22.04.2020

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

Female doctors and nurses carry a double burden during the COVID-19 crisis. Unions in Nepal are coming forward demanding urgent action to safeguard their physical, psychological and economic well-being.

Photo: Public Health Unit of Budhanilkantha Municipality, Nepal (c) Upama Dahal Pokhrel

There are 34.000 doctors and 100.000 nurses registered in Nepal. Many more are working as support staff like cleaners in the Nepalese health care sector. FES Nepal reached out to trade union partners working with health care workers to get a glimpse of their situation.

 

The double burden is taking its toll

According to Pratima Bhatta, Organizer and Treasurer at the Union of Private Hospitals and Healthcare Workers in Nepal (UNIPHIN), more than 75% of care, paid and unpaid, is done by women. Women are on the frontlines 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 March 19. This especially affects female health care workers, who bear most of the responsibility for childcare and household work in their families. In times of lockdown, where everyone not working in an essential service must stay home, many women juggle care responsibilities with paid work in their home office. Workers in the health care sector do not have this option. They also fear getting infected and putting their family and friends in danger through the possible exposure to COVID-19.

Health care workers, cleaners and others working in hospitals face multiple health risks, but also discrimination and social stigma. This is illustrated by a recent case of a nurse that got evicted by her landlord. A female hospital cleaner from Banke District, Province No. 5 in the far-western part of Nepal, finds 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 cloths 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?

Like in many other places, there is a lack of protective personal equipment, especially outside of Kathmandu valley. Despite the difficult working conditions, healthcare professionals work tirelessly to protect the country from the threat, according to Prithivi Raman Thapaliya, President of UNIPHIN.

The union has circulated information about precautions to prevent COVID-19 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 the duty, as the mostly female nurses have dual duties and with the imposition of the lockdown they are under a lot of stress since 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 the staff.

The management of the hospitals has agreed to the union’s demands. The government also provided insurance with a coverage of NPR 2,500,000.00 (about USD 20.500) for each health worker. But since there is a shortage of PPE in the country, especially 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 most challenging topographies, the government of Nepal mobilized around fifty thousand female health volunteers to reach out to the community and village level. The health volunteer system exists since the 1980s and plays a crucial role in providing 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 get engaged in the fight against COVID-19. But there is skepticism, 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, not only in Nepal.

 

 

Jonathan Menge is the Director of the FES Office in Nepal and coordinates the work on gender justice in Asia.


Samira Paudel is a Project Coordinator at FES Nepal.

The views expressed in this blog series are not necessarily those of FES.

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