By Dr. George Jacob
Kochi: If there is one group of professionals who are being taken for a ride, exploited, verbally abused in the workplace, made a doormat, and thoroughly underpaid in Kerala, it is the nurses.
This is, thanks to the adamant attitude of 1,280 private hospitals that dot the nook and corner of the state with their ravenous quench for profit. This has come to remain an integral part of the huge price that healthcare in Kerala, corrupted by over-corporatization of healthcare has been called to pay.
What is so special about Kerala, with regard to nurses?
Malayalee nurses have been traditionally known for their professionalism, knowledge, commitment and dedication that their service was sought after in the other Indian states and abroad too. But, the glitter started to fade the minute ‘nurses’ began to qualify from nursing ‘colleges’ attached to those numerous hospitals of suspicious credentials located in the neighboring states of Karnataka, Andhra Pradesh and Tamil Nadu that have sprouted like mushroom after summer rain.
Admission to these ‘factories of nurses,’ and even doctors are offered almost solely on the basis of money power, calling themselves ‘self financing institutions,’ the likes of which have established themselves in Kerala too, adding to the decimation of the much-acclaimed healthcare dispensation Kerala is known for.
There are now umpteen numbers of so-called ‘nurses’ who have completed their courses without tending to a single patient during their course. There are many who qualify as nurses sitting in their homes, far distant from the ‘colleges’ they’re supposed to be studying nursing.
Logically the nurses’ quality nosedived. Gradually, the once-acclaimed nurses from Kerala fell from grace. Parents made geese that lay golden eggs out of their daughters who qualified as nurses, thanks to huge salaries they draw from the Persian Gulf nations, the West, and countries such as Australia and New Zealand.
They had no second thoughts to avail large amounts of money as loans from private and mainstream banks to finance their daughters’ ‘nursing courses.’ The responsibility of paying back the loans ultimately fell on the young shoulders of the naïve ‘nurses’ simultaneous with their graduation.
Gone are the days when nursing colleges of quality attached to reputed hospitals in Kerala used to churn out nurses having undergone courses of substance, and more importantly, training after the prescribed course in the very same hospitals. Hospitals run by Christian denominations, especially those run by the Catholic order were famous for producing young women who were true and worthy descendents of the Lady with the lamp, Florence Nightingale.
They absorbed them as trainees for menial pay, which is too shocking and even shameful to mention, just because they were doing them a favor ‘by giving them an opportunity to train themselves.’ Hospital managements, with the connivance of their nursing superintendants and directors confiscated the trainees’ certificates to make sure these slaves hung on in those hospitals somehow.
Thus the saga of low pay among nurses took root in Kerala. Their minimum salary is too low that it would embarrass them to compare it with a daily wage laborer doing mason work in Kerala. While immigrant laborers from West Bengal, Bihar and Orissa earn between 700-90 rupees a day, nurses in their own backyard earn as low as 300 to 400 rupees.
The trainees would then continue as trainees for a year or two. Those who continue working would go through a process of ‘appraisal’ (a synonym for eyewash), after which their emoluments might or might not be increased, most probably the latter. The pay hike, if any would follow only after their promotion as permanent staff.
Here is an example of a nurse’s pay in a tertiary referral hospital belonging to the corporate sector. A nurse who joined the hospital in 2011 was offered 9,500 rupees as basic pay back then, which is about a shameful 316 rupees a day. In 2017, she earns 13,500 rupees a month, which is about 450 a day.
A fresher who joins the same hospital in 2017 is offered 13,500 rupees a month, which is exactly what the nurse who joined in 2011 earns in 2017. Seniority is therefore given no due consideration in deciding their pay or, increment, if any. Therein lies one of the most glaring grievances of the nurses.
In 2016, a recommendation by a special committee assigned by the Supreme Court had proposed that all privately owned hospitals with over 50 beds ought to make sure that nurses get basic salaries at par with those in the government sector, which is 20,000 rupees a month. This came after nurses had agitated in Kerala in 2013, under the aegis of UNA (United Nurses Association), when their basic salary was a pitiable 9,500 rupees.
Recently, the nurses in Kerala took to the streets, led by two unions, the Indian Nurses Association (INA), and the United Nurses Association (UNA) demanding the private hospitals to fall in line with the Supreme Court’s order. The agitation was called off when private hospital managements agreed to abide by the Supreme Court’s orders, in a meeting brokered between the striking nurses unions and the hospital managements, in the presence of the Kerala Chief Minister.
Poor remuneration is not the only injustice, so to say, the nurses face as professionals. They are by rule than exception, shouted at and verbally abused by doctors and their superiors, during rounds and other areas of work within hospitals, sometimes before patients they are to tend to(something which if resorted to abroad, especially in the West, would invite severe stricture on the offensive doctor, however ‘great’ he/she might be).
Their work involves long working hours (they are asked to put in extra hours of work in times of crises brought about by the numerous hartals Kerala is famous for, or when emergency like a mass casualty calls on hospitals). They are provided with inadequate facilities in their work places.
Basic facilities such as proper changing rooms and areas to have their meals are conspicuous by their absence in hospitals, for this group among the numerous healthcare personnel even in those ‘five star’ corporate behemoths, where comforts of other employees are adequately addressed.
The nurses’ glaring undoing in hospitals they work in are those of their own ilk, who take on the garb of nursing superintendents, directors and supervisors who stand for everything except their junior colleagues’ welfare. They resort to this attitude in order to rub the hospital managements in the right places, in the right manner, not to topple apple carts, much to their advantage. Those in nursing hierarchies exist only for themselves. They care two hoots for their junior colleagues.
This attitude is the biggest undoing that ails nursing all over Kerala, such that nurses have nobody to represent their grievances to the powers-that-be within hospitals. This is most prominent in private hospitals. Nursing departments are invariably understaffed, that nurses are arm-twisted to do long hours, undermining their efficiency and blowing away the prescribed nurse: patient ratio, even in crucial facilities like the ICU and operating theatres to the wind, putting patients’ life and health at extreme risk.
Their job involves one of personal sacrifice to a great deal. Many of them leave home for work after having packed lunch boxes for their spouses, themselves and other dependants and after having fed, clothed and sent off their children to school. Many of them have been injured in their hurry to beat the swiping machines and the watch. They are forced into this grueling grind because their job is the most important means of sustenance and livelihood for themselves and their dependants.
The other dimension that they need to address as professionals is the heavy bank loans availed to finance their nursing ‘course.’ Apart from this, many of them take on responsibilities that weigh heavy on their young shoulders like refurbishing their homes, or even building a new one, financing a sibling’s wedding, which place them under great financial pressure, ultimately to frustrate them.
It is at this point these ‘angels in white’ go abroad and to other states in search of greener pastures, leaving behind their young family. I have personally heard many a naïve nurse cursing the day he/she decided to take up nursing as a profession, simply because they are unable to measure up in meeting the financial demands they are asked to shoulder. Parents of these young girls indulge in extreme cruelty by making ATMs out of them, in the process sullying a noble profession. This is a social problem that needs to be addressed.
Having said so, private hospitals, which have made lucrative business out of a once noble profession of healing have a lot to do to improve the lot of these ‘angels in white’ who are supposed to hold high the lamps in their hands, but instead are forced to hold banners as they take to the streets searching for long-lasting solution to their vexations, brought on, partially by themselves and their families, and by their superiors at work.
• Minimum wages prescribed by the highest court of the land must be paid to the nurses without fail or hesitation.
• Time bound, unbiased and meaningful appraisal methods that are not intimidating must be followed religiously wherein the deserving nurses, based on their competence are offered increments in their emoluments or as bonuses.
• Once the training period is through, the nurses must be, on merit absorbed into the hospital with reasonable emoluments.
• The disgraceful and hurting practice of being yelled at by doctors and harassment meted out by nursing hierarchy must be made punishable by law, and must be considered negatively when the formers’ aggrandizement is being considered.
• Small clinics and hospitals which cater to local population and simple folk, unable to meet the financial burden brought about by the enhanced pay for nurses must be supported by the government financially, through measures like subsidizing electricity, water and drugs, and cutting down taxes. The maintenance expenses of costly equipment must also be subsidized by governmental intervention. A Network of such hospitals has already been formed-the Kerala Association of Small Hospitals and Clinics (KSASC) to examine ways to cushion the demands thrust on them, by the hike in nurses’ pay.
• Nurses must be provided with basic facilities like changing rooms, rest rooms and eating places within hospitals.
• If possible, nurses must be provided accommodation within the hospital or in close proximity to the same in the form of hostels, rooms and quarters to ease their pressure of travelling great distances to come for work.
• They can also be provided crèches that provide facilities where their young children can safely be entrusted, as that will take a great deal of pressure off their shoulders already sagging with several other telling demands.
Though These may sound utopian, these are certainly achievable if cash-rich corporate hospitals put their hearts and souls into the issue, as basic logic remains that if employees are well cared for by the employer, the latter is sure to reap rich dividends in terms of loyalty and pride in workplaces, which cannot be bought in the market, or extracted by force, but will only stand in good stead to the hospitals’ health, where the sick are cared for. More importantly, the ‘angels in white’ are not the ones who are supposed to hit the streets voicing slogans, and holding up banners and placards to get their just dues. It simply does not sit well in a state that boasts of health standards similar to, or even better than some of the so-called ‘developed’ nations.