Removing her thali (mangalsutra), Kripa (name changed), a staff nurse left for her workplace at the Rajiv Gandhi Government General Hospital (RGGGH) a fortnight ago. That morning remains etched in her mind: it was the first time she removed the thali in over ten years of marriage and left home to be away from her family for fourteen days at a stretch.

Kripa is a senior nurse tending to critically ill patients at the COVID ward of the government hospital. “We have to remove all jewels and accessories when we report to duty, as the virus can stay longer on metal surfaces,” explains Kripa.  

Life in a PPE

Attired in her Personal Protective Equipment (PPE) suit, Kripa worked six-hour shifts for five days. PPE is a critical piece of gear for healthcare workers who work closely with COVID-19 positive patients. Donning it is no easy task, as it takes at least 20 minutes and cannot be removed at any cost in a high-risk area such as a COVID ward.

Before commencing duty, Kripa had to finish her meals and drink lots of water to keep her going for the next six to seven hours. “It was not food or water that I missed. I would desperately wait for the shift to end, just to be able to breathe normally,” said Kripa, who had to put up with the scorching summer heat and dehydration. Soon, she began to suffer from severe skin allergies (presumably from the PPE), insomnia and breathlessness.

The quality of PPE is critical, say medical professionals. “The number of layers in a PPE makes it very hot, the glasses start fogging after a while and one has to speak really loud to communicate. As it constitutes a lot of different parts, allergy is possible,” says Dr Janani Iyer, consultant gynaecologist 

Healthcare workers also complain of the substandard quality of the PPEs. “PPEs that came from China were of better quality compared to those that are manufactured in India. The rough texture of the latter causes irritation and allergies to the skin,” says Sivaraman R, a general surgeon.

Kripa, however, is now on a second round of duty, having completed the earlier round ( five days of work and fifteen days of quarantine between the government quarters and her home). Things have only become more difficult; this time, she has to do 12-hour-long shifts from 7 pm to 7 am in a PPE. 

All this, for what?

The exhausting work schedules of staff nurses in government hospitals and the sacrifices they make are obvious enough. They compromise personal safety to go beyond the call of duty. But do they receive their fair share of dues?

Kripa with over nine years of experience takes home only Rs 14,000 a month. Any leave taken beyond a day in month results in loss of pay. Forget Dearness Allowance, she has to spend from her own pocket for travel expenses and even to buy a uniform every year.

No concept of equal work, equal pay seems to apply to around 8000 such nurses as Kripa in Tamil Nadu, who are working on a contract. The disparities between a permanent employee and those working on consolidated pay contracts are huge. Nurses on consolidated pay have protested in demand for their rights on several occasions in the past but with little result.

“If I was a permanent employee, I would have been taking home Rs 48,000 now,” says Kripa, and promptly explains, “You may be wondering why we still stick to the job. It is only because of the assurances made by the state government; Health Minister C Vijayabaskar promised to give permanent government positions to 1000 temporary workers this year.”

However, the minister now blames COVID-19 and the deficiency of funds for his inability to stick to the promise. 

An unfair deal

The demand for skilled workers in the medical sector encourages students to choose professions related to it. “I took a loan and spent around Rs 10 lakh for my education (B.Sc nursing, a four-year-course). But will you believe me if I tell you that I started my career in nursing for a paltry sum of Rs 4700 in 2012? Today, I take home around 15,000,” says Karuna (name changed), a nurse who works at IOG, Egmore.

In fact, if the then Chief Minister J Jayalalithaa had not passed a government order in 2012, Karuna would have been earning less than Rs 8000 today. “As per the order, nurses can write an exam and get recruited through the Medical Services Recruitment Board (MRB) at a decent scale of pay. I qualified in that exam and my salary doubled,” she added. Thereafter, her salary has grown at a very slow rate.

Despite the creation of the Board which was meant to regularise the employment of nurses and make them permanent government employees, only a few nurses are regularised every year. That too, after several protests were organised over the issue. Most permanent nurses in government hospitals are those who were recruited years ago, from government colleges.

A national issue?

The issue finds resonance across the country and is many decades old, says Dr A R Shanthi, Secretary of Doctor Association for Social Equality. More than 900 staff nurses with the National Rural Health Mission in Punjab had protested to regularise their jobs in 2014. Less than ten days ago, hundreds of nurses protested at Mumbai’s state-run King Edward Memorial Hospital after a contractual employee working in the COVID ward died. Denial of his leave application, even after he had been showing coronavirus symptoms for days, illustrates the shoddy treatment that contractual employees in the nursing profession have become used to.

The Indian government encourages privatisation of the health sector and contributes only 1.2 per cent of the country’s GDP on public health, even though the World Health Organisation recommends at least 6 per cent, said Dr Shanthi. Shortage of funds leads the state governments to rely on temporary workers in the medical field, as three temporary workers can be employed for the salary of one permanent worker. 

“What these contractual nurses are getting today is a direct violation of the the Minimum Wages Act that quotes 18,000 as the minimum salary of government workers,” says Dr Shanthi, who is also an Executive Committee Member of the All India Trade Union Congress (AITUC). 

But as Kripa rightly observed, it is a question that lingers: Why do these nurses stick to their jobs despite being underpaid and shabbily treated? “Leaving this job means ending up in the tangles of poverty. Besides, a majority of them genuinely want to serve people and refuse to switch to other professions. Caring for people brings them job satisfaction,” added Dr Shanthi.