From the Frontline: Underpaid, overworked and now pushed to the limit

Talked about little in the fight against Covid-19 is the condition of nursing staff

Throughout the Covid-19 pandemic in India, while the government has urged citizens to beat thalis and showered flower petals from helicopters to honour the healthcare fraternity’s critical role, a cruel irony has been playing out on the ground. The pandemic has highlighted the long-simmering problems of India’s overworked yet underpaid nurses, estimated to number about 1.8 million. Not only do they have to contend with old issues such as the systemic indifference of hospitals, salary structures not commensurate with their training, and power struggles with doctors, working on the frontlines has thrown up a new set of challenges. Consider these testimonies from nurses in Maharashtra:

• “Initially when the lockdown was announced and my hospital was not permitted by the government to admit Covid patients, it forced us to work for 15 days and take 15 days off. We were paid only for working days.”
• “In many large private hospitals, Covid duty, wearing PPE (personal protective equipment), is for eight hours, which is quite extensive. And they refuse to provide us with another PPE suit on the same day even if (our) PPE suit is torn, damaged or overused.”
• “Our annual appraisals were pending. At times, we had nonstop duty shifts of 12 hours. We were not even paid a Covid allowance. Special leaves were not granted for Covid-positive nurses. We went on strike to raise these demands. Finally, the management agreed to pay us a Covid allowance of Rs 200 per day, which is less than what was suggested by the government, but then they refused to do appraisals, saying the hospital is in loss.”

These stories are echoed by nurses across the country. In the nine months, nurses have struck work in Delhi, Patna and Kolkata, among other states, to protest poor and unsafe working conditions and lack of compensation and compassion for those who have contracted the infection in the course of their work. To date, over 50 nurses have lost their lives to Covid, according to estimates of the Trained Nurses’ Association of India (TNAI), one of the largest and oldest nurses’ unions in India.

Read Part 1 here: Missing from Covid-19 pandemic narrative: Infections among doctors

“Compared to doctors, the fatality rates among nurses are low,” says Roy George, president of the TNAI. This is probably because by the time Covid patients are admitted in hospitals where nurses come in contact with them, not only are safety protocols already in place but the patients themselves are mostly at the fag end of their infective phase. “But unfair working conditions and employment practices have made their lives hell.”

Hospitals, especially in states worst affected by Covid-19 like Telangana, Maharashtra and Delhi, have been overwhelmed by patients, which has resulted in longer, harder and more hazardous working hours for nurses.

Pune-based Support for Advocacy and Training to Health Initiatives (SATHI) released a survey it conducted on 367 nurses with the help of several nurses’ organisations in Maharashtra this week. In the survey, 76 per cent reported being overworked; 65 per cent said they could not get leaves sanctioned during this period; and 17.4 per cent reported working double shifts. Yet, few, other than a handful of large private hospitals in metros, have offered any financial incentives to nurses.

“Forget a Covid allowance,” says Siju Thomas, joint secretary of the Indian Professional Nurses Association (IPNA), “many private hospitals have cut nurses’ salaries by over 30 per cent”.
 

Unfair salary structures in private hospitals have been a longstanding issue for nurses. The TNAI had petitioned for higher salaries for nurses in private hospitals in the Supreme Court in 2016, which then directed the government to fix the salary structure of the nurses. “However, as health is a state subject, only Kerala, Delhi, and Karnataka took note of it,” says George. “And it has since been partially followed only in Kerala.”

Others, like a large municipal corporation of Delhi hospital and a state-run hospital in Pune, have delayed salary disbursements during the pandemic. 

IPNA has taken up cudgels on behalf of 84 temporary nurses who were fired by a well-known teaching hospital in Delhi, allegedly after they had protested that they had been denied Covid tests and adequate quarantine facilities on completion of Covid duty. “One of the biggest private hospitals in Pune actually sent bouncers to nurses’ quarters to intimidate them!” says Swati Rane of the Mumbai chapter of Jan Swasthya Abhiyan, people’s health movement. “We have to devise some way to regulate the treatment of nurses by private health care providers.” 

Another source of insecurity for nurses working in private hospitals and nursing homes is the difficulty some have faced in getting treatment – and the problems that their bereaved families have encountered in their fight for compensation if they have died on duty. “Presently the government is only offering compensation to families of nurses who have died while serving in designated Covid hospitals,” says George.

This excludes those who have been infected in general wards, non-Covid hospitals and clinics. Families, including those of 46-year-old Ambika PK, who became the first nurse to die of Covid in Delhi, suffer endless wait for the compensation of Rs 50 lakh that the government promised at the beginning of the pandemic. “Nurses are exhausted and demotivated,” says Jibin TC, state president of the Kerala-headquartered United Nurses’ Association. “We’ve seen about 800 leave India during this pandemic for countries like the UK and UAE.”

India has only 1.7 nurses per 1,000 population against the World Health Organization norm of three per 1,000.