May 12 is globally observed as International Nurses Day. The day marks the birth anniversary of Florence Nightingale, who revolutionized healthcare and introduced modern nursing. This year, amid the COVID-19 pandemic, nurses have come out to tell us that they have been left behind.
A virtual press conference held by Public Services International (PSI), on the eve of the Nurses Day, had unions from different parts of the Asia-Pacific region talk about the monumental challenges during the pandemic. According to the South-East Asian Regional Office (SEARO) of the World Health Organization, at this time, the Asia-Pacific region needs over 1.9 million more nurses and midwives to achieve a certain parity in healthcare.
The region between India and Indonesia houses more than a quarter of the global population, but has one of the lowest ratios of nurses to people. The ratio currently stands at 18 nurses for 10,000 persons, far below the global average of 34. This data is only the tip of the iceberg.
Representatives of nurses’ unions across the region highlighted a number of problems they face on the frontlines of the battle against COVID-19. These include low wages, lack of communication with authorities, lack of protective gear, overworking and exhaustion, little to no protections for frontline healthcare workers, and physical abuse and stigmatization.
Wol-san Liem, director of international affairs for the Korean Public Service and Transport Workers’ Union, an affiliate of the Korea Confederation of Trade Unions (KCTU), spoke of how pre-existing problems within the healthcare sector in the country only were amplified during the pandemic. “The turnover rate for new nurses stands at around 30%, and this has to do with low pay and an extremely hierarchical system among healthcare professions,” she said.
The hierarchical setup that she spoke about refers to a tendency where doctors and male professionals are paid and rewarded far more than nurses. This situation is quite common around the world, where nurses are often hired on temporary contracts or as casual workers. They are often left out of any of the labor protections afforded to other healthcare professionals.
Jibin T. C. from India’s United Nurses Association (UNA), talked about similar discriminatory or hierarchical practices in place in the country. Apart from discrimination in wages and treatment at the workplace, Jibin also spoke of nurses being out of the loop on matters concerning COVID-19 containment or even regarding work conditions of nurses themselves. “There are no nursing professionals involved at any level of the decision-making process,” he said.
The lack of communication with authorities is a problem also faced by nurses in South Korea, where according to Liem, despite great work done in containment, officials continue to overlook nurses and their unions. A similar problem is faced by nurses in the Philippines, where, according Julian Roque of the Public Services Labor Independent Confederation, they have to deal with the “reactionary, arbitrary and short-sighted responses” of the Rodrigo Duterte government.
One of the few countries which has been an exception is Australia. According to Judith Kiejda of the New South Wales Nurses & Midwives’ Association (NSW-NMA), the authorities have been working with nurses’ unions throughout the pandemic.
This constant communication between local, state and federal governments, and bureaucrats and on-ground advice from healthcare workers, made a major difference for Australia. The country has been able to effectively contain the spread of the COVID-19.
Kiejda makes it a point to note that it is nothing short of a “miracle” to see unions working with a conservative government, both in New South Wales, which is the epicenter of the outbreak in Australia, and also the federal government. But this may not have been the case had the unions not been as large and vigilant.
She pointed out that the constant communication and the receptive attitude of the government is largely a result of the constant mobilization by the unions. Nurses’ unions are the largest trade union movement in the country, with close to 275,000 unionized nurses.
“Almost every day, we are close to harassing the authorities, demanding more PPEs, for better pay, better protection for frontline workers,” said Kiejda. “There is tremendous lobbying on the part of the unions to make things work.”
Aprons and garbage bags instead of PPEs
Despite a responsive government, Australia faces a severe shortage of PPEs, with reports of healthcare workers being asked to repurpose aprons for their protection. According to Kiejda, the guidelines for distribution of PPEs are made around the shortage of the resources and often does not prioritize nurses.
Similar troubles are being faced by nurses across Asia as well. Jibin, also spoke of the lack of PPEs for nurses and healthcare workers in Indian hospitals. He painted an especially grim picture of private medical facilities where the shortage is especially dire.
He also said that even in hospitals where doctors are given PPEs, nurses are overlooked. “This is despite the fact that nurses spend more time with patients and are the primary caregivers in any hospital.”
Another issue Jibin talked about was accommodation. In India, nurses who often travel long distances from home to work are housed in cramped hostel accommodation by their employers. The UNA estimates that of the nearly 70,000 reported patients as of May 12, more than 1,000 are nurses and other frontline workers in hospitals.
He also said the governments and private hospitals may be trying to hide data regarding infected frontline workers. “In many private hospitals, we have had to face the trouble of having employers not giving them their test results,” Jibin said, “… Even government data does not indicate how many nurses are being infected, despite our pleas.”
Roque talked about a similar situation in the Philippines, where nurses and even doctors have had to repurpose garbage bags, instead of PPEs, while treating their patients.
Problems of private healthcare
Work casualization and privatized healthcare is also a problem throughout the region. Among the four countries represented, only Australia stood out as one with an extensive public health system. But despite this fact, casualization of work still affects healthcare professionals. This is especially evident in old-age care facilities, where most nurses are casual workers or immigrant nursing students.
In South Korea, India and the Philippines, the private sector provides a huge segment of healthcare services to the people. In India, Jibin noted that nursing education is dominated by private players, who run substandard facilities and training programs, often turning out nurses with little to no professional education.
In all of these countries, private players are notorious for grossly underpaying nurses. In South Korea, Liem added, nursing is often an underpaid job which causes most of them to leave the profession within three years of their service.
In India and Philippines, not only have nurses been underpaid but many have faced delays in wage payments for months on end.
Social stigma, attack on nurses
All the representatives spoke of the general abuse and stigmatization that healthcare workers, especially nurses, have had to face in their respective countries. In India, multiple State governments had to pass laws to protect nurses from evictions by landlords, making it punishable. Jibin spoke of social isolation that healthcare workers, especially those working at a hospital with quarantining facilities, have to face.
In Australia, Kiejda spoke about an incident of a nurse being spat at by her neighbor. While the government was prompt in taking action, she mentioned that there is still underlying stigma associated with those working in the healthcare sector. Roque also spoke of Filipino nurses being attacked by tenants and community members, and added that there is very little protection afforded to healthcare workers who face such attacks.
But it is not just attacks from neighbors and landlords that the nurses have to face. In India, State governments and hospital authorities have initiated lawsuits against nurses who have resigned over highly unsafe working conditions. Even those who have protested against the unsafe working conditions in hospitals have been targeted by hospital management and authorities.
Not empty praise, but concrete action
The general feeling at the press conference was summed up by Roque, who said “They don’t need to call us heroes, we already know that we are. We don’t need empty praise.”
All union representatives have put forward some key demands to governments and policy-makers. They have called for a major expansion in public healthcare, better rights and protections for nurses, better wages and extra pay for their work during the pandemic, and more PPEs to better protect them from infections.