of the government and private hospitals were not fully prepared to handle the crisis situation. This is the reality, whatever may be the claims of the PM and other members of the government and administration.
Despite the efforts of the government to set up special isolation wards and convert other parts of the hospital into coronavirus screening and treatment wards, their capacity remains limited. Although private hospitals have been allowed to set up COVID-19 centres, only a very small number of private hospitals have obtained licences to do so at this time. They are not equipped to follow all the government guidelines on this epidemic. Moreover, private hospitals charge a price for the screening test and other treatment. They mainly cater to well-off patients, who can afford to pay the high charges.
Hospitals do not have sufficient isolation/quarantine facilities. All hospitals, government and private, are also facing shortage of ventilators and other medical equipment as well as protective gear for doctors, nurses and hospital staff, to deal with the current crisis.
MEL: What are some of the specific hardships in their working conditions that nurses are facing at this time of crisis?
RJ: In many hospitals nurses are required to work in 12 hour shifts. Due to shortage of staff, nurses have to sometimes work single-handedly in the coronavirus screening area, without any stand-by during the entire shift. A young nurse at a private hospital complained on one occasion, that during her night shift she was unable to use the washroom for nearly 12 hours, as there was no one to relieve her.
Often they have to stand continuously for many hours at work, resulting in swelling in the legs and feet, varicose veins etc. Shoes provided with the uniform are often painful and not suitable for standing for such long hours.
There is great panic among people regarding the coronavirus outbreak. Nurses are in the forefront of dealing with this panic and fear among the patients and their relatives. They often have to face the anger and frustration of people, including verbal abuses and physical attacks.
Nurses in government and private hospitals are not receiving any financial compensation for the additional working hours they have to put in at this time. In many private hospitals the management has warned them that due to the economic crisis, the nurses may not receive their salaries for the next several months.
In government and private hospitals, nurses have had their leave cancelled, their working hours and work load increased. Even pregnant nurses have been forced to work for long hours, seriously jeopardizing their health.
MEL: What are the difficulties nurses are facing due to shortage of protective gear?
RJ: Nurses are forced to work in COVID-19 wards without proper protective gear. Protective gear provided in many private and government hospitals is of sub-standard quality. Internationally, the use of N95 masks has been prescribed, designed to provide reliable respiratory protection, for the doctors and nurses working with coronavirus cases. However, there is serious shortage of N95 masks in the country as these are not manufactured indigenously and have to be imported. Nurses often have to work with normal surgical masks, which make them very vulnerable to infection by the virus. In the private hospitals especially, but also in some government hospitals, the nurses working the COVID-19 screening area are not provided with adequate protective gear such as proper masks, gloves and eye protection.
MEL: Under what conditions do nurses themselves have to be quarantined and what problems do they face then?
RJ: Nurses who are working in COVID-19 wards have to be undergo quarantine when either they themselves, or their patients test positive. Often, the hospital does not have quarantine facilities to accommodate them, so they are asked to quarantine themselves at home, exposing all their family members to risk.
Nurses who are quarantined in the hospital have to face ill-treatment by the hospital staff who are afraid of contracting the infection from them. For example, in one branch of Artemis Hospital, a young girl who had joined duty as a nurse just a couple of months ago, was exposed to infection in the COVID-19 ward and had to be quarantined in the hospital. Her family members and friends were not allowed to visit her. The hospital authorities asked the security guard to deliver her meals to her. The security guard, overcome by panic, left the food outside her room, without informing her. As a result, she had to go without food for three days, before she realized what was happening.
MEL: What are some of the social pressures that nurses dealing with coronavirus cases face at this time?
RJ: Nurses working on COVID-19 cases are facing severe social boycott. No public vehicles such as auto rickshaws etc. are willing to transport them for fear of infection. Landlords have demanded that they immediately vacate their rented homes, putting immense pressure on them, such as throwing out their belongings, cutting off water and electricity supply, etc.
MEL: What are the problems faced by hospital nurses in general? How have these been aggravated in the present crisis?
RJ: Nurses are hardly ever given any recognition for their dedicated service, without which all forms of hospital treatment are impossible. Nurses are forced to work like slaves. They are under compulsion to follow orders of not only the senior doctors in the specific areas where they are working, but also to submit to the commands of the hospital authorities who “treat them like dirt”, with no respect.
Nurses are not represented in the governing bodies of any of the hospitals, government or private. Their conditions remain largely unreported and their demands largely unaddressed.
Nurses’ jobs in private hospitals are largely on contract, which can be terminated at any time depending on the arbitrary whim of the authorities. So nurses are afraid of complaining about any of the problems they face.
The authorities discriminate between doctors and nurses in terms of facilities provided, etc. This discrimination, which is a normal feature in all government as well as private hospitals, has become acutely visible in the present crisis. Whereas the doctors working 24X7 have been provided accommodation by the government authorities in plush hotels in the city, e.g. The Lalit, the nurses, also working 24X7, have been provided very meager accommodation in the regular hostels.
Hospitals provide very little accommodation for nurses. So, a large majority of the nurses are forced to take up private rented accommodation and travel to work under sometimes harsh circumstances, such as at present. For example, the premier government hospital, AIIMS-Delhi has more than 5000 nurses but provides accommodation for only a few hundred. Many nurses have to wait for several years to get accommodation in the hospital. Their conditions of work require them to be separated from their families for long periods of time. The loneliness and social isolation adds to their trauma. Many nurses are victims of depression and display tendencies towards suicide.
MEL: What are the lessons we should draw, from the current COVID-19 crisis, to improve health facilities for people of our country?
RJ: The COVID-19 crisis once again points to the urgent need for reversal of privatization of the health sector. It reinforces the need for the state to take over the health services and provide universal, good quality and adequate health care, at affordable prices and accessible to all our people.
MEL: On behalf of the nurses of our country, what is the message you would want to convey to the society?
RJ: We want to say that nurses do not want token gestures like “clapping”, etc. They want recognition of their vital services in the health sector and they want to be treated with respect and dignity. Nurses demand working conditions fit for human-beings and an end to the exploitation and discrimination they face.
MEL: Thank you for enlightening our readers about the difficult conditions of the nurses and the heroic work they are doing in service of the society. Mazdoor Ekta Lehar will continue to campaign for the rights of nurses, as a vital component of the health care services in our country.