Last year in May, Southampton General Hospital in the United Kingdom woke up to a Banksy artwork that depicted a young boy kneeling by a wastepaper basket. He had discarded his Spiderman and Batman figures in favor of a new action hero - a nurse. Appearing in a Superman pose, she wore a facemask, a nurse’s cape, and an apron with the Red Cross emblem in the artwork. The world got its new superhero.
Every year International Nurses Day is celebrated on May 12, which commemorates the birthday of Florence Nightingale. Known as the Lady with the Lamp, Nightingale is considered to be the mother of modern nursing. There are several legends and stories of her caring for British wartime soldiers setting an early precedent of the welfarist principles of the profession. Cut to the COVID-19 pandemic in 2020 through the coronavirus second wave this year, the significance of International Nurses Day has increased manifold.
Soldiers of a different kind
According to the International Council of Nurses (ICN), as of December 31, 2020, more than 1.6 million healthcare workers in 34 countries have been infected by COVID-19. India’s defence allocation in 2019-20 was Rs 2,82,733 crore, while the allocation for health was Rs 63,538, making the defence budget 4.8 times the health budget. The budget allocation for the Department of Health & Family Welfare surged from Rs 37,061 crore in FY17 to Rs 65,001 crore in FY21. Reports suggest this is hardly enough.
Soldiers are sent to defend a country’s borders; its sovereign territorial integrity and in effect, its national pride. The subject of defence is largely a male-dominated bastion. Women breaking into the bastions of military forces is surely a story of empowerment, but military narratives projecting male military personnel as heroes of strength and bravado have dominated popular imagination even in the modern world. The COVID-19 pandemic saw a departure in this narrative of heroism with nurses emerging as soldiers of a different kind. Soldiers whom the nation needed in its deepest and most devastating humanitarian crisis since Independence.
Stories of nurses working day in and day out, often without a break, at the forefront of fighting the COVID-19 pandemic have populated timelines. Tales of these health workers providing critical and quality care in COVID-19 wards at a grave personal risk alerted one and all to the significance of this profession — one that combines the learnings of medical science with the principle of care.
Take four-month pregnant Nancy Ayeza Mistry working at a Surat hospital, who takes care of patients while observing Roza. “I am doing my duty as a nurse. I consider serving people as a form of prayer,” Mistry was quoted by the media.
According to the World Health Organisation (WHO), “'nurses account for more than half of all the world’s health workers, yet there is an urgent shortage of nurses worldwide with 5.9 million (2020) more nurses still needed, especially in low- and middle-income countries.” India has 1.7 nurses per 1,000 population, 43% less than the World Health Organisation norm (3 per 1,000). This includes nurses, midwives, women health visitors and auxiliary nurse midwives. Overall, India has 3.07 million registered nursing personnel, the government told the Rajya Sabha on March 3, 2020.
An army of overworked, underpaid workers
“Doctors view nurses as mere assistants, hospitals see them as cheap labor and patients consider them customer care employees in India” – a report published in 2018 presented this harsh reality that explains the disparity that nurses face in the Indian healthcare system. Nurses have typically been relegated to a secondary role. They do not carry the weight, prestige and authority of a doctor and face systemic discrimination. It is akin to an image trap – that of the proverbial Nightingale – that dictates the role of a sacrificial caregiver.
Dr Minakshi Biswas, assistant professor at BHKM, West Bengal State University had tested COVID positive and had to be admitted for a week in a COVID facility. She said to the media, “In times when I would feel better… I would talk to the nurses and housekeeping staff stationed on duty in the ward. While they would be covered from head to toe in their PPE kits, I would be amazed at their level of patience working tirelessly throughout the day. My COVID ward had around 14 to 15 beds and each of these nurses were to be on an eight-hour duty. At times there would be two nurses and during night mostly one of them in these wards catering to 14-15 patients.”
Reportedly, Mumbai has set up five new COVID-19 centers where nurses are being recruited on one-month contracts, which may keep getting extended as per need. “Many nurses would probably prefer unemployment instead of such an insecure job,” said Jibin TC, the state president of United Nurses Association. Similar situations exist in other states as well.
Short-term contractual nature of employment has created an adverse impact on the prospect of nursing recruits amid the pandemic. Salaries for these contractual nursing recruits could vary anywhere around Rs 10,000 to Rs 20,000 approximately. The duties, however, would be the same as that of permanent employees including administering intravenous drips and oxygen masks, monitoring treatment, taking blood samples, giving status updates on each patient to the hospital control room at regular intervals.
The Kerala nursing model: A future of hope
The state of Kerala under Health Minister K K Shailaja has earned accolades and generous international press through the pandemic. “The Kerala nurse returning to duty after recovering from COVID-19 will be the enduring symbol of our healthcare system,” said Prof Roy George, national president of Trained Nurses’ Association of India to the media. The Kerala government had announced a fixed minimum wage of Rs 20,000 for nurses.
To counter the deadly second wave, Prime Minister Narendra Modi announced “key decisions to boost the availability of medical personnel to fight COVID-19” on May 3. These decisions include engaging final-year medical and nursing students in full-time COVID work. Such contingency measures should meet long-term sustainable goals to incentivize the profession duly.
Let us, however, continue to salute the spirit of the likes of Mistry and Reshma Peter Gaurea who was threatened by the natives of her village Bhayandar every time she stepped out to go to Mumbai’s Wockhardt Hospital on her duty as staff nurse. Owing to stigma and fear, the villagers feared that Gaurea would bring the virus to their homes despite her providing essential service.
(Edited by Amrita Ghosh)