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Lack of salary, long-shifts, lack of financial security: Junior doctors, nurses’ long time despair reflects amid Covid-19

August 24, 2020

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Lack of salary, long-shifts, lack of financial security: Junior doctors, nurses’ long time despair reflects amid Covid-19

Bengaluru: Amid the COVID-19 pandemic, junior doctors and nurses are having to deal with issues such as delayed or reduced salaries, shortage of PPE kits and lack of proper security measures. Experts say that the administration tends to overlook such issues but the COVID-19 pandemic has shown the plight of healthcare professionals as well. 

In Delhi, more than 350 junior doctors at Kasturba Hospital and Hindu Rao Hospital, which comes under the North Delhi Municipal Corporation (NDMC), have not been paid salaries for the last three months. After not getting the salary, Resident Doctors Association (RDA) of the Hindu Rao Hospital wrote a letter to the Lieutenant Governor of New Delhi. 

In the letter to the Lieutenant Governor’s office, the RDA said they have constantly pushed for regular disbursal of salaries, but no action is being taken. Earlier, the salaries for March and April were credited after the Supreme Court and Delhi high court took cognisance of a threat of mass resignation by doctors, the letter added.

Dr Abhimanyu Sardana, president of the RDA of the Hindu Rao Hospital, told 101Reporters  that for the last three months, over 1,500 people including junior doctors, sanitisation and municipal workers from the NDMC area have not got paid and the reason given to us is the lack of funds, he added.

He said that they haven’t received any reply from the Lieutenant Governor’s office. 

When contacted, the hospital administration department of NDMC directed 101Reporters  to the Press and Information Department,  who didn’t pick up the numerous calls made by the reporter. 101Reporters also tried to reach out to Delhi’s health minister Satyendra Jain, Principal Secretary Vikram Dev Dutt and Secretary Padmini Singla but was told that they were in meetings each time the reporter called.

On July 23, North Delhi Mayor Jai Prakash expressed the civic body’s inability to disburse salaries due to its healthcare workers at once and said the plan was to give it to them roster-wise.

Dr K R Antony, a Kochi-based public health consultant, told 101Reporters that the COVID-19 pandemic revealed many issues that doctors are facing for a long time.

The long-existing problem for doctors is the lack of salary in government hospitals owing to which they join private hospitals and in many cases, the private doctors and junior doctors also don’t get their salaries on time, Dr Antony said. 

Despite working hard, no stipend

In Karnataka, more than 200 postgraduate residents of Jagadguru Jayadeva Murugarajendra Medical College (JJMMC), Davangere, are demanding stipends from the government. The government has said that they should demand it from the college administration, but the protesting doctors say that they serve the government hospital in Davangere, so they should be paid by the government.

The Karnataka government stopped paying stipends to PG (post graduate) residents from private medical colleges in 2018. Dr Nidhi Shetty, a PG resident at JJMMC, said, “We have not been paid for the last 16 months.” “The government was paying a stipend for the last 50 years but now they are not paying even after we take care of the entire 900-bed government hospital of Davangere which has only 32 senior doctors, so it’s the responsibility of the government to pay us,” Dr Nidhi added.  

Dr Bharath Kumar, president of the United Residents and Doctors’ Association, Karnataka, stated that despite working day and night during the COVID-19 pandemic, they aren’t getting paid, forcing them to go on strike. These issues of non-payment of stipend to PG residents of private medical colleges from the last 16 months and not increasing the stipend of government medical colleges for the last five years has been brought to higher authorities multiple times but nothing has happened, he added.

Not only in Karnataka, but junior doctors from all over India are protesting demanding an increase in the stipend. In Pune, the junior doctors of Sassoon Hospital are asking for a hike in their stipend.

Dr Prashant Mundhe, a junior doctor in Sassoon Hospital and Pune Coordinator for Indian Medical Association-Junior Doctors’ Network, Maharashtra Chapter, told 101Reporters  that they are getting Rs 54,000 as stipend for their work, but there is a delay in payment every month. He also said that they are demanding COVID-19 bonuses for working extra hours but the authorities are not listening to them while he claimed that in Mumbai, the stipend has increased from Rs 54,000 to Rs 90,000.

In Madhya Pradesh, a conflict arose between the doctors and the administration of Bundelkhand Medical College Sagar district as about 69 junior doctors and health workers have not been paid for the last three months.

In Uttar Pradesh, the junior doctors from King George Medical University, Lucknow and Lala Lajpat Rai Memorial Medical College, Meerut held a peaceful candlelight march. Their demand was to increase the stipend. They are getting Rs 7,500 per month as a stipend. 

In Jharkhand, nearly 42 junior residents at Patliputra Medical College and Hospital (PMCH), Dhanbad, went on a strike demanding salaries for February. 

Lack of financial security

After treating a 28-year-old resident doctor Joginder Chaudhary of Delhi government’s Baba Saheb Ambedkar (BSA) Hospital at Sir Gangaram Hospital, Delhi, the hospital administration had presented a bill to his father, ThePrint reported.

His father had requested the hospital to waive off his fees but eventually presented him with a bill of around Rs 4.5 lakh. Joginder’s father had initially paid Rs 1 lakh, and around 100 doctors from BSA Hospital’s Resident Doctors’ Association raised around Rs 3 lakh for Chaudhary’s treatment.

Dr Vineet Kumar, president of BSA Hospital’s Resident Doctors’ Association, wrote, “Our appeal for ex-gratia and modification of afore laid policies for the treatment of health care workers has been put forward among the ministries following a channelised route. We hope for a quick and healthy response from the concerned authorities.” 

Dr Pankaj Solanki, former president, Federation of Resident Doctors’ Association, told 101Reporters that they had written to the government that junior and contractual doctors are extended the same benefits that the senior doctors have. If the junior doctors get infected by COVID-19, the treatment should be taken care of by the government, he added.

Dr Antony stated that the doctors are not willing to work because of the lack of security. There were many incidents in the past after which doctors staged protests demanding proper security but that was overlooked by the government and people and now there is lack of Personal Protective Equipment (PPE) kits, masks and other security gears for doctors, he added.

“Doctors are also human beings, not gods. They also have families, they also need security. As many as 104 doctors have died till now owing to COVID-19 and at the time they needed to be saluted, they did not even get the dignified cremation. All these things have discouraged doctors from working and they are resigning,” Dr Antony said.

Senior doctors not working

A video of a doctor, Dr Taha Mateen, from HBS Hospital, Bengaluru, went viral where he said that there are enough ventilators, oxygen cylinders and beds in his hospital but there is a shortage of doctors. He expressed that doctors are not working.

“Patients are continuously calling me because their fathers are breathless, their daughters are breathless, their brothers are breathless, and they cannot find a room in a hospital in Bangalore. And at this time, you see me, there is one Mr Shiva here…and there is no other doctor willing to come and work in this hospital at this time. There are 30 more vacant beds and all equipment, but all the doctors are on WhatsApp, instead of the hospital,” he said in the video.

Dr Mateen also appealed to doctors to work at least six hours per day in a hospital. “Sometimes, the Army is at the frontline, sometimes the police are at the frontline, right now, you and I, my fellow doctors are on the frontline. Let us show that we care for humanity here.”

Sassoon hospital’s Dr Mundhe added that no seniors are working at their hospital and are just supervising them. “It really discourages us that these senior doctors are not taking part in the work with us. Still, those doctors get Rs 2,00,000 a month and we are not even given bonuses.”

JJMMC’s Dr Shetty voiced a similar concern. She said that they are working in the out-patient department, but the senior doctors are not working. 

Vijaykumar Seethappa, a health activist from Karnataka Janarogya Chalauli, told 101Reporters that the senior doctors are not working out of the fear of COVID-19. 

“The doctors are now pure businessmen. They think that if everyone is making a profit in life, why can’t we. In this profit-making, they forget that they need to take care of each and every patient coming to them without thinking to them, which is also the oath they take and their ethics also directs them this. But in the time of COVID-19, these doctors can’t make much profit, so they are not coming out,” he commented. 

Long 18-hour shifts

There is a shortage of doctors in the country owing to which the doctors have to work for 16-18 hours a day, which affects their personal life and sometimes doctors get depressed or discouraged due to this, Dr Antony said. 

The total number of allopathic doctors possessing recognised medical qualifications registered with state medical councils or the Medical Council of India till 2018 were 11,54,686, which translates to one doctor for every 1,126 people, according to the National Health Profile 2019. The World Health Organization (WHO) says that there needs to be one doctor per 1,000 people. To reach WHO’s standard, there is still a need of 1.5 to 2 lakh doctors in the country. 

The number of allopathic doctors employed by government hospitals, as per the NHP, stands at 1,16,757, which implies that there is one government allopathic doctor in every 11,000 people in India. But almost 68% of the people in India have very limited or no access to medicines and can not afford private healthcare, the study said. This makes India’s need for government allopathic doctors more prevalent and if the WHO standard needs to be met, there is still a need of 12 lakh government allopathic doctors in India.

In 17 states, 428 equipment, including ultrasound, x-ray, ECG, cardiac monitors, auto analysers, incinerator, OT equipment, blood storage unit etc costing Rs 30.39 crore were lying idle or unutilised owing to unavailability of doctors and trained manpower to operate the equipment and lack of adequate space for their installation, according to a report by the Comptroller and Auditor General (CAG). 

Shortages of doctors and paramedical staff were also observed in almost all selected facilities by the CAG as well. In selected community healthcare centres of 27 states, the average shortfall of five types of specialists (General Surgeon, General Physician, Obstetrician/Gynaecologist, Paediatrician and Anaesthetist) ranged between 77%-87%, said the CAG report.

Due to the shortage of doctors, we have to work for at least 16 hours a day and we have no time to relax, Dr Prashant said. Dr Bharath Kumar also mentioned about the long shifts they have to undergo and due to which they can not have their own time.

“In the pandemic, when senior doctors are not working and only directing, the work of junior doctors have been increased more than twice. They used to work for eight hours a day and now sometimes, some doctors work for 24 hours as well”, Dr Bharath added.

Dr Sylvia Karpagam, a Bengaluru-based public health expert, stated that before Covid-19 as well, there was a shortage of doctors in India, but after COVID-19 it came out in open.

This shows a big failure on Indian government’s part because our healthcare system “was already on ventilator earlier” as well, but it came out after the COVID-19 pandemic, which showed that there is a lack of doctors, beds and government hospitals in the country, she said.

The government can hire doctors, make hospitals and increase the number of beds but they are not willing to do that because they want to promote private healthcare and are thus, discouraging the public healthcare system, she added. 

Nurses also distressed

In Pune, over 300 nurses of Jehangir Hospital staged a protest demanding better working conditions and pay. They alleged that the hospital is making them work for 12 hours without any break with the same salary and reduction in holidays. 

A nurse Harshida Gosavri, who is working at Jehangir Hospital, stated that they have to work for more than their usual shift hours, so they approached the HR department in the hospital, but the hospital management said that if they aren’t able to work for extended periods of time, resign or face termination. 

She said they have been going through this for the last four months and they were not getting any allowance, the increment has been stopped even though they are working for 12 hours wearing PPE kits. 

As per rules, they are required to work for eight hours, but now they are being made to work for 12 hours in the ICU, while having the same salary, she added. 

Jibin TC, president, United Nurses Association, Maharashtra state chapter, told 101Reporters that it’s inhumane to make the nurses work for extended periods of time and that they have written a letter to the hospital demanding that duty hours should not exceed six hours with PPE and adequate rest should be provided.

He said that they have also demanded a revision in salary, medical insurance and maintaining a nurse-patient ratio.

It is extremely shameful that the doctors and nurses are not being paid and at the time when doctors need to be rewarded, they are protesting for their salaries, safety, security, Dr Antony said. He added that there is a lack of political will behind this because it is not a very big thing to pay the doctors when you can construct Rs 3,000-crore statues and temples, but paying doctors and making a better healthcare system don’t pull votes and politics in India is entirely based on votes.  

Lack of budget allocated to healthcare 

During the pre-COVID-19 phase, numerous studies and experts have raised their voice on the problems that India’s healthcare system is facing. Vijaykumar Seethappa pointed out that the main problem in India’s healthcare system is the lack of budget allocated to healthcare in the Gross Domestic Product (GDP) shows how concerned the government is towards healthcare. “It is only one percent of the entire GDP, it is a shame that we are such a low-spending country that even our neighbours like Sri Lanka, Thailand and Bhutan spend a greater percentage than us in healthcare,” Seethappa added.

India was ranked 145, which was even worse than India’s small neighbouring countries like Bangladesh, Sri Lanka and Bhutan, in a study published in The Lancet. The cost of treatment has been on the rise in India and it has led to inequity in access to health care services, while in 2017-18, India spent only 1.28% of its GDP as public expenditure on health, according to the National Health Profile (NHP) 2019. 

(Source- National Health Profile 2019)

Because of such low spending on healthcare for so long, a good environment for healthcare was not created in India and it caused lack of medical equipment, doctors, public healthcare centres in our country, and it became more visible during the COVID-19 pandemic, added Seethappa. 

Talking about the solution, Dr Antony stated that the solution lies in increasing the budget for healthcare in India. “From a long time we are demanding at least 3% of the GDP should be allocated to healthcare. So if this comes true, the public healthcare services will be changed.”

The security, salary and benefits of the doctors also need to be increased and the government should hire doctors and buy medical equipment, he added.

(Kapil Kajal is the staff correspondent of 101Reporters.com, a network of grassroots reporters)