By Dr S. Saraswathi
When the WHO decided to designate 2020 as the Year of the Nurse and Midwife, its 194 member countries did not foresee the tremendous role and responsibility waiting to fall upon the nursing fraternity during the year. Nurses are hailed now as Corona Heroes along with several other professional and non-professional, skilled and unskilled, paid and voluntary workers engaged in Operation Covid-19 in India and worldwide.
2020 is celebrating 200th Birth Anniversary of Florence Nightingale, founder of modern nursing whose selfless nursing of soldiers of British and allied forces in the Crimean War in Turkey is inseparably linked with nursing profession. Today, we have to express our gratitude to thousands of corona warriors in the forefront of the battle against the pandemic.
Nurses constitute the “bridge” of healthcare services. They are crucial in any healthcare system and play a central role in a health team. Their role is vital in providing health services and often they are the first and even the single point of care in a community. They have duties in all stages of healthcare – disease prevention, diagnosis, treatment, care, rehabilitation and recoupment of the patient. They care for individuals of all ages, families, groups and communities, sick or well and in all settings.
As such, they remain close to the community more than the doctors who stay with the patient for minimum time. Nurse-patient interaction is crucial to public health and disease control.
To achieve Universal Health Coverage, a strong nursing and midwifery workforce is indispensable. When the declaration of 2020 as the Year of Nursing was decided, Covid-19 had not made its appearance to draw the committed services of nurses and other health, sanitation, and pharmaceutical workers wholesale in many countries.
Nurses form over 50% of health workforce in many countries. In India, they are the only health providers in many rural areas and account for about 30.5% of its health workforce. A WHO publication in 2016 giving some details of the strength of nurses has mentioned that Orissa, Nagaland, and Meghalaya had about 50% nurses in health workforce while UP had 17.95%, Haryana 18.6%, and Bihar 19%. It concluded that across India, percentage of nurses in the health workforce was negatively correlated with percentage of doctors.
A government doctor in India today attends to over 11,000 people, more than ten times than what WHO has recommended. It is estimated that there is a deficit of 600,000 doctors. Nurse-patient ratio is roughly 1:483 which indicates a shortage of 2 million nurses.
India has much less number of nurses than China or Italy worst affected by COVID-19. They are also concentrated in urban areas. India’s health sector is facing a crisis of inadequate infrastructure and human resource.
Even in a progressive and worker-sensitive State like Kerala, which is also providing the largest contingent of nurses in the country supplying to many States and to other countries also, the state of nurses is no better than in other places. The Indian Nurses Association was formed only in 2011 after the tragic incident of suicide of a nurse working under a bond system which shows the lack of collective strength of nurses to promote their own and their profession’s status in the community.
If the world is to meet the SDG target of providing Universal Health Coverage, it is said that it must urgently address the global shortfall of 9 million nurses and midwives. Further, their professions need to be strengthened in order to achieve the three most important targets of improving healthcare, promoting gender equality, and supporting economic growth.
The barriers in uplifting the nursing profession and professionals are many – professional, socio-cultural, and economic. COVID-19 crisis has brought into focus the tremendous importance of nurses and other health workers and their immeasurable contributions. Since the science of medicine has not yet found a remedy to the disease, the supportive system and the auxiliary troop of doctors have to provide relief, ability, and enthusiasm for the patients to resist the disease.
Indeed, nurses are in many cases the real “life savers” by their prompt action and presence with the patients. Nurses are no longer the “handmaidens” of doctors; today, they are looked upon as responsible for over-all care of the patients.
The situation of coronavirus + patients is different from many other patients as they cannot have visitors including close family members. This puts extra strain on nurses to keep the patients in good humour in spite of their tedious medical work. Unfortunately, this role of nurses hardly gets recognition while patients and their family are quick to find fault with them and other hospital staff.
Prime Minister Modi’s call to the people of India “to clap as a mark of gratitude” to those working round the clock to keep the country safe should not remain a symbolic gesture without any intent.
Women form the major proportion of nurses in all countries. In fact, historically, nursing has been regarded as a female profession naturally suited to women. It is embedded in the gender-based power relations of a society. Hence, improving the status and working conditions of nurses will also mean a step towards gender parity.
The American Federation of State, County, and Municipal Employees, despite a sound healthcare system in the USA finds many inadequacies. Its President has pointed out that public health workers continue to lead us through this national crisis confronting the most difficult possible conditions imaginable, doing life and death work, but do not have the critical tools they need, nor the economic support required in the short and long term.
He has noticed that front-line workers of all kinds – healthcare professionals, park attendants, correction officers and more going without the gear that allows them to safely do their jobs. Skilled and courageous nurses were resorting to wearing garbage bags.
Associations for doctors in India are also campaigning for protective kits for them as cases of doctors catching the disease are emerging. Doctors and nurses are advised to wear triple layer mask and gloves. Hazmat Suits (hazardous material suits) used by doctors abroad are not wearable in the Indian climate. Manufacture of Personal Protection Equipment (PPE) made in India must be augmented.
Healthcare workers have always faced less pay and more work than other workers and at the present time, they work under extraordinary pressure and constant fear of contracting the disease which spreads very fast. At home, they have to remain isolated from other family members. They are undergoing tremendous physical and mental pressure.
In short, the entire healthcare workers are working like soldiers in war time. Reports of instances of social boycott of nurses and doctors attending COVID-19 patients and even their eviction by landlords may be partly results of lack of adequate defence equipment for these warriors.
The Government of India has announced health insurance for Rs.50 lakh for health workers fighting Covind-19 under which sanitation staff, doctors, ASHA workers, paramedics, and nurses will be covered. The nation is indebted to these soldiers fighting an invisible enemy. People must unite to protect and reward them. — INFA
( The author is former Director, ICSSR, New Delhi)