Kerala nurses wage war against abysmal pay and government apathy; launch indefinite strike

From New York to London and from Tripoli to Mosul, Indian nurses have toiled hard under all circumstances. Such is their value at the international scene that forty-six of them could walk out unharmed from the Islamic State stronghold of Mosul three years ago. But, in ‘God’s own country’ they are now making a pitched battle to gain a respectable level of subsistence.

Thanks to the adamant attitude of 1,280 private hospitals that dot the nook and corner of the state with their never ending quench for profit, these nurses, both men and women, are the worst paid workers of Kerala.

Their minimum salary is so low that it would embarrass them to compare it with even a daily wage labourer doing mason work in the state. While immigrant labourers from West Bengal or Bihar earn anywhere between Rs 700 to 900 a day, the nurses in their own backyard get as low as Rs 300 to 400.

While the labourer winds up his work in nine hours, the nurse’s job seldom has a deadline and would depend more on the medical emergencies at hand. Compare this to the Rs 27,000 a nurse earns every month at the entry level in the government sector and the volume of the injustice hits you hard.

All this happens in spite of a Supreme Court appointed special committee’s directions in 2016 to all state governments to ensure that private hospitals with more than 50 beds pay a basic salary that is commensurate with what a nurse gets in the government sector. A whopping 95 percent of the private sector keeps violating this Supreme Court order at will and the government has been looking the other way.

“We have no option now. Even if we starve to death we have decided that we will fight this to the end because we cannot survive on this meagre salary in today’s world. In the next few days, 80,000 of us are going to march to the government secretariat in protest and nurses across private hospitals will start boycotting work soon,’’ Jasminsha, president of United Nurses Association (UNA) told Firstpost.

At a time when the state is reeling under a fever endemic , this is one trouble the government can do without. Though the latest round of talks with the nurses and the association of the hospitals’ managements have failed, the state has asked the nurses to hold their horses until the end of July to find a solution.

The nurses meanwhile are continuing with their agitation but without affecting Out Patient and other duties across hospitals. An indefinite dharna has already started in front of the government secretariat.

Gross injustice against ‘white angels’?

The may be called ‘angels in white’ but in God’s own country, their treatment does not befit the name. Take the case of 23-year-old Reshma PB (name changed), a staff nurse at Kerala Institute of Medical Sciences (KIMS) – one of the premier multi-specialty hospitals in Thiruvananthapuram. She is the only breadwinner at her home of four people. Her father had undergone two cardiac operations and her younger brother is still in school. With her meagre earnings of Rs 6,000, which she gets in hand after all the deductions per month, Reshma has been struggling to make ends meet.

“The outside world knows this (KIMS) as the best paying hospital. But only we know the condition. They have made it compulsory for us to stay in their hostel for which again we need to pay the fees. How will I ever pay off my student loan? I want to support my ailing father but with this salary, how can I ever?’’ asks Reshma.

Sujatha P (name changed) has fifteen years of experience as a nurse at the Baby Memorial Hospital (BMH) in Thrissur. Her husband has returned from the Gulf due to ill health and today she is left to take care of a family of six that has two children studying in high school and ailing parents. Even after all these years of service, her salary still languishes at a dismal Rs 9,000 a month after deductions.

“I have colleagues here who earn as low as a few thousand at the same time those who earn my salary in spite of being six years junior to me. There is no proper system for all this. While these hospitals earn crores every month in terms of nursing fees from patients, when it comes to giving us a respectable pay, they turn their heads away,’’ says Sujatha.

Sujatha was among the pioneers who sat on hunger strike as early as 2012 to demand better pay. “At that time, none of us knew what kind of salary that we had a right to. Most of us were desperate for a job and not many complained. Now we are better organised to deal with the situation,’’ she added.

The need to give the nurses a better pay is perhaps best understood when you look into the kind of work these men and women do. Though they rub shoulder to shoulder with doctors and often are a notch above the doctor when it comes to giving personal care to ailing patients, the pay disparity is huge to even make a comparison of.

“Take the case of those who work in operation theatres. If we have a day shift, we just don’t even know what time we will come out from there. Above this, we will have to rush back for emergency cases. We do it with pride. But it hurts when it comes to treating us as second class employees,’’ added a nurse, working in a private hospital in Kottayam.

‘Second class employees’ is perhaps the norm across this sector because while specialised doctors take huge paychecks well above their eligibility, most of the times done by hospitals in desperation to retain or to poach them from elsewhere, the nurses hardly have a say in what they get.

It was in 2011 that a case was first filed in the Supreme Court of India, asking for better wages for nurses working in private hospitals across the country. The apex court appointed a committee to study the issue and give directions, which took half a decade to come through; when it finally did in January 2016, the Supreme Court asked all state governments to ensure that private hospitals pay the nurses salary at par with the government nurses.

But apart from a few hospitals, not many have taken any concrete step towards achieving this and the Kerala government – be it the LDF or the UDF – has hardly moved a finger on this issue.

In spite of appointing a minimum wages committee in the state to look into the issue, the stalemate continues.

What the hospitals say

The private hospitals in the state are saying that it would be near impossible for them to give in to the demands of the nurses. The Kerala Private Hospitals Association (KPHA), that is at the moment talking to the nurses with the government as moderator, said the steep cost of running the health care sector is what is forcing them not to increase the wages for the nurses.

“See, a huge chunk of our members have below-50 bed hospitals, which means they do not churn out that kind of a profit to give a hike of more than 30-35 percent to the nurses. But their demand is way over this which cannot be justified at any cost,’’ advocate Hussain Koya Thangal, general secretary KPHA told Firstpost.

Thangal goes on to add that the recommendation of the apex court-appointed committee has no relevance in Kerala’s case since the health sector is a state subject and that they have been able to get a stay order from the Kerala High Court on this matter.

He goes on to say that it would be wise to leave it to the state government to issue a notification in this regard and then see whether it would be possible for either party to go with it.

But not many agree with what Thangal says. This is primarily because of the double standards the hospitals show when it comes to paying the doctors and the nurses.

“If their excuse is that hospitals cannot afford the cost of hiking the nurses’ salary then that is just a lame excuse. How are they able to pay such hefty salaries to the doctors? They very conveniently forget the fact that most of the time it is not the doctor but the nurse who puts in extra hours to look after the patients. Why should they be discriminated like this?’’ asks CR Neelakandan, a civil rights activist who has now sworn his support to the nurses’ strike.

The KPHA meanwhile is trying all it can to break the strike. It has even blamed the nurses for the timing of the strike as the state is in the grips of a terrible endemic, which is getting worse with the monsoon.

But the nurses association clears the air. “We have not boycotted duty yet and will not do it when there is a health emergency going on in the state. All the nurses who are striking are doing it after their shift is over. So in fact, we are losing rest and sleep. But then when the times are desperate we have to take such steps,’’ added Sibi Mukesh, Thiruvananthapuram district secretary of UNA.

Playing into the hospitals’ hands?

Many experts who have worked with the nursing sector say most of the blame for these shoddy affairs of things lies in the sudden drop in demand for nurses abroad.

Professor Roy K George is the state president of the Trained Nurses Association of India (TNAI), which had been at the forefront of the fight to get higher pay for nurses. Roy says that initially, nurses who were just out of training were happy to get a certificate of experience from any private hospital and use it to go abroad to get a decent paying job.

“We have ourselves to blame for letting these hospitals exploit us. For experience certificates, many were even ready to work without pay for a few months. But then things changed at the international scene and the demand for nurses dropped in the last few years and many even returned. But the hospital managements here were only too happy to continue exploiting them. The resistance is coming through now but initially who gave them the stick to beat you?’’ asks George.

The Labour Commissioner has meanwhile urged the nurses to wait till a final round of talks along with the state government on 20 July, a time frame which the nurses feel is too far away for their liking.

Though the nurses have not initiated a pan-Kerala strike, which is likely in the coming days, district wise agitations and strikes have already started at many hospitals. All eyes would now be on the state government, which is expected to resort to a notification as the final resort if the talks collapse altogether.