Under pressure: Health care workers fighting at the frontlines in Nepal

There are 34,000 doctors and 100,000 nurses registered in Nepal. Many more are working as support staff, such as cleaners, in the health care sector. FES Nepal reached out to trade union partners working with health care workers for a glimpse of their situation.

The double burden is taking its toll

According to Pratima Bhatta, organizer and Treasurer with the Union of Private Hospitals and Healthcare Workers in Nepal (UNIPHIN), more than 75 per cent of care, paid and unpaid, is done by women. Women are on the front lines of the fight against COVID-19 and at the same time shoulder most of the unpaid care work.

Schools and day care facilities have been closed since 19 March. This especially affects female health care workers, who bear most of the responsibility for childcare and household work in their family. In times of lockdown, when everyone not working in an essential service must stay home, many women are juggling care responsibilities with paid work in their home office. Workers in the health care sector do not have this option. Yet, they fear being infected and putting their family and friends in danger through possible exposure to COVID-19.

Health care workers, cleaners and others working in hospitals face multiple health risks as well as discrimination and social stigma. This is illustrated by a recent case of a nurse who was evicted by her landlord. A female hospital cleaner from Banke District in Province No. 5 in the far-western part of Nepal found herself in a genuine dilemma: “I am doing my regular duty with safety measures. I am very thankful that the hospital has provided a mask, a separate dress and gloves to me. The only problem I am facing now is complaints from my neighbours. They say, ‘Every day you go to the hospital and come back home.’ I try to stop them from worrying by saying that I have applied all safety measures and that I also wash my clothes every day and have a bath after returning to my room. I am very careful about everyone’s safety.”

Who cares about the health of health care workers?

As in many other countries, there is lack of protective personal equipment, especially outside Kathmandu Valley. Despite the difficult working conditions, health care professionals are working tirelessly to protect the country from the threat, according to Prithivi Raman Thapaliya, President of UNIPHIN.

The union has circulated information on precautions to prevent infection among its members, especially targeting non-medical staff. It demands that hospital owners and authorities:

1. Provide personal protective equipment (PPE) to all staff on duty.
2. Deploy only a minimum number of nurses and female paramedics for duty because the mostly female nurses have dual duties; with the imposition of the lockdown, they are under much stress because they are also taking care of children and other family members.
3. Provide a one-time allowance amounting to two monthly salaries to the staff.
4. Provide adequate insurance for staff.

The management of the hospitals have agreed to the union’s demands. The government also has provided insurance, with a coverage of 2.5 million rupees (about USD 20,500) for each health worker. But because there is a shortage of PPE in the country, the first demand seems to be impossible to put into practice.

The highly privatized health sector is already crumbling

In a diverse country with one of the world’s most challenging topographies, the government has mobilized around 50,000 female health volunteers to reach out to residents at the community and village levels. The health volunteer system began in the 1980s and is crucial for basic health services, even in remote places. The volunteers will support the application of safety measures and social distancing and will be remunerated with USD 15 per day for helping in the fight against the coronavirus.

Meanwhile in the urban parts of the country, even without a high number of COVID-19 patients, the highly privatized health sector is already showing signs of failing in delivering needed treatment. While being the best equipped, private hospitals try to avoid possible COVID-19 patients. A number of people with fever or respiratory symptoms are turned down at hospitals. Against this backdrop, the government also issued a package of incentives for doctors and health workers from the private sector to help treat the COVID-19 cases. But there is scepticism, whether or not private hospitals can be convinced to join, especially due to the lack of PPE not being addressed.

When the heat of the fight against the virus has cooled, there will be a need to look at the lessons learned from this crisis that exposes the breaking points of our health care systems, and not only in Nepal.