Unheard & Dismissed: Why Are Nurses Being Denied the Very Basic?
“The major issue here is that we are not consulted when policies concerning us are made,” a nurse tells FIT.
“We are not being provided with accommodation. Many of us have nowhere to go. The landlords refuse to take us in. What do we do?”
“We have no AC. My colleagues have fainted because of working in the laminated PPE kits for hours.”
Nurses form an integral part of the health workforce. They are overworked, underpaid and undervalued, despite putting in extra work and pulling off shifts that stretch for as long as 12 hours. The COVID-19 pandemic has exposed the gaps, discrepancies and disparities that have been plaguing our healthcare system for years.
FIT speaks to nurses working in hospitals across different Indian cities to see how the new COVID pandemic and the reignited disparities are impacting their lives.
No Mandatory Quarantine or Testing Despite Possible Exposure
For many healthcare workers, things went downhill drastically after an advisory issued on 15 May put an end to two significant policies: mandatory COVID-19 testing for the staff after working for 14 days, and the stipulated 14-day quarantine that followed.
In the new order, the Ministry stated that healthcare workers will have to report their risk exposure to an appointed nodal officer, who will decide if it was high-risk enough for a test to be conducted. If not, they must continue to work without being tested.
The order led to chaos and confusion among the workers. There were reports of staff being forced to evacuate the hotels where they were being quarantined, without any prior notice or any arrangement for their transport.
A senior nurse working at a government hospital in Delhi told FIT, “The hospital has stopped providing accommodation during and after duty and has also reduced the quarantine period to 10 days. If the incubation period is 14, how do 10 days make sense? Every day, 6-7 patients are testing positive. How do we know who will be positive?”
The nurse added, “Healthcare workers should be provided with accommodation. With this sudden change in policy, many nurses are left without a place to live. Hostel owners and landlords are not allowing them to enter because of the fear of infection. Where will they go? I had an extra room in my house so I brought one of my juniors home with me. I had to pick her up in the middle of the night. Her hostel owners had told her ‘vaapis aana hai toh test karwana hai’ (you can only come here when you show us your negative test results.”
Even for those who do have their homes in the city, going back and living with their families involves real risks, she adds. “Many of us are living with elderly parents and small children with relatively low immunity. What do we do when we don’t have enough rooms? Isolation requires everything to be separate. How will that be possible?”
She says that even though her hospital administration is responsive and understanding, it is unfortunate that workers have to fight for all this. “We are already stressed about the infection, then about our own risk, and now these are just added issues affecting our mental health and productivity. It is easy to work in a comfortable environment, but for us, our daily battles are just not ending.”
While this government hospital has a 10-day quarantine period, another nurse, working at the ESIC hospital in Mumbai, told FIT that the policy differs in all hospitals. At his hospital, for instance, workers are not supposed to quarantine themselves at all after performing their duties for 14 days, unless they show symptoms and are tested positive. Others just get a break of one or two days before they are back to the grind, giving them no time to rest after working on a stretch for so long.
“This is not only putting us at risk, but is also dangerous for all hospital employees and the people we live with. How is this helping anyone? We are working so hard to contain the infection and minimise loss of life, but this will do just the opposite,” he said.
“Even when they were providing accommodation, it was only for the doctors, not the nurses. For those who test positive after showing symptoms, there is the provision of getting admitted to the hospital or going home. Nobody wants to go home and put their families at risk, especially in a city like Mumbai where most houses are small. But there aren’t even enough beds in the city to admit more patients. Either way, we are stuck.”Nurse in Mumbai
He added that at a lot of places, the workers are not even being provided transport. Even in Delhi, where DTC buses have been arranged, the facility is not being provided for ESIC staff.
A nurse working at Delhi’s Safdarjung is also worried about what will happen when the lockdown opens. “The DTC buses will then be needed for the general public to use. How will we manage then? Many of us are coming from far.”
While quarantine and transport are major issues being faced by many workers, some places are faring better than others. Indu Thorat, a nurse working at Government Medical College & Hospital, Aurangabad, Maharashtra, told FIT, “In our hospital, a seven-day quarantine is permitted for all workers and we are being provided accommodation throughout our duty and after. But for nurses in Mumbai, the situation is really worrisome. They are being told to go home even when they test positive. If you can’t admit positive nurses, why are you admitting patients? It baffles me, truly. If facilities for 300 staff members can be provided here, why not in Mumbai? How can positive patients be told to go home?”
‘Doctors Can Come & Go, We Have to Be in the Ward at All Times’
All nurses FIT spoke to agreed that the new guidelines had impacted doctors as well. However, in some implicit ways, the struggle could be harder for nurses because of all that their job entails.
Thorat said, “The doctor can visit, check the person’s progress, prescribe the treatment and leave. But we have to be with the patients throughout. Giving them medicines, food, and helping them with anything they need.”
The ESIC nurse also explained that because of the general fear of the infection, a lot of extra tasks that could earlier be divided among ward boys and other helpers, are now all falling upon the nurses.
He added, “Other workers are scared. They don’t even want to come and distribute the mess food to patients, so we are doing that ourselves. If a ventilator needs to be adjusted, we are doing that all alone, while earlier we used to get some help and assistance. The workload has increased tremendously. We had never thought we’ll have to see such a time.”
Another factor that affects nurses in a more severe way is that of testing. With the new guidelines, doctors can easily get their tests done because all that is needed is their own signature. Nurses, however, need to get a doctor’s prescription to get tested, putting them at an unfair advantage and leaving it all on the discretion of the doctors or the hospital/state administration.
Other Concerns: PPE Quality, Shortage of Nurses
Rince Joseph, President, United Nurses Association (UNA), Delhi NCR, told FIT, “As more and more healthcare workers test positive, the situation gets worrying for us. Hospitals have had to shut down because of this, which will only overburden our healthcare systems and lead to a shortage of nursing staff. We have already started seeing a shortage. Authorities don’t seem to be worried that the workers may end up becoming carriers of the disease.”
“This is a very alarming scenario. We need massive action by strengthening the existing staff and helping them work with all safety measures in place. In the coming days, we will be seeing an influx of patients, and if our nurses are not provided the help and facilities they need, then you are looking at a calamity. The UNA has been requesting the Delhi government to protect the workers and give them what they need.”Rince Joseph, President, United Nurses Association
The plight becomes evident when we look at PPEs. While the nurses working at prominent private and government hospitals in the capital (whom FIT spoke to) said that they haven’t yet faced a shortage, others complained of serious quality and supply issues.
Indu Thorat from Aurangabad said, “Everybody is facing a shortage, even though the hospitals and governments are trying to show there is no problem. With time, the situation will only worsen.”
“Once or twice a month we face a situation where there are no PPEs available. We are forced to take a stand, and so we refuse to go to work without the equipment. If nurses get infected, who will do their duties?”Indu Thorat, Government Medical College & Hospital, Aurangabad
Another nursing staff member from Ahmedabad complained of receiving laminated PPEs, which makes the material less breathable and even more suffocating than it normally is. “We have no AC. My colleagues have fainted because of wearing this laminated kit. We complained to our medical superintendent who has written to the state government asking for better equipment.”
A nurse working at a reputed hospital in Delhi said that even though one PPE kit is being provided for a day of duty, many workers have bought equipment for themselves separately too. “We are getting the kit from the hospital, but it’s still best to buy one for ourselves and not rely on the hospital completely.”
Not getting good quality PPEs can be fatal for healthcare workers who are at high-risk because of their jobs. The recent death of a nurse in Safdarjung Hospital brought the issue to light, because she, along with her colleagues at Kalra Hospital, had reportedly been made to re-use PPEs, while doctors had been given fresh kits. “If we raised objections, we were told that since this is not a designated COVID-19 hospital, we are at little risk, and can reuse PPE,” a senior nurse at the hospital told The Indian Express.
‘Lack of Planning & Preparedness Has Left Us Suffering’
The nurse in Ahmedabad, Gujarat shared that the hospital he is working at was converted into a COVID-19 hospital on 15 May, without any necessary arrangements or preparations. The lack of facilities are being attributed to the state government not providing funds to the hospital, he said.
“We haven’t been provided with a place to live, food to eat or even our own water dispenser. There is no AC in our facility - we have had to ask for it. There were no jugs for patients to drink water from, we had to ask for them too. We made temporary arrangements for our stay at a girls’ hostel in a nursing school nearby, but there is no food there. If we come back after a long day of duty, we are expected to go back to the hospital to have food. We have written to the health secretary of Gujarat to make the situation better. For now, the admin has told us that they will solve it.”
He adds that there is no arrangement for a washroom on the floor they work on, so there is no option but to go downstairs to use one. “Even the basic facilities are not there. Is it too much to ask for a glass of nimbu pani, or just a cup of tea once a day? We are working non-stop in uncomfortable PPEs and no air conditioning; sweating profusely and getting dehydrated. Eventually, we were all given ORS dissolved in water, for the time being, just to keep us going.”
Again, staff members are only being tested if they show symptoms. They are supposed to work for 7 days, and then quarantine themselves for the next 7 days. Quarantine - remember - in the girls’ hostel where they don’t get food to eat, and where six nurses share a room with one common toilet. While the doctors are also not being provided with these facilities, most of them have an extra flat in the city to live alone without coming in contact with their families.
He also shares the responses received from the admin for the demands made by the nursing staff. Here are screenshots of the letter with the requests as well as the replies:
The nurse working at ESIC in Mumbai also spoke about the lack of universal guidelines and policies for healthcare workers. “If you are designating a hospital as a COVID hospital, you need to be fully prepared. Half the places don’t have ACs. Even coolers are only installed when you ask for them. Every place has a different rule for quarantine, testing and accommodation. There should be some uniformity, every worker should be treated equally. It isn’t fair if the staff is getting to go on quarantine in one hospital but not in the other.”
A nurse from a government hospital in Delhi told FIT, “The major issue here is that nurses are not consulted when policies concerning them are made. We are not part of the decision-making process. Committees are usually full of doctors and medical practitioners, but no nurses to represent our section of workers, which is why our concerns are only brought to light when decisions have already been made. We need to fight for everything,”
“There have been times when we have thought of quitting. But when we look at our patients, we just know we can’t. We know we have to be there for them,” one of the nurses said.
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