V Prajapati //

A Sorry State Of Affairs Of The Healthcare Workers

Rather than interrogation on a political and institutional level as to why our working conditions remain hazardous, our society is glorifying the struggle! We are being applauded for endangering our lives to help others, but in reality, there is seldom a choice. We’re not willingly working unprotected every day, we have to. We have student loans to pay off, mortgages to cover, and families to support. If we don’t report every day to our hospitals, despite the lack of protections, we risk our livelihoods. In this sense, we’re not heroes as much as we’re desperate and bound, trapped in disempowering working conditions and with few alternatives because we’ve sacrificed too much time and money to pursue our professions.” These are the lines of frontline healthcare ‘warriors’, as the State proclaims them to be. Doctors, nurses, ASHA workers, paramedics and sanitation workers are facing unprecedented workload in overstretched public health facilities, with no end in sight. With absolute absence of agency and discretion, it would not be an overstatement to say that they have been pushed into bondage by the capitalist State. They are under-protected, overworked, and vulnerable to infection. And this is so not because of any scarcity of material resources or productive capabilities, but, due to the bourgeois class character and profit-above-all attitude of the state amidst plentifulness and overcapacity insofar as the overall financial, technological or scientific stock of society is concerned. Their present-day condition is the outcome of the same social system based on capitalist profit that exploits the toilers and workers, oppresses other strata of the people and turns their life miserable and unbearable.

The frontline workforce is going through what can be called a ‘multi-layered fear and agony’. Multiple risk factors like state apathy in the form of lack of personal protective equipment (PPE) and masks to insulate themselves, long and exhausting work schedule, possibility of them transmitting virus to family members, facing societal wrath in the form of ostracization, harassment both physical and verbal, facing administrative flak in the form of suspension or deduction of salaries for voicing concern about the lack of basic facilities and the policy of coercing pregnant, lactating or immune compromised health workers to turn up for service rendered the workers victim to psychological distress, depression and anxiety. Simmering anger coupled with deep sense of betrayal can be noticed among health professionals who say they feel forsaken by their government. “My fear is that this will all get whitewashed — where we’ll look back and say that everyone rallied and was heroic,” the New York City physician said. “Voices of reason and science were shouting the truth — but were allowed to be ignored, and thousands died because of it. This is a crucial lesson for history.” Lack of scientific outlook on things, absolute neglect towards indulgence in research, scientists, public health experts and most importantly downplaying the severity of the crisis are the charges that the workforce is found to be levelling against the regime. India’s response to the pandemic was ‘reactive’ when it should have been proactive. The State moved at its leisurely pace without caring to pay heed to the global threat posed by the virus despite having a tattered healthcare.

As early as April 12, WHO stated that the COVID-19 pandemic hit over 22,000 healthcare workers across 52 countries. On account of absence of systematic reporting, these numbers only under-represent the problem. The workforce is in a deplorable state. In one of the accounts, a corona positive nurse, Lisha Jose who had a year-old son and was eight months pregnant recounted as to how all the neighbours looked at her with suspicion and contempt when she was climbing the ambulance at her door. Many whipped out their mobile phone cameras to shoot a video of her when she was reeling under deep mental distress. She said, “I felt like a criminal being taken away…What wrong had I done? I only did my duty.” Reports claim as to how the doctors in hazmat suits cannot eat or take a washroom break for as long as 6 hours! However, the most challenging of all tasks has been to decide whom to offer hospitalization given that the number of beds are limited.

When the healthcare personnel does muster up the courage to raise their dissent against the lack of paraphernalia for treating COVID patients, they are met with gag orders issued under the draconian Epidemic Diseases Act, 1897 carrying sentences of imprisonment for over six months. Such was the case with the personnel at Jammu and Kashmir. In Mumbai, which has reported about 45,000 cases so far, the doctors and nurses are often left to fend for themselves if they test positive. They are required to make use of their ‘own’ resources. The protective equipment is only made available to the ones working with high risk patients in Covid-19 ward while the rest of the staff is given a pittance in the form of masks and gloves even though 69% of the positive cases are of an asymptomatic character. In some cases, the authorities have the audacity to ask the healthcare workers to take 400 mg of chloroquine once in a week for four weeks as a ‘precautionary measure’ in the absence of PPEs, in the process completely sidestepping the side effects the drug may have on the body. In a recent case in Mumbai, a healthcare worker died because of being denied leave from duty and being given the requisite treatment despite exhibiting symptoms since May 20! Truly, the system is leaving no stone unturned in making them ‘self-reliant’, in Prime Minister’s own words! 

As one must have observed over the years as to how governments continue to hang a death warrant around the necks of sanitation workers by pushing them to do life threatening activities till date, in times of health and economic crisis triggered by the virus, one realizes that the already nil value of life and liberty of persons involved in scavenging has further drooped to negative. Their entire community which anyway was engaged in a job where losing life was commonplace, is faced a crisis which has made death ‘immanent’ for them. “Sab log corona ke dar se ghar me hai, hum to yaha pe usise ladh rahe hai firbhi humari koi kadar nahi hai (Everybody is at home because of coronavirus, but we are here fighting it. Even then, there is no appreciation)”, said Radharani, a sanitation worker at Panna, MP.

On the other hand, we find the underpaid and unprotected ASHA workers braving physical attacks, verbal slurs, social stigma and the transmission of virus. For a work that involves door-to-door educating people about maternal and child health, contraception, immunization and sanitation, as well as enrolling them in health programmes and monitoring the results, and in current times also educating families about isolation and monitoring for symptoms of the virus, they get only 30 rupees a day! “The value of our life is just 30 rupees [less than half of $1], according to the government,” says Alka Nalawade, a community health worker in the western state of Maharashtra. “How are we supposed to meet our household expenses with 30 rupees?” she asks. ‘‘What if I get infected with the virus? Who will look after us? Will I get treated for 30 rupees?” Anjana laments on the indifferent attitude of the people in administration. “From the prime minister to the chief minister, everybody only praises doctors and police.” She says that’s unfair since the government relies on the data that Ashas collect daily. The ordeal doesn’t end here for these women workers. The hostile locals check their identity cards, snatch away papers and tear them misconceiving it to be an NRC exercise. They are accused of singling out families from minority communities. The anger which had to be targeted at the State ends up being vented out at these innocent women.

Thus, the outsourced or the casual workers, owing to the temporary nature of their engagement (even though the work counts as essential service) lack a voice on the decision making table. Their grievances go unaddressed. Their rights remain nominal in this unequal system. In the garb of the ‘just’ contractual system, the Govt. has systematically been washing its hands off from the vulnerabilities and risk of exposure to the virus to these impoverished sections of healthcare workers. Caught in the quagmire of low wages, job insecurity, poor protective measures and increased susceptibility to infection, they end up losing their lives.

Barely a day after the ordinance dealing with violence against the health workers was passed by the central government, a shocking incident of assault against the health workers took place at the LNJP Hospital in Delhi. With the offence being made cognizable and non-bailable, hardly any deterrent effect could be realized. It only reaffirms the fact that laws do not exist in a bubble, they function in socio-political and economic system. In another incident, a 44-year-old man allegedly harassed and attacked women doctors for being inside their house and being spreaders of coronavirus. In the video, a mob of 100 angry residents can be seen howling abuses, throwing sticks and stones and chasing the workers down the lane. In Vishakhapatnam, a doctor protesting against the Govt. for not providing protective gear was manhandled by the police on the charge of creating a ruckus on highway and subsequently admitted in a ‘mental health hospital’!

As per the findings of the study Frontiers in Psychiatry, more than a third of healthcare workers while responding to the Covid crisis during its peak, suffered insomnia, depression, anxiety and stress based trauma. The veterans of the SARS outbreak in 2003 reported high rates of post-traumatic stress, psychological distress, low productivity, increased substance use and elevated levels of burnout. Seeing the magnitude of the damage being caused to the healthcare workers by the COVID-19 crisis, it may also affect them similarly in the long run as in the SARS case. The chain of condemnable incidents against the saviours give us a reflection of a future where the likes of working class will be stifled and compulsorily made to work as per the dictates of the fascist emperor.

Crisis Of Capitalism: Overstretched Public Healthcare System, Untapped Resources In Custody Of Private Sector And Its Impact Upon Healthcare Workers

While examining the plight of healthcare workers, it is needed that we understand the environment in which they work and look for the deep-rooted single reason why they are having to undergo such miserable conditions? The capitalist crisis unfolded the true character of the unsustainable system of healthcare which operates on the anvil of profit making and upholds the interests of corporations. Proponents of commodification of healthcare would vociferously argue that rationing of the so-called scarce resources is to be done. Thus, we look at the healthcare graph of India prior to COVID 19 which will be a proof of how capitalism is the root cause of havoc in the lives of the working class as well as the healthcare force.

India ranked 57 in the Global Health Security Index (2019) indicating that the country may be more vulnerable than China (51) and Italy (at 31) which have seen the highest number of COVID 19 related deaths uptil now. The index measures the pandemic preparedness of a country based on its ability to prevent, detect, mitigate and cure diseases. India’s public healthcare system, in its dilapidated form, has consistently and massively failed in mitigating the health crisis even prior to corona. Corona only laid bare the hoax.

Post Corona, the already inefficient and almost defunct public health system was pressed into performing multifarious and complex functions like – public awareness, prevention, surveillance, epidemic control involving tracing, isolation and quarantine, laying down standard protocols, and treatment of patients without refusing anyone on financial grounds. As per National Health Profile (2019), it was found that only 0.55 beds per 1000 population existed and the doctor patient ratio stood at 1:1800. Bihar, with an abysmal performance could only provide for 0.11 beds per 1000 population. 70% of health care expenses are met by out-of-pocket expenditure.

If the case study of Madhya Pradesh were to be done, out of the 50 districts, as many as ‘30 districts’ had no ICU facility in 2015. That more than two-thirds of the facilities were concentrated in just four districts. It had only 2.5 ICU beds per 1,00,000 population and 83% of these were in the hands of private players. Almost 9 out of 10 facilities were of low quality. In essence, low count of ICU beds, poor quality of healthcare and skewed distribution of resources due to private ownership formed the key barrier in access to quality healthcare, a fundamental right! The relentless and blind persuasion of privatization in healthcare and simultaneous weakening of public health system has brought society to a stage where only few lives matter and the rest are left to die. Persons with co-morbidities and senior citizens automatically turn into an unfortunate lot that is kept last in the line of preference when it is being decided as to who deserves the ICU bed. 

This leads us to the frequently made proposition; “The surge in coronavirus cases has crippled health systems in many countries, primarily due to shortage of hospital beds, manpower and equipment (personal protective equipment, ventilators etc)” Did coronavirus cripple the health system? Is there a dearth of resources within the system? To cut the clutter, such propositions are baseless and keep artificial scarcity as the premise. The abundant resources lying under the control of private sector create an impression of artificial shortage in the market and thereby rake in profit through high pricing. The majority which earns enough for living another day is compelled to shed away all his possessions and income to get his treatment done in a private hospital since the public hospital at subsidized rates provided poor quality health care. John Hopkins Resource Centre recently reported about patients abandoning state run isolation wards due to poor infrastructure. One of the patients remarked, “The most difficult part of the night was not being able to use the washroom. I felt tortured, like a prisoner. When I demanded that we should at least be given water to drink, they asked us to drink directly from [bathroom] taps which had no water in them.” Policymakers have suggested social distancing and lockdowns as effective solutions to tackle the gargantuan crisis. They say that the measures would also prevent overburdening of the health system. Lockdowns and preventive measures like physical distancing only have an “incidental” role to play. It is the public healthcare system that is of fundamental importance. Until the latter is overhauled, the curve would not flatten.

With resources, expertise, infrastructure and specialized care at their disposal, why isn’t the Govt. not requisitioning private institutions? Why are they not being held accountable in humanitarian crisis? Isn’t it problematic to see the private hospitals which account for two-thirds of hospital beds and almost 80% available ventilators handling less than 10% of this critical load as it watches the public system battle the pandemic? Despite private hospitals employing four out of five doctors, they can be found refraining from providing even the non-Covid health care. Be it the Wockhardt in Mumbai or the private hospital in Bhilwara, they have been refusing to admit patients and suspended their services when healthcare is dire need of the hour! Lockdown restrictions, lack of internal protocols, fear of infection to its own doctors and nursing staff, unwillingness to risk the business through non-Covid patients and increased costs of operation for Covid patients are the primary ‘justifications’ slipped in by the private sector. The state of Bihar has witnessed an absolute withdrawal of private health sector which nearly has ‘twice the bed capacity of public facilities’ and most importantly, since the number of people relying on private healthcare over public for both out-patient and in-patient services in Bihar is ‘far higher’. By abandoning their job of providing medical care, they have left the job of handling the crisis upon government hospitals that lack the wherewithal. The claims made by the private sector about inadequate capacity and capability are nothing short of bogus. A 56-year-old Jaideep Jaywant who suffered a heart attack lost his life when multiple private hospitals turned him down.

Way Ahead

It is this lop-sided healthcare system, where health has turned into a luxury commodity, which can be afforded by only handful of people. In an overstretched and overstressed setting, the healthcare workers are being pushed to throw themselves into saving lives when it is the very neo-liberal and pro-capital policies which have systematically maintained misery in the lives of the working class. A fully functional, free, quality, and universal healthcare premised on the expropriation of private property lying untapped, unused, and unutilized for public welfare is the sole way to come out of the reeling crisis. Corona has lifted the veil of the unstable worldwide capitalist order and carries the potential to unify masses for the upheaval of the status quo. The recent steps by a few states to allot 25% of beds for Covid -19 patients in private hospitals or partial takeover of few private hospitals is a welcome but a piecemeal measure.

The incidences happening worldwide are beginning to show that it is a fight between capitalism and humanity. The time is not far when we shall see all the democratic and progressive forces following the footsteps of the working class. In such a crisis, the State would urge the healthcare fighters to sacrifice their lives in the service of people and keep up to the standards of this humanitarian profession, in an attempt to brush the massive failures in its plans and policies under the carpet, nevertheless we are to stand firm on systemic change. It is interesting to note how the State and the Central Govts. are making use of regressive legislations to round up people committing violence against the healthcare workers while if the workers themselves were to point out loopholes in the governance, they are meted with the same State violence. The deaths that have happened as a result of lack of protection towards healthcare personnel, denial of treatment to non-Covid patients as well as hunger-exhaustion-poverty-unemployment-denial of medical care to the migrant workers are all linked to the capital centric State sitting at peace, having a great laugh at the widespread destruction.

It is highly important for the frontline health workers to know that the Indian State is the harbinger of millions of suicides and deaths that take place every year as a result of poverty, hunger, unemployment, and malnutrition. A study published in The Lancet states that every year, nearly 16 lakh Indians die due to poor quality health care or non-utilization of healthcare services. These are not just deaths or suicides; they are State perpetrated mass murder. Health care workers, therefore, need to build solidarity that grounds itself in labour struggles and understand the reason behind societal paralysis, which is undoubtedly the capitalist order. The deaths of healthcare workers on the front lines demand revolutionary upheaval! The words of Lenin in 1920 ring true in these times:

“All our determination and all of our experience of the Civil War we must apply to combating epidemics. Only collaboration between scientists and workers can put an end to oppressive poverty, disease and dirt. No forces of darkness can withstand an alliance of the scientists, the proletariat and the technologists.”
V. I. Lenin, Sochinenie, p. 375, 1920

Originally published in The Truth: Platform for Radical Voices of The Working Class (Issue 2/ June ’20)

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