It wasn’t until #InternationalNursesDay, on May 12, that Prime Minister Narendra Modi thought to tweet to specifically thank India’s “hardworking nursing staff, who is at the forefront of fighting COVID-19”. It was a lukewarm message, compared to the last time when he had thanked nurses (as opposed to all healthcare workers) on May 12 one year earlier.
The previous tweet, during the first wave, was more promising:
“Inspired by Florence Nightingale, our hardworking nursing staff personify abundant compassion. Today, we also reiterate our commitment to keep working for welfare of nurses and devote greater attention to opportunities in this field so that there is no shortage of caregivers.” (emphasis added)
A year later, these words seem spiked with costly irony. As we enter the pandemic’s second wave, the shortage of caregivers has never looked so desperate – and the welfare of India’s nurses has never seemed so neglected.
Few of us, perhaps the Prime Minister included, have any idea how the physical and psychological demands India’s nurses have endured in the second wave. It strains the imagination. A typical COVID ward in a government hospital in Delhi has 40 beds – always filled – and attended by two nurses per shift. Two people have to manage to feed, supervise, and administer care to 40 patients. That includes emotional care, as patients can be badly frightened at finding themselves in the chilly environment of an ICU, isolated from their families, surrounded by other breathless victims and weird figures clad in PPE.
For nurses, the full PPE is its own trial, in the heat of summer. It stays on through extended shifts of six to eight hours, restricting the use of bathrooms, which in turn restricts tea, food or even water. But what is shattering, even for experienced nurses, is confronting this much death.
“One or two patients die in each shift,” one nurse at New Delhi’s LNJP hospital told Malayalam Manorama, in early May. “[Yesterday], I saw a patient in the morning, feeling better and I helped him go to the bathroom. When I came back later to give him an injection, I was told he had died. I almost collapsed.”
Less difficult moments are work, too. Staying back after shift, nurses help patients video-call their families, trading in their own precious hours of rest and domestic responsibilities.
With this level of exposure to COVID patients, nurses face the most risk of infection – even if they have been vaccinated. Many nurses continue to fall sick, or to carry the virus back to their families; they also continue to die from COVID infections, remembered by the Trained Nurses’ Association of India as ‘Covid martyrs’.
It is no shock to learn that nurses are stretched to their limit, keeping the country alive. What is a shock, or should be, is how little we are doing in return.
Undervalued and underpaid
Even before the pandemic, the profession was shockingly underpaid and treated with too little respect. A nurse with 10 years’ experience can take home Rs 15,000 a month; some with three decades of service still receive a gross salary of Rs 45,000. As Usha Krishna Kumar, president of the Nurses’ Welfare Association of India, observes, this puts the compensation for front-line medical workers – people with four-year degrees (and corresponding loans) – in the same range as Delhi’s minimum wage for domestic labour.
It is inescapable that the profession has always been underpaid and undervalued because most nurses (four out of five) are women. The overlaps with ‘lower’ caste and minority religion are also plainly visible. Most hospitals’ nurses are now hired on temporary contracts, extended for year after year – trapping them in ad hoc, insecure employment. The refusal to regularise nurses, in private or government employment, is the central issue of nurses’ welfare. It has left trained nurses with not much to look forward to, except going overseas – and that has left India’s medical system grimly understaffed, with fewer than two nurses for every thousand people in the country.
Even as the champions of our war on COVID, nurses saw no effort to improve their salaries, working conditions – or their numbers. Far from delivering on the PM’s “commitment” to ensure “there is no shortage of caregivers,” the Centre has done almost nothing. It made an emergency allocation of Rs 15,000 crore for healthcare across the country, which is less than 0.01% of its vaunted pandemic stimulus package, with no clarity on how that is to be spent.
When the medical crisis hit Delhi in April 2021, it was reported in terms of shortfalls of medical goods like oxygen, drugs, ventilators. That was actually the smaller challenge, given the shortage of medical workers, who actually treat the sick. It was only in May that the Centre announced new measures to recruit student nurses for COVID facilities. To call it ‘too little, too late’ might be a compliment.
In fact, this recognition of nurses and their value is overdue from all of us. In 2020, COVID lockdowns helped many societies notice how the most ill-paid and denigrated jobs (transport workers, cleaners, garbage removal) were actually their ‘essential workers’, and deserved corresponding dignity and pay. India has yet to notice this even about our most obvious champions: the people pulling us back to dry land as we drown in the second wave.
We aim to praise these workers by comparing them to soldiers in a war against COVID-19. In his own tweet this May 12, home minister Amit Shah called them our “frontline warriors”, whom he “salutes… for their selfless care, devotion and commitment”. But the comparison of these essential services to the defence services should be more than just metaphorical. An army lives on more than just salutes from the home minister. Front-line workers could be regularised and resourced, precisely as “armies” for health and social welfare.
With that should come compensation, not just for nurses’ training and labour, but for the traumatising effects of serving in COVID wards and ICUs through the deadly second wave. The emergency induction of younger, inexperienced nurses will expose them, too, to the brunt of this trauma. Who will nurse the nurses? I think of the ICU nurse in-charge interviewed by the BBC, echoing what every nurse quoted the press has attempted to say:
“When a patient dies, I feel crushed. I’m especially tormented by the death of young people, it breaks my heart each time…Last week, 25 patients died in my hospital after oxygen pressure dropped. I felt so helpless and angry.” These aren’t sentimental phrases – they are the words of a professional gasping with frustration and trauma.
And betrayal. The nursing in-charge continued: “I always used to take pride in being an Indian, but it breaks my heart to see what’s happening…and I blame our leaders for it. All they care about is winning elections.”
A year has been lost, spent winning or losing elections, but it is not too late to keep our May 12 promises.