WHAT HEALTH WORKERS WANT US TO KNOW

The World Health Organization (WHO) said recently that the pandemic ‘has demonstrated the consequences of chronic under-investment in public health.’ In some countries, poor infrastructure and inadequate equipment meant health systems were overwhelmed even before the pandemic

For months now, health workers have been doing their jobs in exceptionally difficult conditions. And despite the fact that COVID-19 infection rates are rising in many parts of the world, the sacrifices made by health workers are no longer in the headlines. Many of us are exhausted by news of the pandemic, and public displays of solidarity have dwindled as restrictions drag on. 

But as the race for a vaccine gathers pace, it’s more important than ever to hear the stories of health workers. COVID-19 has exposed and exacerbated longstanding weaknesses in some health care systems, and there are many lessons to be learned from this pandemic. The insights of health workers must be listened to and their concerns addressed; this will be crucial for better protecting human rights and lives in the future. 

With this in mind, Amnesty asked health workers in 12 countries to share their experiences of the pandemic so far. 

We spoke to people in  Eswatini, Finland, France, Kyrgyzstan, Greece, Indonesia, Italy, Madagascar, Pakistan, Papua New Guinea. South Africa and the UK.

Here are some of the things we learned: 

COVID-19 has exposed a lack of basic infrastructure

The World Health Organization (WHO) said recently that the pandemic ‘has demonstrated the consequences of chronic under-investment in public health.’ In some countries, poor infrastructure and inadequate equipment meant health systems were overwhelmed even before the pandemic.  

Anara*, a neurologist at a hospital in Kyrgyzstan, worked on a COVID-19 ward for a month between August and September. She told Amnesty that the conditions ‘made [her] want to cry’. 

“There was not always enough light – the switches would break, and the surgeons would mend them. Sometimes the plumbing broke down too, and there were only two plumbers for the whole hospital. Once a window smashed in the wind – we had to fix it ourselves even though we were afraid of tearing our [surgical] gloves. We also did not have specialized intensive care beds, and we often had to put patients on the floor to carry out resuscitation. 

Rado* is a stretcher bearer at a hospital in Madagascar. Since the start of the pandemic he has also been working in the hospital’s makeshift morgue, preparing bodies for burial. He said: 

“A lot of things make me anxious – first of all, the equipment wasn’t sufficient. There was no proper morgue here – we had to empty a storage building to put bodies in. Think about that. I trained at a hospital that had proper equipment for handling bodies, but here we just make do with what we have. I want to emphasize this point to the government: all hospitals should have a morgue. There are other problems too – if you walk around you’ll see missing tiles, the hospital is in ruins.” 

Misinformation can cause stigma and hostility  

David* is a doctor in Papua New Guinea. Amnesty has previously documented how Papua New Guinea’s emergency laws state that only the Police Commissioner and the Prime Minister can release information on COVID-19.  

David described how misinformation has contributed towards hostility aimed at health workers: 

“At the start there was the misconception that COVID-19 was like the plague. Back in March, hospital staff were turning away patients because they were afraid - now health professionals are using PPE and people understand better.  

“I know of a nurse who became positive and her family kicked her out of the house. Then people didn’t believe she was negative when she recovered. They thought it was like HIV, something she would always have. There is also a small minority that has concluded the pandemic is a hoax. Combatting misinformation in mainstream media is a challenge we need to address.  

“There is also a stigma on testing - I’ve spoken to two pilots who said they would not get tested even if they had symptoms in case they lose their jobs. The fear, especially in rural areas, is of losing a job and income.” 

Hira* is a police officer in Pakistan, where Amnesty has recorded several instances of violence against health workers. Hira said:  

“We had to provide security to hospitals being routinely attacked by frustrated family members of people who had succumbed to COVID-19. Hospitals were not releasing the bodies as part of the protocol to help curb the spread, and that meant that they had to be guarded. We would be stationed next to suspected COVID-19 patients - it was very sensitive. 

“We also had to be stationed at entry and exit points for the targeted lockdowns, in areas where no one could go in or out. We put up cloth barriers, but to really enforce the lockdown, we had to be there. The public did not react well to this. People get agitated. Dealing with that, while worrying about the exposure was a lot. We would be working for 24 hours with barely any shift changes, and a lot of us got sick.” 

To counter stigma against health and essential workers, states should disseminate accurate and evidence-based information about COVID-19, including how it spreads and how it can be prevented. They should also publicly state their support for health workers. 

Health workers feel some lives are valued more than others  

Several health workers told Amnesty that they felt decisions about who to prioritize for PPE had left them unprotected.  

Tshepo*is a radiographer at a hospital in South Africa. She said: 

“Certain professions were given priority for proper protection. Early in the pandemic hospital departments were categorized as either low or high risk. Our department (X-Rays) was classified as low risk, even though we are in contact with COVID-19 patients. This meant we were issued with just one surgical mask, one visor and one plastic apron per shift. I contracted COVID-19 in March. 

“We have protection now but it’s demoralising to think we were not protected from the outset, especially as my body has still not healed. The virus has affected my breathing and sinuses, and I am fatigued.” 

Hanitra* is a hospital quartermaster in Madagascar. She said: 

“At the beginning, only the doctors received PPE. They got all the new suits, then we washed and reused them. That mentality - it was degrading. We complained, but for a long time we were ignored.”  

Robert* is a pharmaceutical technician at a hospital in Indonesia. He said: 

“Some policies don't make sense. Previously, pharmacists were classified as medical support personnel, but then we were reduced to non-medical personnel. We feel disrespected.   

We also studied, we also work hard, and we have specific expertise. Patients need to know how to take their medicine and doctors don't really understand that. And we are also in contact with COVID-19 patients - there are quite a few people in the pharmacy department who contracted the virus.” 

There are many reasons why workers across the world have been finding it hard to access PPE, not least the fact that there is a genuine global shortage. The WHO has published guidelines on PPE distribution - standards of protection for workers at equivalent levels of risk should be the same. 

Health workers are paying the price for policy failures  

Rhea* is a doctor at a hospital in a Greek island. Greece is one of several countries where Amnesty has documented the detrimental impact of austerity measures on health services.  

Rhea said: 

“There has been no support to the national health system and its staff for many years. [Our island] has a very particular set of challenges. It is hours away from the mainland and [we also provide services for] thousands of refugees who rely on the national health system. Provincial hospitals face difficulties attracting doctors. Vacancies have been announced at times, but the salaries are so low that there is no incentive for anyone to work here. 

“As health workers we know the needs of the places we work in. There was no planning or the infrastructure in terms of space or additional staff in any of Greece’s hospitals to enable the integration of COVID-19 patients. As a result, our already tired staff has been burdened much more. 

Like many workers, Rhea stressed her dedication to the job. 

“The conditions are very bad, but I do not begrudge it. I am tired and there are times when I am angry about how successive governments have treated us. But I am always happy to go to work.” 

Social care workers in Europe are angry

Of the dozens of health workers we spoke to, social care workers were among the most angry and exhausted.  

Annalisa* works in a residential care home in Italy. The WHO has said that “European Region, long-term care has often been notoriously neglected”, and called the high death toll in long-term care facilities an ‘unimaginable human tragedy.’

Annalisa said: 

“We were never called for a meeting or consulted in any way by our management. We never received precise instructions. During the peak almost all my colleagues got sick and about half the patients died. I had never seen so many deaths in my life – it was waves of 2-3 per day. I felt so helpless and angry. In our region, facilities for older people were acting as a barrier to prevent the health system from totally collapsing. 

“We asked for swabs in early March but didn't receive any until late May. If people had been tested and asked to stay home until the results came, it might have saved everyone else.  

“I continue to be very concerned about the current situation and the future. The guests we receive now are even more fragile[…] I wouldn't be able to face all those deaths a second time.

Laly* is a home care worker in France. She said: 

“We don't have goods in front of us, we have human beings. That means we should be a public service, like the public hospital, and be supported by the health sector. During the peak [of the pandemic], some of my colleagues went to pharmacies to ask for masks and were turned away because they weren't on the caregiver list. 

“I think there is a lack of understanding in our government about the emotional support aspect of our work. During lockdown we had to play the role of psychologist, assistant and family. Our jobs are about supporting a person from the moment they get up until they go to bed - sometimes we work 24 hours a day. Yet many people have precarious contracts and are paid below the minimum wage. The government really underestimates our anger.  

Low pay is demoralising 

Lovasoa* is an ambulance driver in Madagascar. He said: 

“Remuneration in health institutions is very, very low. It doesn’t fit our needs - it’s hard for people to send their children to school, for example. There is a lot of corruption in Madagascar and I think that’s partly due to the low salaries in some sectors. If people can pay their rent, electricity, school fees, I think Madagascar would be able to move away from corruption.” 

Sarah* works in a residential care home in the UK. Care homes have been hit hard over the years by UK government austerity measures, and cuts have continued even recently.  

Sarah said: 

“During the pandemic, many agencies came in to support at the nursing home. The bosses could see the difference [in quality of care.] I don’t want to say the agencies are bad – it’s just that permanent staff know the routine of each resident. The agency staff get paid more, sometimes they pay the agency double what they pay us. That is not fair.  

"I feel really sad because some of my colleagues don’t think they deserve better pay or conditions. Some people said this was not the time to ask about pay rises, but when is the time? We are an extension of the NHS (National Health Service) and we want to be treated like NHS staff - with a living wage and decent conditions.” 

There have been some positives  

Ntombezulu* is a community care worker in Eswatini. She said: 

“I am not afraid because I received training. I attended a workshop where I received training on social distance protocols, how to wear the mask properly, wash hands properly, and socially distance. This has helped me not contract the virus even though I have been in direct contact with two infected people.” 

Tiina* is a nurse in Finland. She said: 

“The good thing about the pandemic is that now everyone takes much better care of hygiene in our unit. This will protect our patients from other infections as well as COVID-19. 

Tiina added: 

“My employer gave us a bonus for our work during the epidemic, but not everyone in Finland has received a COVID-19 bonus. Pretty much everyone in Finland thinks that nurses are underpaid, but other priorities always get in the way.” 

Laly in France said: 

“The positive side would be that this strengthened our bond with our patients. Sometimes we were their only point of contact and it changed their outlook on who we were. We had thanks from the families - on that side, it was enriching and positive.” 

Anara in Kyrgyzstan said: 

“A group of young people came and gave a concert for us – I am grateful for their courage. Also people agreed to help us for free - for example lawyers advised us how to stand up for our rights, without charging fees we cannot afford.” 

Rado in Madagascar said:  

“I learned new skills doing a job I hadn’t done before. I also met people I wouldn’t have expected to before - senators, members of parliament, high ranking officials. I had a lot of exchanges with them because I was the one taking care of the bodies of their family members.”  

Health workers are the backbone of health systems They have rightly been lauded as heroes of the COVID-19 pandemic, but we cannot allow governments to rely on their sacrifices. First and foremost, they are individuals with human rights – listening to their views and protecting their wellbeing is essential both for them, and for us. They have the right to safe workplaces, decent working conditions, and the freedom to speak out and carry out their work.  

As COVID-19 immunizations start to become a reality, every health worker who puts themselves at risk for us must be given adequate protection and access to vaccines, wherever in the world they may be. In this sense, it is crucial for all governments to protect health workers as they roll out vaccine plans and recognize the definition of “health worker” as everyone working in the health sector and involved in the delivery of health care in any capacity.  

*All names have been changed to protect identities