Why are Healthcare Workers in Lahore on Hunger Strike?
Lack of testing and PPE has left healthcare workers at the mercy of COVID-19, while the government moves only to criminalize their protests.
Police clash with doctors protesting the lack of protective equipment made available to them by the government. Photo: Twitter
The virus threatens to kill us and the government’s ineffective response to the pandemic is making matters worse — we are on hunger strike for safer working conditions.
Dr. Salman Haseeb Chaudhary, the president of Young Doctors Association (YDA) Punjab is among several frontline healthcare workers protesting unsafe conditions for workers fighting COVID-19 across the province. YDA, with sister groups across the country, has emerged as the voice of young early career doctors. But their concerns on the mismanagement of the COVID-19 crisis are going unheard.
Public sector hospitals in Pakistan serve the majority of the population but remain short-staffed and ill-equipped. The workers that drive the wheels of a broken and outdated system do so with sheer grit and, for the most part, a lack of choice. This is especially true of the lowest paid and least regarded — the cleaners, paramedics, nurses, and ‘junior’ doctors. The staff is overworked, underpaid and highly vulnerable to COVID-19.
For a government that touts itself as pro-people, the reasonable expectation is the rapid formulation of effective policies with input from frontline staff. Given the lack of resources, slowing the pandemic is our only hope. While the cost of preventative measures is high, this is no doubt cheaper than the human and financial toll of the pandemic in the absence of effective prevention strategies.
However, the lack of concerted action has been alarming. Prime Minister Imran Khan’s ambivalent messaging, ongoing religious gatherings, and inconsistent lockdown policies across the country have been a clear failure of consensus and leadership. In addition, the ambitious state-sponsored relief efforts face serious operational challenges. It is unclear how they will reach the most disadvantaged in the country, many of whom are not officially registered in the national NADRA database. Given these glaring gaps, and the lack of credible pandemic-related data collection, things could easily escalate to disaster proportions.
Lack of PPE is threatening the lives of frontline healthcare workers. Young Doctors Association is on hunger strike to demand safe working conditions. Photo: Aurat March Lahore
The people we must listen to are those fighting at the frontlines: the healthcare workers. In Lahore, the Grand Health Alliance, a representative association of nurses, paramedics, and doctors, is staging a peaceful hunger strike at the Punjab government’s Specialized Healthcare & Medical Education Department, responsible for healthcare policy-making and regulatory functions across Punjab. The hunger strike, which began on April 16, aims to highlight the lack of appropriate personal protective equipment (PPE), quarantine facilities, and testing for all healthcare workers. It is being supported by the Young Pharmacists’ Association of Pakistan, Haqooq-e-Khalq Movement (a grassroots movement for citizens’ rights), and the Barabari Parrty of singer and political activist, Jawad Ahmad.
The YDA has recently been part of multiple bitter standoffs with the government regarding the implementation of the Medical Teaching Institute (MTI) Act, first in Khyber Pakhtunkhwa and now in Punjab. YDA regards the Act as paving the road to privatisation of public sector teaching hospitals, which they contend will further reduce access to healthcare for the poorest population.
Members of the Haqooq-e-Khaq Movement in solidarity with doctors and nurses at the Grand Health Alliance's hunger strike camp in Lahore. Photo: Twitter
“The YDA fears as many as 50% of healthcare workers may be infected with COVID-19”
For Dr. Salman, the hope with the hunger strike is to exert pressure and force the government to come to the table, engage in dialogue, and make necessary changes to protect healthcare workers and patients. It must be clarified that those on hunger strike are a select group of representatives of nurses, paramedics, and doctors from multiple hospitals across the province. The central leadership has directed all healthcare staff to continue serving in their respective positions. “We do not want the public to suffer. This hunger strike is to highlight the situation and hopefully get our demands heard.”
Who is Responsible for Their Deaths?
The YDA fears as many as 50% of healthcare workers may be infected with COVID-19, though it is hard be certain in the absence of testing. “People don’t realize the toll this is taking on us and our families”, lamented Dr. Salman. He gave the example of Dr. Moeen from Rahimyar Khan, who got infected with the novel coronavirus at work. Both his kids and wife are now ill with the virus, while his brother-in-law is in critical condition on a ventilator. A nurse from Jinnah Hospital, Karachi was also infected, with her mother now on a ventilator. “We hope they recover. [But] if they don’t, who will be responsible for their deaths?”.
Unlike other countries, healthcare staff in Pakistan are not being adequately tested for the virus, and are not being provided temporary facilities to live away from their families if they test positive. Instead, those who tested positive have been locked up in dilapidated sections of hospitals under poor sanitation conditions, posing additional risks of cross-infection. This has counter-productively spread fear among healthcare workers, such that they are hesitant to get tested at all.
Fundraise your own PPE
The supply of PPE has been extremely insufficient and of poor quality. The government is refusing to provide emergency rooms with the special N95 masks required to protect against aerosol droplets which can contain the virus, saying these are “not needed”. Current scientific evidence indicates that COVID-19 is a droplet infection, meaning a simple surgical procedure mask (with eye shield, gown, and gloves) provides reasonable protection for most procedures. However, more severe cases require special life-saving medical procedures (e.g. intubation, chest compression) which can aerosolize the virus, making the N95 mask a requirement. These situations are not uncommon in the emergency room, COVID-19 wards, and operating rooms. While the N95 mask may not be needed all the time, it needs to be made available for healthcare workers to provide care while being safe in all such situations.
“At some hospitals, doctors and staff have been forced to pitch their own funds together or collect donations to buy their own equipment.”
Alarmingly, at some hospitals, doctors and staff have been forced to pitch their own funds together or collect donations to buy their own equipment. “We raised around Rs 1.5 million (9,000 USD) worth of PPE in the last few days”, Dr. Salman said. But this is not a sustainable situation and cannot go on indefinitely. “What people don’t realize is that a few patients have the potential to affect a large number of staff. We are right there and without PPE, we get exposed”.
The availability of PPE was not taken seriously by the provincial and federal government from the early days of the pandemic. The results have been disastrous. At Punjab institute of Cardiology, it took only a couple of COVID-19 patients to infect several healthcare workers who had no protective gear. Dr. Salman has also been learning from YDA representatives that the situation is no better in Khyber Pakhtunkhwa, Balochistan, or Sindh. Despite the lack of complete data, numerous reports from China, Italy, the United States and other countries have shown a high burden of COVID-19 infections among healthcare staff, whose only line of defense is adequate PPE.
Disregarded in Wards, Brutalized on Streets
Dr. Salman strongly criticized the way the Pakistan Tehreek-e-Insaaf (PTI) government is treating healthcare workers: “There is a resistance to our demand for testing all healthcare staff, as the government fears a public backlash if true numbers emerge. A nurse who has now passed, died from symptoms highly suspicious of COVID-19. Testing was repeatedly requested and denied, [but] she had all the symptoms and was taken ill while working in the coronavirus ward. We wanted her death to be recognized and acknowledged as Shaheed as she died fighting at the frontline. We were told that…it is not certain she had COVID-19, since she was never tested. We feel that the administration fears they may have to pay compensation if they acknowledge that she died from COVID-19. This is very disheartening for all healthcare staff”.
Adding further insult to injury, the government keeps insisting that it is providing doctors with ‘double pay’. “This is to portray us as greedy and as capitalizing on the situation to demand [more money]. I want to clarify that this is not the case,” said Dr. Salman. “First, only certain designated staff will be getting double pay – 20 doctors, nurses, paramedics at one hospital. That, too, has not yet materialized. [More importantly] We have stated time and again that we do not want double pay — we ask only for a safe working environment for all of us so we can continue to provide service. This kind of [misinformation] is insulting to us when our demands are just.”
Nurses join in support of the YDA strike in Lahore. Photo: Naya Daur
“A nurse who has now passed, died from symptoms highly suspicious of COVID-19. Testing was repeatedly requested and denied...”
Together, these events have further exposed the strong sense of mistrust between healthcare workers and the current powers that be. “We all saw how our colleagues peacefully protesting for PPE and safer working conditions, were violently beaten and arrested earlier this month in Quetta,” Dr. Salman reminded us.
Patient demographics in Pakistan are different from those in Europe. “We have a younger population overall. We don’t have a lot of people over the age of 80. Of the patients we are seeing, those who succumb to the illness range from 40 to 60 years old. We even had a few deaths of people in their 20s and 30s,” said Dr. Salman. However, he also agreed that official figures are likely underestimating the number of cases and deaths.
The problem is multi-tiered. Access to healthcare is a huge issue. While testing is free in government centres, there are not enough testing supplies available. There are many reports of people being turned away and told to return in a couple of days to get tested – they are then lost to follow up. Suspicion of state agencies, and their record of brutalizing impoverished communities, means that ordinary people have also been scared to come forward and get tested for fear of being locked up. In fact, there have been instances of people who have tested positive for COVID-19 running away from health facilities. Given the circumstances, even healthcare workers are afraid of getting tested. There is also a significant lack of awareness of the disease, its rapid transmission and the critical importance of preventative measures, which in itself is a failure of a robust public service and literacy campaign.
Doctors protesting the lack of PPE in hospitals were beaten up and humiliated by police in Quetta. Photo: The Guardian.
Amidst all this, the actions of the Punjab Health Ministry are criminally bizarre. Not only have their mitigating measures fallen short of what is required, they have refused to take the demands of frontline healthcare workers seriously. Instead, they are actively working against the workers — through the threatening and vilifying comments of the Minister of Health, Dr. Yasmin Raashid, and what appears to be a deliberate public smear campaign to malign the very people who are manning the emergencies, wards, and ICUs during the pandemic.
“YDA’s demands include universal testing of healthcare workers, better quarantine facilities, and PPE to allow us to perform our duties.”
The Punjab government hasn’t just stopped at that. The same security apparatus that was made to salute healthcare workers not days ago in a publicity stunt by the government, wreaked violence on the handful of healthcare workers peacefully hunger striking for the last couple of days for their rights to a safe work environment so they can continue to provide care. Videos have emerged of healthcare workers being slapped, shoved, and beaten up. This callous treatment of healthcare staff seems to be the order of the day under the present regime. The images of doctors facing state violence in Quetta just days ago are still fresh.
“We have been sitting here and no one from the government’s side has appeared for a meaningful dialogue with us”. This is shameful evidence that frontline healthcare workers who are not only indispensable but also the best-informed to confront this pandemic, have been excluded from crucial policy and decision-making while being asked to put their lives on the line.
The YDA’s demands include nothing but “universal testing of healthcare workers, better quarantine facilities, and PPE to allow us to perform our duties.” They are working in conditions which threaten their personal safety, itself intimately tied to the safety of their loved ones, their patients and the public at large. This strike action is a fair start to at least a dialogue and eventually, effective action. Pakistan is at best in a partial lockdown, which is already on its way to being relaxed and will likely cause a rise in cases. If health authorities continue on this path and fail to respond effectively to the pandemic, things can only get worse.
Zainab Afroze* is a physician of Pakistani origin who has practiced extensively in Pakistan and is currently working in Canada. She is committed to progressive healthcare reforms, especially pertaining to women’s health and reproductive justice.
*The writer is using a pseudonym.