The Wire’s Banjot Kaur spoke to James Smith, a lecturer at the University College London’s Institute of Epidemiology and Health, about the Israel-Hamas conflict’s impact on healthcare workers and more.
New Delhi: James Smith, a lecturer at the University College London’s Institute of Epidemiology and Health, wrote an editorial on the ongoing Israel-Hamas conflict along with his colleagues last month in the BMJ Global Health journal.
In that piece, Smith and his colleagues not only went on to describe the details of the attacks and their impact, but also gave important historical and political context.
Many members of the healthcare worker community criticised him for the strong stand taken in that piece.
The Wire spoke to him about the various aspects of the editorial, the suffering of the people as far as health and trauma are concerned, the conflict’s impact on the mental health of healthcare workers, the precedents of such conflicts in which attacks on healthcare facilities were involved, and most importantly, why the healthcare community is shy to take a political stand on crises like these.
Union health secretary Rajesh Bhushan called the shortfall a “serious concern” and said state governments should fully vaccinate this group of workers asap.
Bengaluru: When Prime Minister Narendra Modi flagged off India’s COVID-19 vaccination drive on January 16, 2021, he said the first phase would cover the country’s frontline and healthcare workers by July.
But on June 10, the Union health ministry admitted that while 82% of healthcare workers had received at least one dose, only 56% had received both doses. Similarly, 85% of frontline workers had received at least one dose and 47% had received both doses.
New Indian Express quoted Union health secretary Rajesh Bhushan saying the shortfall was a “serious concern”, and that state governments should fully vaccinate this group of workers asap.
The authors of a study of nearly 9,000 healthcare workers at Christian Medical College, Vellore, said some of them couldn’t get the second doses “initially due to vaccine shortage and subsequently, despite vaccine availability, due to changes in guidelines on the interval between doses.”
After India’s vaccination drive began in earnest, the country began reporting supply issues by March. At the same time, the government expanded eligibility for vaccination to the 45+ age group in April and to the 18-44 years group from May 1.
Both the Indian government and the vaccine-makers had overestimated the manufacturing capacity. The government also undertook ‘vaccine diplomacy’, exporting 58 million doses to 70 countries by mid-March and 66 million doses to 94 countries by late April.
While local manufacturers couldn’t keep pace with the rate of vaccination, the supply of the one other vaccine in India’s drive – Sputnik V from Russia – faltered as well.
The first two or three months of the vaccination drive were also marked by vaccine hesitancy, directed especially at Covaxin, which India’s drug regulator had approved without data from its phase 3 clinical trials.
There were also issues with the vaccine registration system and a shifting vaccination policy. On the former: the CoWIN portal has been criticised because it makes the registration process much harder for people who are not technologically savvy.
On the latter: between late April and early June, the Modi government adopted a procurement policy in which the Centre would buy Covaxin and Covishield doses at lower rates from vaccine-makers, while state governments and private hospitals could negotiate separately for their requirements.
The underlying moral and ethical issues drew the Supreme Court’s ire, as well as that of numerous politicians and independent experts. The government subsequently restored its original policy of centralised negotiation and procurement.
But taken together, these issues have ensured not even a fifth of the country has received at least one dose of a COVID-19 vaccine. At present, 14% of Indians have received at least one dose and only 3.3% have received both doses.
Healthcare workers are at greater risk of contracting COVID-19 because of their exposure to patients with the disease. The Indian Medical Association said on June 1 that 1,300 healthcare workers have died of COVID-19 since the pandemic began, almost 600 during India’s second wave.
Many participants have alleged they were led to believe they were getting the vaccine itself.
New Delhi: Two reports, by The Caravan magazine and NDTV, have found that several people who had taken part in COVID-19 vaccine trials in Bhopal were not informed that it was trials that they were participating in. Many of them, who have claimed to be illiterate and belong to severely disadvantaged sections of the society, have said that they signed up believing that they were getting vaccinated.
In trials held by the People’s College of Medical Sciences and Research Centre – a private hospital – residents of four areas close to the Union Carbide factory that caused the gas disaster of 1984 were allegedly told that they would get an injection that would prevent COVID-19.
The areas are Gareeb Nagar, Shankar Nagar, Oriya Basti and JP Nagar. Residents were allegedly offered Rs 750 each for receiving the shots. The location is significant considering that more than 100 survivors of the industrial tragedy died after testing positive for COVID-19 until early December, 2020. The Caravan report says that some of the survivors were also part of the trials.
While the NDTV report does not mention which vaccine was used in the trial on the Bhopal residents, Caravan says it was Covaxin, Bharat Biotech’s vaccine candidate that is already embroiled in other controversies.
Some of those who received shots told NDTV that they were not given the ‘informed consent’ form, which acts as legal proof that a recipient was informed of the situation and was willing to sign up for it, as is mandatory for such trials. Some were not even told of probable side effects and received no follow up calls from the hospital.
Out of the nearly 250 people who took part in the trials, many also said that they did not know if they will be insured in case they needed treatment for complications arising from the vaccine.
While the hospital has denied the allegations and professed ignorance when NDTV pointed to specific instances and names, the claims by trial participants constitute severe violations of norms.
While participation in trials constitute risks, the process is made fruitful by trust between volunteers and medical practitioners. The latter are supposed to inform the former fully of said risks and the former owe it to the latter to report truthfully on the effects. Many of the trial participants in Bhopal could not do the latter either, because they could not read or write but were nonetheless handed a four-page symptom booklet.
In an analysis of trial ethics, one of India’s authorities on India’s COVID-19 vaccine journey, Gagandeep Kang, had written, “We must respect those who participate in clinical trials as volunteers for a greater good. And as clinical researchers, our responsibility is to make sure to do all that we can to minimise risk.”
NDTV has quoted working men and women as having run into unforeseen situations because of having been vaccinated without knowing what would follow. A 37-year-old man, Jitendra Narwaria, was reportedly compelled to shell out money for medicines after participating in the trial.
Narwaria’s children, he said, have no food and the additional expense was an imposition.
Narwaria appears to be the same ‘Jitendra’ the gas tragedy survivor who has been quoted in the Caravan report, but has been identified only by his first name and as a ’36-year-old’. He was reportedly enrolled in the phase three trials of Covaxin – something he realised much after going to the hospital.
Two vaccines have been approved for emergency use by the CDSCO, out of which, Covaxin, has been green-lit in a confusing “clinical trial mode”. Both approvals have come under scrutiny, are being called hasty, and have already put pressure on a process that can only thrive on complete clarity.
The Caravan account says that while Jitendra had informed trial authorities of health complications, he was told that the vaccine would “clean his blood, [and] not cause a fever”. The report says that while it is not known whether he received the vaccine or a placebo, Jitendra developed jaundice in the aftermath of the vaccine and was forced to seek treatment elsewhere when the hospital did not pay for his treatment or tests. Still ill and in debt to feed his children now, Jitendra was never told whether his complications were due to the shots he received.
Caravan has reported that a total of seven people have said that they had suffered as a result of being administered vaccine (or placebo). Some of them were, however, not asked to pay for subsequent tests and medicines, unlike Jitendra.
According to the New Drugs and Clinical Trial Rules of 2019, Bharat Biotech, as the sponsors of the clinical trial, must ensure that medical expenditure of a trial participant is taken care of should complications arise out of a vaccine administered to them.
The hospital’s dean Dr A.K. Dixit told NDTV that all ICMR guidelines had been maintained and “all participants were required to stay back for 30 minutes to check for immediate adverse effects and a seven-day follow-up was conducted over the telephone.”
This is not the first time that Bhopal gas tragedy victims have suffered due to involvement in an unethical drug trial. In 2011, a Right to Information request revealed that 10 survivors had died in barely monitored drug trials run by companies like Pfizer, AstraZeneca and Sanofi.
Meanwhile, Madhya Pradesh’s medical education minister Vishwas Sarang had a strange take on the matter, telling the news channel that political detractors of the Bharatiya Janata Party were spreading this news. Sarang also promised an investigation into the matter.
The government had brought the ordinance on April 22, to amend the Epidemic Diseases Act, 1897, to make incidents of violence on health workers treating COVID-19 patients a non-bailable offence.
New Delhi: The Lok Sabha on Monday passed legislation that provides for up to seven years in jail for those attacking healthcare workers fighting the coronavirus or during any situation akin to the current pandemic.
The Epidemic Diseases (Amendment) Bill, 2020, will replace an ordinance issued in April by the government. The Rajya Sabha has already passed the bill on Saturday.
With the Lok Sabha giving its nod, it will soon become an act, which is going to amend 123-year-old legislation.
The government had brought the ordinance on April 22, 2020, to amend the Epidemic Diseases Act, 1897, to make incidents of violence on health workers treating COVID-19 patients a non-bailable offence, with provisions of a penalty and a jail term of up to seven years.
The bill intends to ensure that during any situation akin to the current pandemic, there is zero-tolerance to any form of violence against healthcare personnel and damage to property.
Under the proposed act, the commission or abetment of such violence will be punishable with imprisonment for a term of three months to five years and with a fine of Rs 50,000 to Rs 2,00,000.
In case of causing grievous hurt, the imprisonment shall be for a term of six months to seven years and with a fine of Rs One-Five lakh.
Replying to a debate on the bill in the Lower House, Health Minister Harsh Vardhan said this was empowering legislation and states could make additions to the act.
The ordinance has given a very strong message to perpetrators of violence against medical professionals and health workers during the pandemic, Vardhan said.
“We have all noticed that there has been a dramatic decline in the incidents of violence against health workers all over the country,” he said.
Vardhan explained that the ordinance had to be brought as incidents of harassment and violence against health workers were rising amid a lack of awareness about coronavirus.
“Everyone was feeling sad and bad. That was the time the Government thought of taking a proactive step. When the Government reviewed, it found there were minimal laws and powers in some states. There was a need to have a central law to put in place a prohibitory mechanism to stop such activities,” Vardhan said.
With regard to certain objections raised by members from opposition parties regarding some legal flaws in the Bill, he said the bill had been drafted after taking legal opinion.
Adhir Chowdhury of the Congress said it seemed that the Government had brought the Bill in haste as certain provisions were an area of concern.
As the saying goes, “haste makes waste”, he said, adding: “I would request the Government to send the bill to the standing committee and comprehensive legislation should be brought in.”
Under the bill, there is a provision that says the offender would be presumed to be guilty of the offence unless proved otherwise by the accused defender, Chowdhury said, adding that this was an incomplete deviation from the principles of the country’s criminal law.
Bhartruhari Mahtab of the BJD and Kalyan Banerjee of the TMC also raised legal lacuna in the bill and wanted the government to consider changes.
The Health Minister said, “our government from the last 3-4 years is working on a National Public Health Act to comprehensively deal with issues related to biological emergencies”.
Subhash Bhamre of the BJP said healthcare workers should be allowed to work in an environment free of abuse. He said 68,000 healthcare workers had tested positive for coronavirus so far and 500 doctors had lost their lives due to the infection.
Bhamre said when doctors were working round the clock, donning PPEs, which makes it difficult to work, and without caring for their lives, the healthcare workers should get the respect they deserve.
T Sumathy Thangapandian of the DMK said the bill talked about violence against healthcare personnel during the pandemic, asking what would be the case after the pandemic ended.
Kalyan Banerjee said West Bengal already had legislation that provides protection to healthcare workers. He said the states should be authorised to take a decision on the punishment.
K Suresh of the Congress cited various instances when healthcare workers and doctors were attacked during the pandemic.
Government-sponsored programmes like beating thalis, lighting candles and showering petals from the sky do nothing to change the fundamental socio-economic and political determinants of health.
Note: This article was first published on August 15, 2020, and was republished on August 22.
The COVID-19 pandemic has devastated many lives and livelihoods around the world, but in India, the challenges have perhaps been the most formidable to its health system and its workers. Prime Minister Narendra Modi underscored this when he announced a complete lockdown across the country on March 24 and said, “Think about the doctors, nurses, paramedical staff, pathologists who are working day and night in hospitals to save each and every life. Think about hospital administration staff, ambulance drivers, ward boys, sanitation workers who are working to serve others in these difficult condition.” He also asked for the people to pray for personnel engaged in the delivery of essential and emergency services (e.g. police, fire service, garbage collectors, etc.).
In fact, the Centre on April 21 launched a portal – at covidwarriors.gov.in – to maintain a database of healthcare professionals and volunteers, including ASHA workers and anganwadi workers, and claimed 1.24 crore such individuals were available in the country. The portal is meant to help local administrations and state governments tackle COVID-19. The number of infected and killed workers could be extrapolated from the COVID-19 positivity and fatality rates respectively. But these figures would be mere conjecture – not desirable substitutes for validated data.
A recent study in the UK and the US showed that healthcare workers’ risk of contracting COVID-19 could be three-times higher than that of the general population. Data collated by Amnesty International shows that, globally, over 3,000 healthcare workers (HCWs) have died from COVID-19 and that 63 countries – including India – are seriously short on PPE. In recent months many casualties among HCWs were sporadically reported from different cities of India. The Indian Medical Association (IMA) on August 9, told journalists that 196 doctors have died in the line of duty for treating patients of COVID-19. They appealed to the prime minister for help and extension of life insurance facilities to all the doctors. The information on COVID-19 fatalities among nurses is patchy. And practically no data about other HCWs and volunteers is available. The government ought to release data of death and disability among all HCWs. This is not to overlook contributions and sacrifices by people from other walks of life, particularly those engaged in the essential services during this pandemic.
One may recall that the IMA had threatened to go on strike amid the pandemic over stigmatisation, assaults, lack of safety and inadequate or inferior PPE. The strike was called off after meeting with Union home minister Amit Shah and health minister Harsh Vardhan, who both assured them of safety and security. So a large number of deaths among doctors pose serious questions over the adequacy of infection prevention and control measures in hospitals. The death of a doctor is a poor reflection of the facility where it happened. It necessitates a critical review of the hospital’s workplace environment and safety culture, where staff members are falling ill. It also has serious ramifications for non-COVID-19 patients because pre-symptomatic or asymptomatic HCWs could potential sources the virus.
Events of infection and deaths among HCWs, therefore, need to be audited across all private and public health facilities to then locate deficiencies in the implementation of infection prevention and control protocols and their compliance. The lessons learned from these audits will help develop and implement corrective measures, minimising morbidity and mortality. This is extremely important because the WHO has warned that the pandemic is likely to go on for longer. The Delhi government audited its hospitals and, based on the findings, issued new guidelines for better care and treatment outcomes. However, an audit becomes more credible if performed by an independent third party and whose findings are subjected to independent peer review.
It is also appalling that HCWs have to wait for many months to get their salaries. An annoyed Delhi high court has castigated Delhi government and the municipal corporation and ordered them to pay salaries within 15 days. The Supreme Court had to issues two orders – first on June 17 and again on July 31 – directing the Centre to ensure timely payment of salaries to doctors and other HCWs, and ruled that the quarantine period can’t considered as leave. These orders may not necessarily and automatically evoke compliance and benefit HCWs in the private sector. Reports of protests by nurses against exploitative wages and sub-optimal working conditions bear testimony to their vulnerability. The situation of HCWs working on contracts is indeed the most precarious.
Government-sponsored programmes like beating thalis, lighting candles and showering petals from the sky to honour coronavirus HCWs create the emotive and surrealistic imagery of warriors standing on pedestals – but they do nothing to change the fundamental socio-economic and political determinants of health and equity. No wonder nobody is promising HCWs that their sacrifices will not go in vain.
Dr L.R. Murmu is a professor of emergency medicine (surgery) in the department of emergency medicine at the All India Institute of Medical Sciences, New Delhi. The views expressed here are the author’s own.
Solicitor General Tushar Mehta said that many states have complied with the directions but some of them like Maharashtra, Punjab, Tripura and Karnataka have not paid salaries to the doctors and healthcare workers on time.
New Delhi: Maharashtra, Punjab, Karnataka and Tripura are yet to follow directives on timely payment of salaries to healthcare workers engaged in COVID-19, the Centre on Friday told the Supreme Court, which said it cannot be “helpless” in implementing the directions.
The court directed the Centre to issue necessary directions for releasing salaries of doctors and frontline healthcare workers engaged in COVID-19 duty on time.
A bench of Justices Ashok Bhushan, R. Subhash Reddy and M.R. Shah asked the Centre to also clarify on treating compulsory quarantine period of healthcare workers as leave and deduction of their salaries for the same period.
“If the states are not complying with the directions and orders of the Central government, you are not helpless. You have to ensure that your order is implemented. You have got the power under the Disaster Management Act. You can take steps also”, the bench told Solicitor General Tushar Mehta, appearing for the Centre.
Mehta said that after the top court’s directions on June 17, necessary orders were issued on June 18 to all the states, with regard to payment of salaries to healthcare workers.
He said that many states have complied with the directions but some of them like Maharashtra, Punjab, Tripura and Karnataka have not paid salaries to the doctors and healthcare workers on time.
Senior Advocate K.V. Vishwanathan, appearing for petitioner Arushi Jain, said the high-risk and low-risk classification made by the Centre has no basis and the government advisory of June 18 after the top court’s order has no rationale basis.
He said that there is still non-payment of salaries to healthcare workers.
The bench was hearing a plea of Dr Arushi Jain, a private doctor questioning the Centre’s May 15 decision that 14-day quarantine was not mandatory for doctors.
The top court also took note of an application filed by United Resident Doctors Association (URDA) through advocates Mithu Jain, Mohit Paul and Arnav Vidyarthi that salaries of doctors are being deducted for the period of compulsory quarantine treating it as leave period.
To this, Mehta conceded that “the said period can’t be treated as leave” and said that he would take necessary instructions on the issue.
He said the Central government will take steps to ensure that the salaries of doctors and healthcare workers are paid on time.
The top court posted the matter for further hearing on August 10.
On June 17, the top court had directed the Centre to issue orders in 24-hours to all states and Union Territories for payment of salaries to doctors and healthcare workers as also for providing suitable quarantine facilities for those who are directly engaged in the treatment of COVID-19 patients.
It had said, “The Central government shall issue an appropriate direction to the chief secretary of the states/Union Territories to ensure that the orders are faithfully complied with, violation of which may be treated as an offence under the Disaster Management Act read with the Indian Penal Code.”
Dr Jain had also alleged in her plea that frontline healthcare workers engaged in the fight against COVID-19 are not being paid salaries or their wages are being cut or delayed.
The Centre had earlier told the top court that the May 15 circular on the standard operating procedure (SOP) will also be modified, doing away the clause for non-mandatory quarantine for healthcare workers engaged in COVID-19 duty, and they will not be denied the quarantine.
On June 12, the top court had observed, In war, you do not make soldiers unhappy. Travel an extra mile and channel some extra money to address their grievances.
It had said that the courts should not be involved in the issue of non-payment of salary to healthcare workers and the government should settle the issue.
The Nursing Superintendent has denied the allegations and said that the hospital had been following the due process of renewing the yearly contracts of the temporary nursing staff.
New Delhi: A group of nurses at the Hakeem Abdul Hameed Centenary Hospital (HAHC) have accused their employer of wrongly “terminating” 84 of them “without any notice and without a valid reason.”
The nurses have speculated that the reason they were terminated was that they had been raising their voice against the poor management of the COVID-19 ward, and the medical staff attached to it, by the hospital.
The Nursing Superintendent (NS) of the hospital, however, said that they had only been following due process of renewing yearly contracts of temporary nursing staff, and that they had not terminated anyone.
A young nurse, who was a part of the agitation that occurred on July 13 and July 15 outside the hospital premises against the alleged termination, told The Wire that the nurses had been at loggerheads with the hospital management for over 15 days.
Accusations against the hospital
On June 23, the nurses at HAHC penned a letter to the hospital management raising the issue of the poor condition of nurses and and accusing the hospital of various violations.
In the letter, the nursing staff at HAHC accused the hospital of denying them a COVID-19 test, and adequate quarantine facility after completing a COVID-19 duty.
“If I work in a COVID ward for seven days, I should get seven days’ quarantine facility, I can’t go back to my house where I may infect others,” a young nurse from HAHC said, on the condition of anonymity. “In my hostel, nurses who are working in the general ward live with nurses who are working in the COVID ward. How risky is that?” she said.
In the letter, nurses at HAHC also accused the hospital of not giving them proper PPE and N95 masks. Another nurse who spoke to The Wire said that they were given 3M pollution masks instead of N95 masks and the PPE was of inferior quality and “did not properly cover [the] neck area”.
82 nursing staff of Jamia Hamdard HAHC hospital, Delhi are terminated for demanding PPEs & other basic facilities like quarantine, food & water. We condemn these draconian orders & demand immediate restoration of all #FrontlineWarriors with acceptance of all their genuine demands pic.twitter.com/4l014ozEig
— Harjit Singh Bhatti (@DrHarjitBhatti) July 13, 2020
“We don’t have a proper donning and doffing area, where we can properly wear or discard our protective suits,” a nurse said.
As a result, 7-8 working staff members at the hospital have tested positive in the span of over four months since the hospital started a 219-bed COVID ward.
Surprisingly, the nurses also accused the hospital of not providing them with drinking water. According to a nurse, only 3-4 days ago, a water dispenser was installed after they protested.
“There was no water dispenser in the COVID ward since its inception. Packaged water bottles were brought for COVID-19 patients and we, nurses, were asked to buy the packaged water. On a different floor, one water dispenser is installed but how can we, who are attending COVID-19 patients, use a water dispenser that everyone else uses?” she asked.
“Finally, just 3-4 days ago, water was provided to us,” a nurse said.
Alleged termination of the nursing staff
The young nurse who spoke to The Wire said that since the nurses had accused the hospital of serious violations, the hospital management had used its power to not extend their yearly contract citing COVID-19 and have “terminated” 84 of them.
The hospital order informing staff nurses about the alleged termination was sent on July 11. The order said: “Extension in the contract of 84 staff nurses was due between Feb 2020 till July 10, 2020. These cases could not be processed due to the prevalence of COVID-19.”
The order further states: “ The Competent Authority has approved the extension in the contractual appointment for all 84 nurses…till July 10, 2020 only. All these nurses therefore stand relieved from July 11, 2020”.
The young nurse said that none of the 84 nurses were given any notice before their alleged termination. Ideally, a one-month notice is required for terminating a contractual nurse.
“All nurses were on duty when they received a WhatsApp message about the termination. They were all terminated while on duty,” she said.
The IPNA and the UNA are two organisations who are helping staff nurses at HAHC raise their demands. The UNA has also written a letter to the chief minister of Delhi, Arvind Kejriwal to take cognisance of the alleged termination of nurses.
Nursing Superintendent’s defence
Speaking to The Wire, the Nursing Superintendent (NS) of the HAHC has defended the hospital. “They have not been terminated. They have been, with due process, relieved by the hospital because their contract had ended. We have called all of them for fresh interviews as per our protocol”, she said.
As per the rules of contractual employment, all the 84 nurses who have been relieved by the hospital have been asked to come for fresh walk-in interviews to renew their contract, the NS said.
“We will give them fresh offer letters like we do every year. Those nurses who are below average [in their work], they will be given feedback and their contracts will not be renewed. This also we do every year. There is nothing wrong in this,” she added.
On the other accusations, the NS said that after the Delhi government asked them to increase the number of COVID-19 beds in the hospital from 30 to over 200, there were many structural changes that were required to be done. According to her, some basic changes were made, a separate donning and doffing area was provided to the nurses. However, she admitted that some additions to the area still need to be made. “Painting of the walls, setting up of lighting etc. is gradually being done,” she said.
The NS also said that after the hospital became a COVID hospital, it had to bear enormous expenses and they did whatever they could to provide their nursing staff with appropriate PPE kits and masks.
When asked why 3M pollution masks were given to the staff instead of N95 masks, she said that the 3M masks were equally good too. “I am also wearing 3M masks, they are absolutely fine,” she said. “At the double-triple rate our management purchased masks for our staff.”
The NS also denied that the nurses were not given proper drinking water. “There is an RO at every floor,” she said.
According to the NS, while the hospital management did not put up nurses and medics at a hotel for quarantine, they reserved a 50 bed ICU for the nursing staff. In addition, 4 private rooms have also been made available. “Before this agitation, 67 nurses were quarantined in these facilities provided by us”, she said.
The NS has said that at least 40 of the 84 nurses who were relieved have now been issued fresh contracts. But both the young nurses who spoke to The Wire speculated that these fresh contracts had been issued because of pressure from the nurses’ union.
Member of parliament and CPI leader, Binoy Viswam also penned a letter to chief minister Arvind Kejriwal on July 13, saying that if the hospital “is not able to justify their termination, they must be reinstated immediately.”
— Inayat Singh Kakar (@inayat_s_kakar) July 13, 2020
The Wire has also reached out to the doctors of the hospitals to ascertain the claims of the nurses as well as the hospital management. The story will be updated when a response is received.
Just as strong healthcare systems were vital to combat the coronavirus, strong public service systems are vital to combat any economic or social crisis, panellists from international NGOs said.
New Delhi: In the wake of the coronavirus pandemic, the value of high-quality public services such as healthcare and education has become more apparent than ever. An online panel discussion held by Public Services International (PSI) and ActionAid International discussed the importance of having well-resourced public service institutions in the context of a pandemic. The panel featured Rosa Pavanelli, David Archer, Nisha Larma Arki, V Narasimhan and Enebish Amarsanaa.
David Archer, the head of public services at ActionAid, explained that there are three primary reasons why countries are unable to adequately fund their public service development. First, rising debt rates undermine developing Asian nations’ capacity to spend on public services. He said that countries should try to keep their debt rates below 12% in order to improve this capacity.
Second, International Monetary Fund policies for low- and middle-income countries appear to be counterproductive. IMF recommendations to keep low single-digit inflation rates are widely disputed. Moreover, the IMF also advises countries to cut their public sector wage bill, leading to a smaller number of public service workers available.
Lastly, he said the low tax revenues seen in Asian governments also compromises the ability to spend on public services. Globally, the average tax to GDP ratio is 17% and rich countries average out at 34%. Meanwhile in Asia, there are many countries like Bangladesh, Pakistan, Cambodia and Myanmar with ratios under 10%. All in all, there is an acute issue of governments not being able to adequately resource these institutions due to high debt, ineffective policy and the inadequate tax base.
Adding to the discussion of the IMF policies for freezing public service budgets, the general secretary of PSI, Rosa Pavanelli, explained that such policies result in understaffed hospitals and schools, and the absence of strong workers’ unions. While this certainly has a negative impact on the lives of workers, she said, it also has a strong impact on society as it undermines the universal access to public services. She suggested that significant tax reforms should be implemented instead of freezing budgets.
The issue is not that there is a shortage of money, but rather that there is an inequality of it, according to her. Pavanelli called for the increase of taxation on corporates and the ultra-wealthy. In particular, she believes the IT industry should be exceptionally taxed in light of the pandemic as it was the only industry to flourish.
The shortcomings of Asian public service institutions were highlighted by their inability to properly handle the pandemic situation. The case of coronavirus is Nepal is an eye-opening one, according to Nisha Larma Arki of ActionAid Nepal. She explained that the effect of inadequate institutions coupled with the pandemic was felt the worst by the women and girls of Nepal. Unable to cope with the outbreak, Nepal faced increasing numbers of incidents of domestic violence, sexual violence and unwanted pregnancies. Women had no access to family planning resources or proper maternity care and there have been an increasing number of deaths during childbirth.
The pandemic also worsened the burden of unpaid domestic work, which was already a cause of significant mental distress in women and young girls. ActionAid found that often young girls are unable to cope with their school work because of the immense burden of domestic work that they face. When these girls do badly in school, they are pulled out. This is also linked to high rates of child marriage.
There were two key takeaways from this discussion. First, the panelists believe countries must restructure their finances to accommodate for better resourced public service institutions. Archer suggested that countries currently stuck in bad debt come together and look into the possibility of a debt renegotiation process.
The other key takeaway is the need to strengthen the dignity of public service workers. Pavanelli explained that even though we call them the heroes of the pandemic, their treatment has been far from the treatment of heroes. We must learn to treat these hardworking people well and with respect, since they are the ones who bring public services to all.
Vir Singh is a student at Ashoka University and an intern at The Wire.
Many are leaving the city because private hospitals are deducting salaries and fear of contracting the disease due to insufficient protective gear.
New Delhi: Facing exhaustive working hours, sub-standard protective gears, low salaries and no assurance of their safety from the government, reports suggest that several nurses employed in Delhi’s private healthcare sector have resigned.
Nurses, many of whom are from other parts of the country, are particularly worried about contracting COVID-19 amidst inadequate treatment facilities in the national capital.
Rince Joseph, the president of the United Nurses Association, a nation-wide association comprising of about 5.2 lakhs nurses, wrote to Delhi chief minister Arvind Kejriwal, saying the staff is worried for their lives, according to the Indian Express.
“The staff is worried for their lives. There are no quarantine facilities and many are leaving the city. Many private hospitals are also deducting salaries. We have written several times to both the governments, state and Centre, but there has been no reply,” the letter says.
With COVID-19 cases rising sharply every day, two nurses in Delhi have died from the viral infection, while more than 800 healthcare workers have tested positive. On Thursday, the state reported a record spike of 2,877 cases, taking the total tally in the national capital past 49,000. The death toll is currently at 1,969.
Hospitals report substantial drop
Various private hospitals in Delhi have registered a substantial drop in the number of nurses employed with them before the lockdown.
Saroj Super Speciality Hospital, a dedicated COVID-19 facility, now has only 60 nurses, down from 262 before the lockdown. In early June, the nursing staff at the hospital went on a one-day strike to demand better salaries for handling COVID-19 patients, according to the Indian Express.
On June 10, after the hospital was ordered by the Delhi government to be turned into a COVID-19-only facility, the nurses again went on a strike.
The hospital reportedly promised an increase in their salaries, after which a few nurses resumed work. “Around 40 of our nurses have already resigned as their parents were worried for them. Many stopped coming during the lockdown due to the limited availability of public transportation,” Dr P.K. Bharadwaj, chief executive director of the hospital, told the Indian Express. “Last week, the nurses went on strike though some of them joined back after we promised a raise. As of now, we have 60 nurses.”
At the Sir Ganga Ram City Hospital, 40 nurses have resigned after it was declared a COVID-19 dedicated hospital. “Around 40 nurses employed with Sir Ganga Ram city hospital resigned when it became COVID-19-only. There were 110 nurses at the city hospital, and to meet the shortage, staff from the main hospital were brought in. Besides, many are under quarantine since they have been directly dealing with Covid patients. We are seeing how to fill the gap,” Dr D.S. Rana, chairman of the hospital’s board told Express.
Similarly, the Delhi Heart and Lung Institute (DHLI) is functioning with just 60% of its nurses at the moment.
Medics wearing PPE kits with COVID-19 suspected patients at AIIMS. Photo: PTI
Primus Hospital files case
Meanwhile, the Primus Super Speciality Hospital has filed an FIR against nurses who have demanded Rs 1,500 per day as COVID-19 allowance. The medical superintendent of the hospital wrote to the SDM (Chanakyapuri) claiming that the nurses had abandoned patients and their duties “with certain ulterior motive”, according to the Indian Express.
However, the nurses rejoined duty on Thursday night after the hospital’s administration assured them that their duty hours would be reduced.
Private hospitals, meanwhile, are blaming the government for the nursing staff feeling insecure. “Our staff was not even given time to be trained to handle a pandemic like this. Most of the nurses are from other states and have no social security here. They were never made to feel secure,” Dr Chandra Prakash, president of the Delhi Voluntary Hospital Forum that includes around 40 private hospitals told the Indian Express.
While nurses at Kalra hospital said they have not been provided sufficient equipment, the hospital’s owner has denied the allegation.
New Delhi: Nurses at Kalra Hospital in Delhi’s Safdarjung Hospital, where 46-year-old nurse Ambika P.K. had recently died due to COVID-19, have alleged that they were asked to reuse personal protective equipment (PPE), including gloves and masks, for the past two months.
“While the doctors were given fresh PPE, the nurses were asked to reuse PPE. 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 Kalra Hospital told the Indian Express.
Another nurse close to Ambika disclosed that on her last day on duty a week ago, she had raised the issue of non-availability of “fresh PPE and masks” with the nursing in-charge.
On May 18, after finishing her morning shift, she complained of fever, bad throat and body ache and didn’t come for the night shift. On May 21, after she developed difficulty in breathing, she was taken to Safdarjung Hospital.
Ambika succumbed to COVID-19 on the afternoon of May 24. She had been working at the Kalra hospital’s neonatal wing for the past ten years and was recently deputed at the ICU. She lived in Delhi along with her 16-year-old daughter. Her husband resides in Malaysia and her son in Kerala.
“My mother’s condition deteriorated so rapidly. I couldn’t understand how to get here sooner. Over a week ago, she mentioned that the hospital was making her reuse PPE and charging money for masks. I got agitated and told her to just stay at home, but she didn’t listen to me. She continued working, and now she is dead,” Ambika’s 22-year-old son Akhil told the Indian Express.
Doctors at the hospital had also objected to nurses wearing used PPE. “The doctor said he won’t allow us in, and tore the discarded PPE. He said it wasn’t safe for us or the staff or patients. So, we have been wearing the OT gown instead. Instead of N95 masks, we have been given washable cloth masks,” said a senior nurse at the hospital.
Meanwhile, nurses at Kalra Hospital have decided not to go to work until adequate safety arrangements were instituted. “Today it’s Ambika, tomorrow it can be me. I have not reported to work since Ambika’s death. Our neighbours aren’t happy about having a nurse next door,” a senior nurse said.
A nurse at the hospital said her parents “pleaded with her to skip work after they read about Ambika’s death”.
The hospital owner, R.N. Kalra, has denied the allegations saying that adequate PPE and hand sanitisers were being provided to all employees. “I have not received a single complaint from any staffer. If there is a single discrepancy, I will investigate and take strict action,” he said.
Similarly, nurses in-charge S. Wilson and Anita Soni, also denied the allegations and said, “PPE, gloves and sanitisers are available in bulk.”
Following Ambika’s death, the MP from her native place of Kerala’s Pathanamthitta, Anto Antony wrote to Prime Minister Narendra Modi requesting the release of insurance cover of Rs 50 lakh to Ambika’s family. He even alleged that private hospitals were not providing any kind of protective material, including N95 masks, to staff employed in their hospitals.
He has also written to Delhi chief minister Arvind Kejriwal, asking for Rs one crore compensation for Ambika’s family.
Kalra Hospital in Delhi’s Kirti Nagar. Photo: kalrahospital/Facebook
“She is the first nurse in India who lost her life due to COVID-19. There are reports that nurses and healthcare workers in several hospitals in Delhi are forced to work without protective equipment even now. It is also requested to take urgent measures to ensure that hospitals are taking all mandatory measures to ensure safety of health workers,” Rajya Sabha MP K.K. Ragesh wrote to Kejriwal.
On Monday, COVID-19 claimed the life of another worker who was working without protective gear at AIIMS, New Delhi. Senior sanitation supervisor Heera Lal had developed symptoms of COVID-19 last Tuesday. He was asked to rest at home after the hospital conducted his blood test but after a few days, his condition deteriorated. He was rushed to the emergency ward where he tested positive and died within a week.
“People whose roles need them to engage with all kinds of potential infection sources should get priority in protective gear. We have hundreds of sanitation staffers who are constantly on the job and at risk,” said Kuldip Singh, General Secretary of AIIMS’ SC-ST Association.
Ironically, on Thursday, the Union government claimed that it had become the world’s second-largest manufacturer of personal protective equipment (PPE), after China.
