The number of COVID 19 cases gets higher each week. Thankfully, 50% of the total population now having been vaccinated means less people are falling seriously ill than before. This is in addition to the social distancing, mask-wearing, hand washing and sanitising that most of us do as part of our daily lives now, while battalions of health workers do contact-tracing, do the lab work for PCR tests, are on duty in newly set up COVID testing centres, and do regional mass testing, all of which helps to “flatten the curve”, at the same time.
What Health Minister Jagutpal does not inform us, however, is just how understaffed the health system that is protecting us during this epidemic really is. That would mean he would have to recruit staff immediately. LALIT and unions of nurses have repeatedly called for more nurses and other staff to be recruited. We had been calling for this from even before the epidemic started. In the middle of this coronavirus crisis, the 2021-22 budget has created not a single post for the recruitment of a health worker. Why does the MSM-ML-ex-MMM Government refuse to recruit? Why did Opposition MP’s not take this point up in the National Assembly during budget debates? Most of the media, quick to amplify potential cases of negligence in public healthcare does not take this up in a systematic way. What does this accentuated understaffing mean for public healthcare?
Public Healthcare workers: Work Overload
It means the 8,552* actual doctors, nurses, health care assistants and hospital attendants running the public health and healthcare sector are having to care for all of us during the coronavirus epidemic, even though very seriously understaffed from beforehand. They are the ones who run the additional COVID testing units, do the contact tracing, do the mass testing, run the health aspect of the PCR tests by the thousand, run normal wards converted into isolation wards, run whole quarantine centres (hotels and even the 13 “dormitories” horrendously converted into quarantine centres), run COVID treatment centres, the ENT COVID treatment centre and its ICU, run 17 COVID vaccination centres and mobile units, prepare COVID and other health statistics as well, all this on top of their normal work-load. That is, this same staff runs 13 hospitals, the blood bank, the renal dialysis units, the links with labs, the x-ray centres and other imaging sections, the pharmacies, dental clinics, area health centres and contraception units, mediclinics, community health centres, dispensaries, home visits for the bedridden, the SAMU ambulance service, the occupational health unit, and ensure public health services at the port and airport. The health system is so understaffed that retired doctors nurses have had to be recruited (called “bank doctors” or “bank nurses”), from before the epidemic, to keep public healthcare services ticking over.
Everyone knows that public healthcare staff do a kind of work that is, by its very nature, both physically and emotionally demanding. Everyone also knows that, during the epidemic, they are at risk, being on the frontline and exposed to the highest “viral loads”. They are exposed to the virus themselves, and can potentially spread it to patients and to their loved ones. Health staff are almost all by now fully vaccinated – unless they have serious health issues – and this helps curb the spread through them. Ironically, health workers, who are our greatest allies against the spread of coronavirus, can, if not enough precautions are taken to protect them, become a vector of the spread.
Public Healthcare dangerously depleted of staff
We will now explain the way way in which the public health sector gets even further depleted of health workers. Some health workers need to go into quarantine every time they come into close contact with a patient found COVID-positive in a ward. Patients are given PCR tests on admission but are naturally admitted to the ward for care and treatment pending the PCR test result. If a patient is found to be COVID positive, then the ward is quarantined immediately – no-one allowed in or out until it has become clear who has been in contact with who, thus who might be positive. Health workers who were in contact with the patient in earlier shifts are contacted at home to pack their bags and go into quarantine. If they are found to be positive, they go to a COVID treatment centre. The remaining quarantined health workers found to be negative resume work. The ward is disinfected. The remaining staff do a 24-hour shift, then go to the nearest quarantine centre to stay for the next 24 hour. So they have to get their bags packed and brought to them too. Two teams of 24-hour shift health workers are constituted, so that they alternate for patients to be able continue to get the healthcare they need. This is how a whole ward can get converted into an isolation ward until the danger of contamination is past.
Staff are also at constant risk working at the ENT, itself, or at any other new treatment centre for mild cases, or even at the quarantine centres. Precautions are taken to stop the virus spread: vaccinated staff at the ENT COVID centre, for instance work for 7 days, then are in quarantine for another 7 days, then do self-isolation at home for 7 days. This also means staff are, by force, not able to be at work for twice the number of days that they are usually at work.
How does all this affect a hospital ward, say? A hospital ward has 20-30 patients at any one time. 5-7 nurses and health care assistants are needed to care for patients in each shift. The care is actual physical nursing care for their illness or after an operation, and also human care for all the daily and hourly needs of patients, as individual beings and as social beings. Before the epidemic, because the government was already not recruiting enough nurses, there were only 3-4 nurses in a ward. Right now in many wards, there are only 1-2 nurses looking after patients. Supporting staff (health care assistants and hospital attendants/general workers) are having to chip in to assist in some of the nursing work. Health care assistants and hospital attendants, being more in contact with patients making their beds, helping them eat food, bathing them, washing their plates and mugs if they are not able to, are far more exposed to the virus than perhaps any other health care worker.
All this is the day-to-day reality for health care workers.
Privatisation brings increased work load
In addition, the day-to-day work load of public health worker staff in each ward has increased. For instance, because of privatisation, cleaning contractors send workers to clean hospital toilets and bathrooms. This was already a problem before the epidemic. Contractors are paid for workers taken on by them to clean ward toilets and bathrooms three times a day, and two times at night. Public sector workers have a responsibility to ensure the health of patients in their care. So during the epidemic, when toilets and bathrooms in a ward need constant cleaning every time they are used by patients, it is nurses and attendants who are having to do this work, too. Private companies will do only what they are paid to do, for a profit for the owners of the company.
ENT becomes multifunctional
The ENT has been transformed into an organisational centre, as well as being a treatment centre. There is the ICU unit for COVID patients who are very ill. There are also patients who have co-morbidities, or are elderly, or are pregnant need to be kept under observation. There are also COVID patients who are admitted because they are in need of medical treatment for some other unrelated reason: a broken arm, an abscess, cancer treatment, all the cardiac cases and any other health problem unrelated to COVID. There was even a patient admitted to give birth there, at ENT. Given the particular difficulty of caring for psychiatric patients, a nurse from Brown Sequard psychiatric hospital has to accompany and stay with any in-patient admitted to the COVID treatment centre, or even in quarantine. This, in turn, means more nurses not on normal duty.
The organisational centre at the ENT has to organise for relevant doctors to be on call to treat these patients for their specific medical needs, and to do the follow-up. It is also at the ENT that the roster for all the quarantine centres is organised: each hospital in turn has to prepare a roster. Two doctors, two nurses, 2 nursing assistants and four attendants are needed for each quarantine centre. All over the country, there are hotels acting as quarantine centres, remember.
At the ENT ICU treatment centre, masks are supposed to be changed every 4 hours, but this is often not possible because of the heavy work load. Staff at the ENT need to have had their two vaccines to be able to work there at all. There are cases where a staff-member has only had one vaccine, but has had to work there because there is no other health worker available. This exposes health workers even further. Vaccinated staff at the ENT work for 7 days, are quarantined for 7 days, then stay home in self-isolation for another week. There is provision for only 90 patients, no more.
Staff at the ENT see the results of vaccination: it really makes a difference.
4,000 more police recruits, 0 new health worker recruits
The MSM Finance Minister Padayachy, in his budget speech, announces plenty of measures to re-inforce the repressive state apparatus. On another note, it is to be wondered whether he notices that ex-Police Commissioner Mario Nobin is being prosecuted on corruption charges for “using office for gratification” while Assistant Police Commissioner Hansraj being investigated by ICAC on corruption charges. In his budget speech, he applauded the police force: “In this budget, we will give additional means to the police force, which has been working tirelessly for a safer Mauritius”. He announced, among other measures, the recruitment of 4,000 police officers.
Mr. Padayachy heaped praise on public healthcare workers in his 2021-22 budget speech: “Our healthcare professionals have made a formidable effort in dealing with the pandemic in Mauritius.” He announced an increase of Rs14.5 billion in the public health budget. Yet, in contrast to the police, he did not make provision for recruitment of doctors, nurses, and other much needed health workers. All he said was, “We will continue to provide all the required infrastructure and equipment to protect our healthcare personnel and better respond to the needs of our population.” Who is to run all this infrastructure and equipment? Who is to run the new cancer centre, the new hospital in Flacq, the new eye hospital in Reduit, the new cardiac centre in Cote d'Or, the 15 new area health centres, community health centres and mediclinics he has announced in his budget speech?
Danger of healthcare privatisation
There is just so much public healthcare workers can do when they are overworked routinely, working under-staffed for such long hours. There comes a point when the cracks become visible, and the whole system threatens to crumble if nothing is done. The pro-capitalist Government and capitalist media will quickly use this as a pretext to privatise healthcare. Yet the coronavirus health crisis is showing us that the private health sector is more totally incapable of tiding us over the crisis, than it is of providing good health care at all. The only “contribution” it makes is to vaccinate adults for a Rs 300 fee even though the public sector provides the vaccines free of charge to the clinic.
Yet the Jugnauth-Obeegadoo-Collendavelloo government keeps on subsidising private health. Consecutive governments have tried to impose private health insurance schemes on public sector workers. LALIT and the trade-union movement have opposed this, seeing it as a massive privatisation assault against public healthcare and against free universal healthcare. The last attempt was just before the coronavirus crisis, in 2019.
What must be done
What must be done is to give healthcare workers the means to provide us with a good public healthcare system. This means recruiting additional staff. It means training new staff. It means re-introducing the School of Nursing. This means giving senior experienced doctors and nurses the time to train interns and trainee nurses so that they have the means to care for us. This means stopping the privatisation of public health services – from the cleaning of toilets to the importing of hospital equipment.
LALIT, since the 1970’s, has together with the labour movement a long history of struggling for the development of good free and universal public healthcare, for the employment and training of more public healthcare workers to provide this service, and against privatisation of healthcare services. This struggle must continue. The MSM Government must be constantly criticized for its neglect of hospital workers and other health care staff, and thus also neglect of all of the population that uses these universal, free health services.
This article was prepared by a group of members of LALIT who work in the public health care sector and who are users of public healthcare.
* Health Statistics Report 2019 – Ministry of Health – Health Statistics Unit