* Nurses across India are testing positive for Covid-19
* It indicates a failure in hospitals to provide personal protection equipment (PPE) to health workers, with doctors being given a preferential treatment
A photograph shared widely on social media said it all. It showed a politician wearing an N-95 mask and a doctor in a 3-ply mask. Next to them was a nurse — with just a cloth mask on her face.
Grateful people have been applauding the services of doctors, nurses and other healthcare workers who have been battling Covid-19 across the country. But little is being done for the protection of nurses, who are at greater risk than other healthcare professionals because they spend the most time with patients.
Scores of nurses across India are testing positive for Covid-19, a respiratory disease caused by the deadly novel coronavirus. While centralised data is awaited, Maharshtra, the worst affected state so far, has 100-odd confirmed cases of nurses who tested Covid-19 positive. The capital has 25 so far. It is worth recalling that as many as nine per cent of all positive cases in Italy were of healthcare staff, mostly nurses.
Akriti (name changed), a 25-year-old nurse in a private health facility in Mumbai, is among them. She tested positive on April 13, though she had remained confined to her hostel room from April 6. She had quarantined herself after the hospital shut down most operations following the detection of positive cases on the premises and required the services of only a few nurses.
“A patient who came for surgery on April 5 was found to be Covid-19 positive. Swabs of the healthcare staff who came in contact with him were sent for testing. But instead of quarantining them till the results came out, they were asked to continue working. Eleven of them tested positive two days later. And they must have spread the virus meanwhile,” Akriti says.
Worried about the safety of nurses during the pandemic, the United Nurses Association (UNA), whose members are employed in private hospitals across India, wrote to the mayor of Mumbai on April 1.
It expressed concern that nurses exposed to Covid-19 patients were sharing hostel rooms and other facilities with fellow nurses. It also flagged the failure of private hospitals to provide personal protection equipment (PPE) to health workers caring for Covid-19 cases. According to UNA, nearly 80 nurses have been found Covid-19 positive in Mumbai alone.
Nurses have been staging protests in different parts of the country. In a video clip that went viral last week, nurses at the government-run Guru Teg Bahadur Hospital in Delhi complained about the quantity and quality of food they were provided at the hospital. “We get two slices of bread and a banana for breakfast. This does not kill hunger. For lunch and dinner we are served only cold rice and dal. There are no facilities to heat food,” a nurse said.
To top it, in an order on April 18, the Delhi government said accommodation and food facilities would be provided only to those hospital staff “who are directly assigned to serve the severe category Covid-19 positive patients in designated... hospitals only for the period of their such duties.”
Spreading worry
“The Delhi government’s order of March 29 said that hospital staff will work continuously for 14 days and stay in quarantine for the next 14 days before resuming duty. For the entire period of 28 days, the government was supposed to provide accommodation and food to prevent transmission of infection to our families. But according to the new order, government accommodation will be provided only for the first 14 days. After that the nurses will have to go back to their home,” explained Anita Panwar, president, All India Government Nursing Federation. She said this has many nurses worried for the safety of the elderly people and children back home.
Others raise the issue of concentrating only on Covid-19 wards. “This is a pathetic situation, to say the least. How can the government provide facilities only to those working in the positive ward? What about the screening centre? Workers there are more at risk because we do not know which patient in that room is positive. The result of a test takes 24 hours and in between they can infect their family if they go home,” says Santosh Mahindraka, research coordinator, Innovative Alliance for Public Health, a Delhi-based organisation of volunteer nurses.
Going back home and infecting family members is the worst fear of nurses, points out Mahindraka. Among those infected was the two-year-old child of a Delhi nurse who had earlier tested positive. The nurse worked at the Delhi State Cancer Institute, which was sealed after 18 healthcare workers tested positive.
The government’s management of the Covid-19 crisis has brought to the fore the sharp contradictions within the healthcare workforce. What dismays nurses is the unwritten hierarchical system, with doctors given preference in the supply of PPEs and other facilities.
“Doctors have always been seen as more important than nurses. They occupy prominent positions and are higher up in the hierarchy. All decision-making is in their hands and, hence, they end up getting a bigger pie in all facilities,” says a spokesperson for UNA, Maharashtra.
Nurses at the Lok Nayak Jai Prakash Narayan (LNJP) Hospital in Delhi complain that they have not been provided with adequate accommodation even though the facility was declared a dedicated Covid-19 hospital earlier this month. The doctors were accommodated in a five-star hotel in the heart of Delhi. However, the nurses were expected to go back home to stay with their families. After the nurses demonstrated in protest, a makeshift arrangement was set up for them.
“We were given common space on the second and third floors of the Maulana Azad Institute of Dental Sciences (MAIDS), located next to LNJP. It was like a dormitory,” says a nurse from LNJP on the condition of anonymity. There was one washroom for 18-20 nurses. “We were clearly told: ‘We cannot afford five-stars for nurses’,” he says.
It took several more rounds of negotiations and altercations before a guest house was readied for the nurses. LNJP has 1,300-odd nurses caring for Covid-19 patients.
First line of carers
It is the nurses who are on the front lines — more than anybody else. As patients enter the hospital, nurses record their vitals such as blood pressure and weight, take down their medical history and check if there has been a possible exposure to the infection. Nurses provide care round the clock for admitted patients.
“It is clear that nurses spend more time with patients and hence have more exposure to a possibly infected patient. Still, they are not on a par with the doctors,” says the UNA spokesperson.
The other fear that is looming large for healthcare staff is financial. The Central government as well as state governments have asked the private sector not to cut salaries. “But we are hearing about salary cuts across the board. We are writing to hospitals to prevent salary cuts. The work of healthcare staff has increased since the outbreak of Covid-19. It is unfair to let them suffer like this,” the UNA spokesperson adds.
In Rajasthan, the police and healthcare workforce have been exempted from salary cuts. Elsewhere, it is almost certain that cuts are on the cards. A private hospital in Mumbai issued a circular stating that salaries of the entire staff — from doctors and nurses to drivers and office boys — would be halved.
Sanitation workers are also at the receiving end of this underwritten code of discrimination in the health sector. Sevak Ram, a sanitation worker in Kalawati Saran Children’s Hospital in Delhi, used to commute daily to work from Baghpat district of Uttar Pradesh, nearly 50 km from the Capital. Ever since the lockdown, with the suspension of train services, he has stopped going to work.
Kalawati Saran’s sanitation services are outsourced to the Sulabh International Social Service Organisation. The hospitals are providing pick and drop facilities to permanent staff but not contractual employees such as Ram.
“We have not received our salary for March. We do not know whether we will get any salary for April as we are contractual employees and work on a day-to-day basis,” adds Ram, who is also an office-bearer of the Kalawati Saran Aspatal Contract Karamchari Union.
Salaries are not being paid despite a memorandum from the ministry of finance, dated March 23, which specifies that salaries of contractual staff will not be deducted during this period, says Surya Prakash, a lawyer affiliated to the All India Central Council of Trade Unions.
“I have worked in the hospital for the last five years. My duty is from 7am to 2pm and it takes two-and-a-half hours of travel to work one way. Even after working so hard, I am left with no job and no money in these trying times,” Ram says.
The workers have just one request. Help those who are helping patients. And that’s not just the brave doctor but also an army of equally intrepid nurses, ward boys, cleaners and other employees.
J yotsna Singh is a freelance healthcare journalist