Heath workers and technicians work before Tamil Nadu chief minister Palanisamy’s visit to a COVID-19 care centre in Chennai, July 7, 2020. Photo: PTI/R Senthil Kumar.
Chennai: South India has generally had a better reputation when it comes to healthcare relative to the rest of the country. However, as India’s COVID-19 epidemic continues unabated, their fortunes seemed to rise at first before falling. Today, all state governments in this region are on the back foot, due to demands for better working conditions and job security from healthcare workers.
India’s first COVID-19 positive case was reported from Thrissur in Kerala on January 30. A month and a half later, Prime Minister Narendra Modi hailed the contribution of frontline healthcare workers in fighting the virus’s spread. The country will always cherish their contribution, he said. Another five months later, the ground reality is vastly different. Many demands of frontline workers across South India remain unfulfilled even as they go about work without rest even as the pandemic rages on.
The Indian Medical Association (IMA) recently said nearly 200 doctors have died in the lockdown due to COVID-19. Of them, 43 are from Tamil Nadu. The announcement led to a political controversy in the state and health minister C. Vijayabaskar dismissed the numbers as baseless. He also warned of action against those spreading “false numbers”. On August 14, IMA’s Tamil Nadu state branch said in a press release that 32 doctors from the state had died due to COVID-19 and 15 more who had died had the corresponding symptoms but tested negative.
Doctors and healthcare workers themselves have been upset with the government’s response to the pandemic. Tamil Nadu service doctors and postgraduates association state office-bearer Dr S. Perumal Pillai said many of their demands remain unmet. “The doctors have undertaken state-wide strike on several occasions demanding pay on par with their qualification and experience,” he told The Wire Science. “The health minister promised to look into it but nothing has happened until now. The Chief Minister went to the extent of saying the state would take care of doctors with motherly love. But 118 doctors were transferred to places 400 or 500 km away as punishment postings.”
It would be another seven months before these transfer orders were rescinded, after an order to that effect from the Madras high court. “The health minister is proud in every press conference about our standards, about how Tamil Nadu is the best in healthcare,” Dr Pillai continued. “Over 18,000 doctors in government services are working [on the] frontline. The government announced double salaries but not an extra paisa has been played until now.”
According to sources familiar with the matter, more than 200 non-service postgraduates have been posted in Chennai for COVID-19 duty on a contract basis for three months. Their positions haven’t been regularised yet. “Our salary dues have also not been settled. More than 900 contractual staff nurses are working in this pandemic but many have not received three months’ salary,” one of them said. “The government should post us in regular jobs”
The state of affairs seems similarly dismal in Karnataka. The state has experienced at least three incidents of violence against doctors, and the medical community has been furious. A senior doctor in government service recalled the case of “Dr Manjunath, who was working in the Karnataka health department. [He] fell ill in June – he was not able to breathe. Three private hospitals refused to admit him. After some protests, he was admitted in a hospital, but unfortunately, he died on July 23. Attacks on doctors are really scary and makes us worry. We work round the clock to protect the people but in return, the mobs have been attacking doctors.”
At the time of writing, Bengaluru’s as well as Karnataka’s daily case and death numbers were surging, compounded by a shortage of drugs as well as healthcare workers. Doctors recruited after the pandemic began on fixed-term contracts were becoming more adamant in their demands for more pay, timely pay and permanent positions, joined on the first two counts by ASHA and anganwadi workers as well. They have also complained of inadequate and low-quality N-95 masks, surgical gloves, PPE and proper quarantine and treatment facilities earmarked for doctors. But while the state health minister has promised solutions, doctors said they’re not materialising quickly enough, and their patience is wearing thin.
Meanwhile, the Andhra Pradesh Junior Doctors’ Association has decided to boycott duties if the state government refuses to respond to their demands. Around 8,000 junior doctors are working in Andhra Pradesh, so a boycott could precipitate a healthcare crisis. The fact that many doctors have tested positive also adds to the problem.
Their principal demand is higher stipend and more incentives to work. According to some doctors who spoke to this correspondent, the government hasn’t disbursed stipends since January 2020. Together with subpar PPE gear and N-95 masks, they said they are only becoming more and more demoralised. “We get the least … salary compared to doctors in our neighbouring states,” one doctor said on condition of anonymity. “Many doctors working on the frontline have tested positive and some parents of doctors have succumbed to COVID-19 as well.”
Doctors in Telangana said they have often had to spend 30 hours in one go in hospitals, donning low-quality PPE gear that makes working for many hours together agonising and, at the end of the day, doesn’t fully protect them either. “This leads to many family members of medical workers testing positive for the coronavirus” a woman doctor said. Sometimes, doctors are allegedly forced to pay for their own quarantine facilities. “Since our stipends are also not paid on time, we have to take loans to pay rent for quarantine facilities,” she added.
At the Osmania Hospital in Hyderabad, 60 interns have tested positive for COVID-19 thus far, plus 220 doctors at the hospital’s various branches and facilities. A part of the problem is that the (main) hospital’s isolation ward lies in an old building: “We have [often] requested the government to reconstruct or repair the building,” the doctor said. “The Government is not even providing proper food for doctors on COVID-19 duty,” said Dr Ranjani, Telangana secretary of Indian Doctors for Peace and Development. “And when doctors are in the COVID-19 ward, they don’t have [well-separated] rooms in which to eat food and use the toilet.”
Then there’s the security issue. Both in Andhra Pradesh and Telangana, doctors working in private and government hospitals have been attacked several times. “If more than five [relatives] turn up for a patient and if we confront them, we are assaulted. The government should assure our safety,” the woman doctor said.
In such situations, doctors said, not being paid for their work is utterly dispiriting – a situation they said is also playing out in some corporate hospitals. Some also complained about many unqualified doctors, practising in Telangana in particular, because they enjoyed the patronage of local politicians.
Kerala has been doing slightly better than the other big states of South India in terms of controlling its COVID-19 epidemic and following protocol. However, doctors have been complaining of underpayment here as well. “Over 1,000 doctors were appointed exclusively for COVID-19 care. … The government promised to give us Rs 42,000 per month but so far we haven’t received our salaries,” Dr Ousam Hussain, president of the Kerala Junior Doctors’ Association, said. “We still have no clarity about our designation and duty. The government has not paid incentives or allowance to doctors working in highly risky environments” either.
In press conference after press conference, ministers from the Centre and states have been praising the work of these workers, but few of the latter are content with how they are being treated.
S. Jeeva Bharathi is a journalist in Chennai.