A representative photo of a nurse at work in a hospital in Mumbai, August 2018. Photo: Reuters
- Nurses are paid less than they’re supposed to be, they work in punishing circumstances, and hospital administrators often take their availability for granted.
- During the COVID-19 pandemic, the government and the armed forces feted them as “corona warriors” but elided their agency, rights and resistance.
- Panchali Ray, an expert of gender studies, said the root cause is the “societal contempt for corporeal and affective labour” performed by women and members of so-called ‘lower caste’ groups.
- In this report, Sanhati Banerjee recounts the experiences of several nurses in West Bengal, from being scolded in public to being at the mercy of community vigilantism.
A cancer survivor in her mid-20s, who works as a nurse at a cancer care hospital in a private facility in Kolkata and didn’t want to be identified, undertakes a six-hour commute daily to reach her workplace from her place of domicile in a district of West Bengal.
A three-year general nursing and midwifery (GNM) diploma-holder, she said that even though her nine-hour shift, six days a week, pays too low and isn’t ideal, she wouldn’t like to give it up for anything. “The private sector is more exploitative … as there is no accountability.”
Per Central Bureau of Health Intelligence data, the number of lady health visitors was reported to be 12,854 in 2020 in West Bengal. The total number of GNMs in the state was reported to be 70,442 in 2020. And according to the West Bengal Council of Nursing, there were 1,474 male and 41,942 female nurses (general) as of December 2016.
Similarly, the number of auxiliary nurse-cum-midwives stands at 12 male and 24,341 female, and the number of midwives is at 12 male and 43,616 female, according to the Council. The number of BSc (nursing) students was 2,278, all women, as of December 2016.
“The category of ‘untrained nurse’ is not a legitimate entity, although it might be prevalent in ‘smaller’ nursing homes or private institutions masquerading as ‘hospitals’ that don’t have enough [of a] nursing workforce,” Shreyasee Dey, who has a BSc (nursing) degree, said. Dey lives in Serampore in Hooghly district and is a grade II nursing officer in the state’s Department of Health and Family Welfare. She began working as a full-time nurse in August this year.
Around the same time, about 3,000 nurses from state government hospitals were participating in a sit-in protest at the Institute of Post Graduate Medical Education & Research (IPGMER), in the SSKM Hospital compound.
“Nurses across all categories – diploma-holder, BSc-degree holder, experienced, fresher – get less than what they should be entitled to,” Bhaswati Mukherjee, secretary of Nurses Unity, an association of nurses, told The Telegraph.
Swagata Saha, a BSc nursing graduate, has been working at Kolkata’s Nil Ratan Sircar (NRS) Medical College and Hospital for the last three and a half years, before which she worked at a private facility.
“Our degree makes us eligible to be hired as grade I officers, but we have been hired as grade II officers,” she said. “Currently, we get level-9 pay but we are entitled to level-12 pay [under grade II]. So our pay is not proportionate to either our post or our qualification.”
“Our demands for fair wages had already been ‘approved’ by the health and family welfare department of the state government — we were given due assurance before COVID, in 2019,” Mukherjee of Nurses Unity told this author. “But when the pandemic struck and despite us providing 24/7 patient care, those promises weren’t met. So we had to stage [a] sit-in protest for 12 days in 2021.”
The outcome: the department, she said, told them that the “file” was with the pay commission and that it would be some time because of the “different grades and scales”.
Mukherjee is also the sister-in-charge of the Ramrick Das Harlalka Hospital, an annexure of SSKM Hospital.
“So, in essence, the state administration is not in disagreement with our demands. Kintu amra chai proshashon amader je dabi mene niyeche obilombe sheta proyog koruk. Amra onontokaal obdhi opekha korte chai na,” she said. That’s Bengali for “At present, our demand is that the administration should implement the demands that they agreed to fulfil. We do not want to wait for an eternity.”
Dey, the BSc nursing holder, worked as a community health nurse/worker under a three-month contract with the Union health ministry, for the National Health Mission. Before that, she worked as a clinical instructor and sister-tutor.
“It wasn’t easy for students to navigate 14-hour work shifts and overnight duty with no clear roadmap to their career and at the same time battle a fear of contracting the [novel coronavirus] and keep their families safe,” Dey said. “Often, students complained of exhaustion coupled with anxiety. PPE [also] posed challenges for menstruating bodies. Complications arose as wearing PPE meant being constrained to not consume water/food and visit washrooms for those long hours.”
Saha said, “There were several senior nurses [and doctors] who suffered a lot owing to PPE kits, especially those with chronic obstructive pulmonary disease and those predisposed to asthmatic tendencies and high blood-pressure. One such sister even died … while on duty.”
Saha has had COVID-19 thrice. She was also among the first cohort of frontline staff to volunteer for the first batch of vaccination.
The Telegraph reported that in the second week of May 2020, at the height of the first wave, many of West Bengal’s nurses were returning to their home states.
“The question which everyone should ask but nobody asks is who filled in the vacant seats left by the nurses who returned to their home states,” Mukherjee said. “They were filled by ‘untrained staff’.”
The cancer-care nurse, in her mid-20s, also complained of being “ragged” at her hospital, where she said the untrained nursing staff would often tease, mislead or bully her in an exercise of workplace hostility.
Panchali Ray is an assistant professor of anthropology and gender studies at Krea University, Andhra Pradesh. “Nursing care is both feminine and caste-based labour and is not considered ‘respectable’ work,” she told The Wire Science. “Despite the pandemic bringing home that without such care work life can’t be sustained, we continue to subscribe to and valourise techno-curative models of healing.”
She added that the root of this problem was the “societal contempt for corporeal and affective labour” that is performed by women and of members of the so-called ‘lower caste’ groups, while the scientific and technical jobs assigned to men are glorified.
According to Mukherjee, “hospital authorities didn’t disclose the information of nursing personnel who tested positive, in order to continue to extract their labour. In reality, in most cases, not doctors but only nurses entered” hospitals dedicated to COVID-19 patients.
“Sister-tutors were also deputed to COVID-19 duty,” per another nurse in the state’s employ, who didn’t wish to be named. “Right from the hospital authorities to patient parties, nurses were often soft targets,” she added.
Gendered labour and societal stigma
“I am questioned about my choice of profession, about the late nights and overnight shifts,” Dey said. “Often, neighbours talk loosely about my ‘immoral’ lifestyle.”
A profession where women outnumber men also, unsurprisingly, exposes society’s entrenched patriarchy, misogyny and stigma. The healthcare system itself echoes the dominant ‘upper caste’ and male-centric view of female labour.
Mukherjee recalled one anecdote: At a hospital in a district roughly three hours from Kolkata, a male authority figure publicly berated a nurse on COVID-19 duty, shouting at her, “Choriye aapnar gaal lal kore deoya uchit!” That’s Bengali for ‘you should be slapped on your cheek’.
Her fault? When the nursing super had called her to note down the daily vitals of a patient, she had said that that’s not part of her assignment because the sister-in-charge had divided their duties and allocated patients among the staff nurses. The male administrative staff member was in his early 30s and the nurse in her early 40s.
“Does this warrant this kind of language?” Mukherjee asked.
India’s nurse-to-patient ratio is an important part of the problem. There are only two paediatric surgery departments – one at NRS and the other at SSKM – in the government sector in West Bengal, Saha, who works at NRS, said.
In NRS, according to her, the wards are often overcrowded to such an extent that there are twice as many patients as beds. As a result, three nurses together handle the needs of almost 150 patients in each shift. “It is impossible to maintain due cleanliness and even administer proper treatment in such a setting,” Saha said.
The same settings also leave nurses vulnerable to harsh treatment at the hands of the administration as well as care-seekers.
Paradox of nationalism
“Historically, the Bengali middle-class has held manual labour in contempt, mostly provided by lower-caste men and women. The whole concept of the bhadralok is premised on caste and class norms of refinement that distances itself from physical labour,” Ray explained.
When West Bengal professionalised nursing, she continued, there was a schism: ‘upper caste’ women who had trained to become nurses wished to be identified as “medical workers”, with their labour focused in supervisory and administrative roles.
“This left the feminised labour of bedside care to Dalit women, who worked long hours and in precarity,” Ray continued. “This division was justified by the disposition of women belonging to the bhadra/chotolok samaj, which was further derived from caste and class norms.”
The gesture of the armed forces – to fly fighter jets, shower flower petals from the sky and have military bands perform outside state hospitals – or the Indian government hailing doctors and nurses as “corona warriors” constituted good optics of nationalism. But in the gendered confines of nursing labour, these actions and utterances run the risk of appropriating women’s taken-for-granted unpaid domestic labour as idealised feminine labour that women, in their self-sacrificial role of the nurturer, must provide to the nation state.
The discourse of labour itself, dressed up in narratives of war-like duty and as acts of model citizenship, erases narratives of agency, rights and resistance.
“Outside, there was increasing community vigilantism against us,” the unnamed cancer-care nurse said. “We had become oshprysho” – Bengali for ‘untouchables’.
“It was ironic that when 2020 was on one hand declared the ‘Year of the Nurse and the Midwife’, nurses were practically scrambling to get beds for their own family members during the pandemic on the other,” Manju Chhugani, dean at the School of Nursing Sciences and Allied Health, Jamia Hamdard, New Delhi, said.
She recalled how one nurse would be assigned one patient ‘from admission to graveyard’, foisting on them the responsibilities of administering care, providing grief-counselling and even “packing” the bodies of patients who had succumbed to COVID-19.
“It is critical for nursing communities to include stakeholders from all sectors during conferences and seminars, as only cross-sectional involvement can bring in long-term interventions,” Chugani said. “It’s high time that directorates at the national and the state levels prioritise nursing reforms.”
“What use is the ‘corona warrior’ printed certificate to me?” Saha asked, referring to the reward for serving on duty under the National Disaster Management Act 2005. “In the absence of economic and healthcare benefits, it is a mere label.”
Smritikana Mani, the officer on special duty (nursing) at the Department of Health and Family Welfare, West Bengal, declined comment.
This story is part of the UNFPA Laadli Media Fellowship 2022.
Sanhati Banerjee is a Kolkata-based independent journalist with special interests in gender, health and popular culture. She is a winner of the Laadli Media Awards for Gender Sensitivity 2021.