Editor's note: In 2020, the COVID-19 outbreak upended lives and livelihoods in myriad ways. The novel coronavirus threw up new and unprecedented challenges, especially for people from marginalised sections of society. In a multi-part series, Firstpost explores how individuals from different walks of life lived through the year of the pandemic. This is part four of the series.
Read part 1 of the series here, part 2 here and part 3 here.
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“The manner in which people talk down in any given circumstance is what gets to me the most. There is a hierarchy at every level, from medical officers to staff nurses, from the nurses who are permanent to the temps, from these nurses to sanitary workers. I know this is how it works, but I didn’t feel it this much when I worked at a private hospital. Here, it is just inhuman at times,” says Sharon.
That Sharon is outspoken is something I realised within a single meeting. When I visited COVID-19 care centres across Tamil Nadu, very few healthcare workers spoke about their working conditions to me with full honesty. Sharon on the other hand, walked up to me minutes after realising that I am a journalist.
She told me that she is trying for a transfer to her hometown since she has an infant at home and that even though she’s breastfeeding, she is doing COVID-19 duty. She brought up the issue of regularisation of nurses, including herself, who were recruited in 2015. This was in May.
When I re-visited the district that she was working in for a follow-up story, I couldn’t find her. After inquiring around and a few phone calls, I was told that she had transferred out of the district, something which is usually close to impossible in such a short time. I caught hold of her number and gave her a call.
Sharon was transferred to her hometown, but not as I had assumed. She had to pay Rs 2 lakh for the transfer order. The entire transaction happened through various networks within the establishment. However, when the transfer order did arrive, she realised it still required her to travel three hours from her hometown to her workplace.
Every day, she travels 45 kilometres by bus and 18 kilometres on a bike one way, spending six hours a day just commuting to work and back.
"It is all a gamble, at the end of the day," says Sharon. But is it so, especially if all the circumstances that surround it are skewed against you?
For Sharon, things went south even before the year 2020, designated as the “International Year of the Nurse and the Midwife” by the WHO.
In December of 2019, Sharon received her posting as a government-appointed nurse, a month after she had delivered her second born. She had appeared for the Tamil Nadu Medical Recruitment Board (TNMRB) Exams in her third trimester. An occasion to celebrate, however, quickly turned into anxiety when she learned that her posting wasn’t in her hometown or anywhere around.
Moving away from home wouldn’t have been a problem if she weren’t the mother of two, one an infant, and the other a toddler. The pay was lesser than what she was earning at the moment at a private hospital, and so were the benefits. But the hope of life getting better in the future pushed her husband to quit his job, and the family moved 500 Kms away, to a new town.
With a 45-day old infant, Sharon reported to duty immediately, hoping that she would be granted maternity leave. Permanent nurses are given nine months of maternity leave. After a week of work, Sharon was told she can take the leave but there would be no pay.
This is not the case just for Sharon, but for all who are appointed under the MRB postings. From the time one is recruited till they are regularised, nurses receive a consolidated pay of Rs 14,000 a month. This means there is no ESI or insurance. There is no maternity leave or sick leave. There is one casual leave every month.
The Rs 14,000 monthly salary, however, was hard-fought.
After a high-pitched battle in 2017, which saw more than 3,500 nurses camping outside at the Directorate of Medical and Rural Health Services (DMS) in Chennai — the state government didn't even allow the nurses to use the toilets during the protest — the nurses' salary was raised from Rs 7,000 to Rs 14,000. And that too, only after a direction of the Madras High Court. This raise meant nothing though. Almost all nurses' associations have dubbed the Rs 14,000 salary as grossly inadequate, and are still demanding ‘equal work for equal pay’ in line with the directive of the Madras High Court from 2018, besides seeking a complete upheaval of the consolidated pay contract system. Their demand is that they be treated like any other government employee since they are recruited only after clearing the TNMRB exams.
Three years and a global pandemic later, hikes, regularisations, or any changes are nowhere to be seen. Far from making working conditions better for nurses, the postings granted after the 2019 exam did not take into consideration the location preference, says Sharon. Many nurses that I met since the onset of the pandemic, across districts, have the same story.
“It isn’t that we can’t move, but how do we move with families, with such meager pay and no allowances whatsoever,” questions Sharon.
A directive of the Ministry of Health and Family Welfare in 2016 directed all private hospitals to pay a minimum of Rs 20,000 to nurses working at their establishments and provide for all benefits. It is ironic that the same is yet to be implemented for government nurses.
The excuse that has been used by the Central Government while responding to courts pulling them up for underpaying nurses has been that health is a state subject, and hence there is only so much that they can do to get state governments to pay their nurses.
The Tamil Nadu government, on its part, has done nothing to address the grievances of the nurses, other than repress any form of discontent with an iron hand.
"The unions mostly say nothing against the government, in fact, some of them only do this transfer brokerage,” says Sharon.
Most of the unions are led by regularised staff.
When Sharon joined back for duty in February, after two months of unpaid leave, she was posted at a COVID-19 care centre. This is while she was breastfeeding her baby. Her responsibilities involved interacting with positive patients every day.
“It was a risk but I had no choice. Though there is a government order against this, it wasn’t a practical possibility as the department is already understaffed. I had to do it. I just washed up well every time after I went home, I couldn’t do anything more,” she explains.
A month into this, Sharon’s baby fell sick with a high fever and severe wheezing problems. She wasn’t given leave. The baby recovered the first time. The second time the child suffered from a bout of diarrhoea. Again, she was not given leave. All this pushed the family to leave overnight to their hometown.
By now, her husband was really worried. He told her that there is no point in waiting for a transfer, that they might as well borrow the money for the transfer and move. Sharon was in a fix, but she was worried for her child. She reached out to others who had followed the same route and they put her in touch with a broker, who helped her with the transaction.
Once they received the transfer order and moved back, things didn’t brighten up for Sharon though as now she had to travel six hours a day. Initially, she was kept out of COVID-19 duty as she was breastfeeding, but when her child turned one year old, they put her into COVID-19 duty, which involved her being quarantined away for more than a week. During this period, she had to discontinue breastfeeding her child.
“I wanted to breastfeed him for at least six months more, but again, I had no choice. I was told that six months of breastfeeding is sufficient and beyond that, I won't be allowed to keep away from COVID-19 duty,” she says.
While constantly dealing with a sense of disillusionment and helplessness, Sharon is still very ambitious about her career. She wants to pursue a master's if possible in the future.
“If I get regularised, then I’ve been told that I can take a few years off to study. Maybe then. But 8,000 nurses recruited before me after the 2015 TNMRB exams are yet to be regularised. I don’t know when my chance will come,” she says.
Sharon is in the eligible category for recruitment to AIIMS, after appearing for an exam this year, and she hopes she will soon get a step up from where she is at the moment.
“This is actually a step down for me,” she explains.
Sharon worked as a nurse for seven years before she wrote the TNMRB exams. But when she joined as a government nurse, she was hired at the entry-level. The board doesn’t take into account the varied experience of nurses who write the exams and treats them all as what we commonly refer to as ‘freshers’, irrespective of how many years of work they’ve already put in. Sharon, for instance, has been in highly challenging situations when she worked as an ICU nurse. But now, she works at a PHC, at the entry-level.
When she transferred to her hometown, the other nurses at the PHC did not even allow her to wear a nurse’s coat. “They said it is only for those with 10 years of experience, and that I should wear a dupatta instead,” recollects Sharon. She didn’t say anything, she just stopped wearing her coat.
That the TNMRB has no rationale or a system in place to account for the work experience of nurses taking their exams is worrisome. In addition, the Department of Health and Family Welfare has no system in place for non-regularised nurses like Sharon to share their grievances, whether it is work-related such as transfers or sexual harassment, or personal health problems.
All these nurses are at the mercy of the medical officers they report to. There was nobody that Sharon could turn to, immediately after she was pushed into work in 2020. When her infant son fell sick, Sharon wasn’t allowed to take leave both times. The second time she just left for her hometown with her sick baby, refusing to work anymore. But after a week, she decided to return as her job was the only source of income at the time.
And when she did try to explain her situation to the medical officer, she was subject to a volley of accusatory questions. "I just stood there, not knowing what to do or say,” says Sharon.
Since the start of 2020, Sharon suffered from severe postpartum depression for months, with her work circumstances only amplifying it. She could speak about this with nobody at work. There is no space for this conversation, let alone the options for counselling or treatment.
Sharon is glad that her husband, with whom she was in love since her school days, is around to take care of the children. Otherwise, she isn’t sure if she would still be working.
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