Open Forum
New Delhi, 2 April 2020
Corona Heroes
2020 YEAR OF NURSE & MIDWIFE
By Dr S. Saraswathi
(Former Director, ICSSR, New Delhi)
When the WHO decided
to designate 2020 as the Year of the Nurse and Midwife, its 194 member
countries did not foresee the tremendous role and responsibility waiting to
fall upon the nursing fraternity during the year. Nurses are hailed now as
Corona Heroes along with several other professional and non-professional,
skilled and unskilled, paid and voluntary workers engaged in Operation Covid-19
in India and worldwide.
2020 is celebrating
200th Birth Anniversary of Florence Nightingale, founder of modern
nursing whose selfless nursing of soldiers of British and allied forces in the
Crimean War in Turkey is inseparably linked with nursing profession. Today, we
have to express our gratitude to thousands of corona warriors in the forefront
of the battle against the pandemic.
Nurses constitute the
“bridge” of healthcare services. They are crucial in any healthcare system and
play a central role in a health team. Their role is vital in providing health
services and often they are the first and even the single point of care in a
community. They have duties in all stages of healthcare – disease prevention,
diagnosis, treatment, care, rehabilitation and recoupment of the patient. They
care for individuals of all ages, families, groups and communities, sick or
well and in all settings.
As such, they remain
close to the community more than the doctors who stay with the patient for
minimum time. Nurse-patient interaction is crucial to public health and disease
control.
To achieve Universal
Health Coverage, a strong nursing and midwifery workforce is indispensable.
When the declaration of 2020 as the Year of Nursing was decided, Covid-19 had
not made its appearance to draw the committed services of nurses and other
health, sanitation, and pharmaceutical workers wholesale in many countries.
Nurses form over 50%
of health workforce in many countries. In India, they are the only health
providers in many rural areas and account for about 30.5% of its health
workforce. A WHO publication in 2016 giving some details of the strength of
nurses has mentioned that Orissa, Nagaland, and Meghalaya had about 50% nurses
in health workforce while UP had 17.95%, Haryana 18.6%, and Bihar 19%. It
concluded that across India, percentage of nurses in the health workforce was
negatively correlated with percentage of doctors.
A government doctor
in India today attends to over 11,000 people, more than ten times than what WHO
has recommended. It is estimated that there is a deficit of 600,000 doctors.
Nurse-patient ratio is roughly 1:483 which indicates a shortage of 2 million
nurses.
India has much less
number of nurses than China or Italy worst affected by COVID-19. They are also
concentrated in urban areas. India’s health sector is facing a crisis of
inadequate infrastructure and human resource.
Even in a progressive
and worker-sensitive State like Kerala, which is also providing the largest
contingent of nurses in the country supplying to many States and to other
countries also, the state of nurses is no better than in other places. The
Indian Nurses Association was formed only in 2011 after the tragic incident of
suicide of a nurse working under a bond system which shows the lack of
collective strength of nurses to promote their own and their profession’s
status in the community.
If the world is to
meet the SDG target of providing Universal Health Coverage, it is said that it
must urgently address the global shortfall of 9 million nurses and midwives.
Further, their professions need to be strengthened in order to achieve the three
most important targets of improving healthcare, promoting gender equality, and
supporting economic growth.
The barriers in
uplifting the nursing profession and professionals are many – professional,
socio-cultural, and economic. COVID-19 crisis has brought into focus the
tremendous importance of nurses and other health workers and their immeasurable
contributions. Since the science of medicine has not yet found a remedy to the
disease, the supportive system and the auxiliary troop of doctors have to provide
relief, ability, and enthusiasm for the patients to resist the disease.
Indeed, nurses are in
many cases the real “life savers” by their prompt action and presence with the
patients. Nurses are no longer the “handmaidens” of doctors; today, they are
looked upon as responsible for over-all care of the patients.
The situation of
coronavirus + patients is different from many other patients as they cannot
have visitors including close family members. This puts extra strain on nurses
to keep the patients in good humour in spite of their tedious medical work.
Unfortunately, this role of nurses hardly gets recognition while patients and
their family are quick to find fault with them and other hospital staff.
Prime Minister Modi’s
call to the people of India “to clap as a mark of gratitude” to those working
round the clock to keep the country safe should not remain a symbolic gesture
without any intent.
Women form the major
proportion of nurses in all countries. In fact, historically, nursing has been
regarded as a female profession naturally suited to women. It is embedded in
the gender-based power relations of a society. Hence, improving the status and
working conditions of nurses will also mean a step towards gender parity.
The American
Federation of State, County, and Municipal Employees, despite a sound
healthcare system in the USA finds many inadequacies. Its President has pointed
out that public health workers continue to lead us through this national crisis
confronting the most difficult possible conditions imaginable, doing life and
death work, but do not have the critical tools they need, nor the economic
support required in the short and long term.
He has noticed that
front-line workers of all kinds – healthcare professionals, park attendants, correction
officers and more going without the gear that allows them to safely do their
jobs. Skilled and courageous nurses were
resorting to wearing garbage bags.
Associations for
doctors in India are also campaigning for protective kits for them as cases of
doctors catching the disease are emerging. Doctors and nurses are advised to
wear triple layer mask and gloves. Hazmat Suits (hazardous material suits) used
by doctors abroad are not wearable in the Indian climate. Manufacture of
Personal Protection Equipment (PPE) made in India must be augmented.
Healthcare workers
have always faced less pay and more work than other workers and at the present
time, they work under extraordinary pressure and constant fear of contracting
the disease which spreads very fast. At home, they have to remain isolated from
other family members. They are
undergoing tremendous physical and mental pressure.
In short, the entire
healthcare workers are working like soldiers in war time. Reports of instances
of social boycott of nurses and doctors attending COVID-19 patients and even
their eviction by landlords may be partly results of lack of adequate defence
equipment for these warriors.
The Government of
India has announced health insurance for Rs.50 lakh for health workers fighting
Covind-19 under which sanitation staff, doctors, ASHA workers, paramedics, and
nurses will be covered. The nation is indebted to these soldiers fighting an
invisible enemy. People must unite to
protect and reward them. --- INFA
(Copyright, India
News & Feature Alliance)
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