Co-Written by Prashastika Sharma and Neeraj K
On March 22nd at 5 pm, India witnessed a spectacular event applauding doctors, frontline workers and other essential service delivery personnel. It was nothing we have witnessed before in the name of unity and gratitude in contemporary India. Noteworthy, it was requested by the Prime Minister. We have been now put under a national lockdown of 21 days to break the chain of transmission of COVID-19. The visually and aurally spectacular event, deeply comic and problematic at many levels, raises many eyebrows about the condition of the public health sector and health workers in a general context. However, in the specific context of a ‘pandemic crisis’, the event leaves us with a more fundamental question: Who all are the health workers and what is their status in India?
The General Question
The chasms in the society throw open for us yet again the basis of resource distribution as not just a rich-poor divide, but a divide based on a brahminical hetero-normative ableist socio-economy structure. Those who are poor, disabled, dalit, queer, transgender persons or womxn are left vulnerable to the structures that they bear every day.
The popular and affective appeal to thank the military, doctors, scientists, bureaucrats, and engineers is not new. We have been told since childhood that they are the ‘nation builders’ and thus most dedicated, loyal contributors to the country, and are more important than those invisibilized workers who offer their shoulders for them to climb upon.
What troubles us the most is the State’s and the society’s indifference toward ‘other’ nation builders, specifically health workers who participate in a more fundamental and constitutive form of wellbeing. Nurses, sanitation workers, domestic workers, farmers, milk people, fisher people, ‘housewives’, mothers (yes, that is full time unpaid job) and community level health workers whose problems go deeper and beyond the lack of infrastructure, regulations and employment to the the casteist and gendered practice of professions and the value that is attached to them for their maintenance .
The reports on access to medical healthcare service highlights how practice of untouchability and caste based prioritisation and negligence is implicated in such access. For example, at all levels, locals have reported caste discrimination, and lack of ambulance and low cost/free medicine services. Thousands of cases of negligence in maternal healthcare in India points to the pathetic treatment meted out to people from Dalit-Bahujan-Adivasi communities in rural and urban India. The rural health care system is horribly deficient in functional Primary Health Centers and Community Health Centers.
The clanging of plates, a mode of protest historically observed across the world was used as a strategic event which was at the cost of protesting and distressed farmers who die due to crop failure, the supply chain market and middlemen-state nexus, non farm activity losses, enormous debts and bankruptcy, illness, depression, decreased support from the governments and, general state of agriculture in the neo liberal economy. More than 10,000 suicides were reported in 2017 in India.
We never see the sanitation workers, waste pickers wearing masks and gloves while sweeping the roads or cleaning the toilets. The manual scavengers die of apathy and criminal negligence of the recomposed, recycled urban caste system which grips them in. How many of us even know that manual scavenging is a criminal offence in India? How many of us care that more than 400 people from marginalised communities have died since 2014 while cleaning sewers and that there have been no convictions against those deaths as most cases are under investigation or pending in courts, as reported here.
The Fundamental Question
The aforesaid discussion compels us to ask, “who is a health worker and what will it mean to stop worshiping doctors alone and also start caring about all other health workers”? It would mean to explicitly acknowledge the “other workers” as “health workers”, to abolish manual scavenging, and to imprison the structural and institutional caste system and those practising it. It would mean that the pharmaceutical-surgical-medical industry will not define and hold monopoly as the only legitimate and ‘valuable’ domain of health. A universal public healthcare system must be pushed which will mean universal food security, and low malnutrition and hunger deaths. India ranks 102 out of 117 countries in the 2019 Global Hunger Index. It would mean recognition of all ASHA workers as full time government employees and not ‘volunteers’ with a respectable salary. Their current salary varies between 2,000-5,000 a month in different states. ASHA workers are at the first line of risk during the pandemic and their concerns can be read here.
It would mean womxn’s household work will be recognised as work which is the building block of production and reproduction process, thus paid and valued to say the least. Womxn’s work as care work in the family system and care work as a professional work in the economy is either never recognised seriously, or is severely underpaid. As a paper by WHO points, 70% of the world’s healthcare and social workers are women, which means they are not only the first responders for mitigating the outbreak, but also front in line for catching the disease.
The 21 days lockdown is not a mere burden on work, but has also put many woman at a higher risk of domestic violence at the hands of their relatives. Several reports across the world point to an increased domestic violence against woman and gender non-confirming people due to the lockdown. This has also left the transgender community in a more impoverished situation, assuming they already were not.
A recent statement released by National Platform for the Rights of the Disabled (NPRD) highlights the absolute apathy of the government towards people living with disability. The Finance Minister N. Sitharaman released a relief fund under the PMGKY in which a meagre amount of Rs.333 per month will be transferred to the disabled persons. The platform demands an ex gratia payment of Rs.5, 000 per month for essential support system,
Without a doubt, the pandemic, worldwide death tolls and consequential ‘social’ isolation, is impacting our mental health adversely, provoking anxiety for many people. The negative messaging and misinformation has caused paranoia and outrageous insensitivity in people who are treating those with symptoms like criminals, also pointed by Professor Vikram Patel in his interview with The Quint.
The severity of the problem manifests specifically for persons with disabilities. Many persons with disabilities require support for basics such as to eat, bath and dress. The caretakers of the disabled do not even make it to the list of health workers . Most of the times, they are the immediate family members or someone from lower socio-economic status.
Glorification of sacrifice and suffering based on appropriation and exploitation of sections of people without any sincere effort to change the existing systems is self-defeating. Dare we forget Dr. Payal Tadvi, a doctor in Pune pursuing MD in gynaecology, who killed herself after living with caste based harassment and humiliation for a year by the hands of upper caste senior colleagues and professors? Dr. Kafeel Khan is charged with the National Security Act and is in prison for speaking up against the Citizenship Amendment Act, 2019.
Conclusion
To ‘care’ for health workers would mean to work towards the transformation at a bigger and structural level. Most health-care workers are either unrecognised or receive scanty support from the central and state governments.
We must raise timely debates and in non-academic spaces on how the medical-pharmaceutical economy overtakes and disadvantages the interlinked healthcare economy which is sustained by a mass population engaged in different types of work. How can healthcare be recognised as public good and lastly, how do caste, gender, and class play a role in alienating the primary health workers? The state is pulling away from its responsibility of ensuring that a big chunk of the budget goes to the health sector and health workers, and thus its time we ask these questions.
Prashastika Sharma and Neeraj K are research scholars in Women’s and Gender studies at Ambedkar University and Center for Women’s Development Studies, Delhi. Neeraj is also a queer affirmative counseling practitioner and therapist.
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