Short-Staffed Hospitals Tell Workers Not To Get COVID Tests Despite Showing Symptoms, Say NHM Workers

CHANDIGARH — On August 11 this year, Ruksana Aujla, an ANM sought a day’s leave from her post as a receptionist at the flu clinic at a government hospital an hour’s drive from Punjab’s state capital. Aujla had developed classic covid-19 symptoms — fever and diarrhea — and was five months pregnant at the time.

But Kaka Randeep Singh, the local Congress MLA, was visiting the hospital that day to formally handover an ambulance he had bought from the MP-LAD funds and so Aujla’s request for leave was turned down.

Worse, Aujla said the hospital administration informally told the NHM staff members not to get a covid test as they were already short-staffed. 

“They even asked me not to get tested as there is already an acute shortage of staff members in the hospital,” Aujla recalled. Aujla complied because she is a contract employee under the National Health Mission and so has no security of employment.

Her condition continued to deteriorate, Aujla finally took a test and was found to be positive for the coronavirus on August 29; she spent 17 days in home quarantine and is now back to work at the flu clinic.

“They asked me to work at the flu clinic or else depute someone else at my place,” said Aujla. 

Dr. Balwinder Singh, the senior medical officer of Civil Hospital at Mandi Gobindgarh, said he was unaware of this informal directive that NHM workers hold off from getting tested, and suggested Aujla was not in a frontline role. 

“She is working at the clinic reception and is not collecting samples. She only takes down the name, addresses and contact details of the suspected cases,” he said. “We are facing acute shortage of staff and hence have to put her at the flu clinic once a week.”

Later, Aujla told HuffPost India that the SMO forced Aujla to sign a written declaration that she did not work at the flu clinic. After much persuasion, Aujla signed the letter but wrote that though she did not collect COVID-19 samples, she worked at the clinic reception. 

Auhjla’s is not an isolated case.

S.K (name withheld on request), another NHM contract employee working as a nursing officer in a government hospital in Chandigarh for six years, had a similar experience. She too, she says, was told to hold off her leave after she developed a high fever and underwent COVID test on August 31. 

“I underwent a COVID test around 10 am and asked for a day’s leave as I was feeling acute weakness due to high fever. My sister in charge told me to wait till 2 pm as the labour room was too busy. I was scared as being a nursing officer inside the labour room, I had to take the newborn babies in my arms,” said  SK. It was only after 2 pm she was allowed to go home. Her RT-PCR test result came positive on September 2. 

When SK asked the hospital authorities to send a team to her house to conduct a test of her family members, the staff turned down her request. Along with SK, many other staff members including NHM workers, outsourced staff members and sanitation staff members tested corona positive in the next few days. 

“Since the onset of COVID-19 this year, the central government has announced numerous incentives and health benefits for regular health workers, the Chandigarh administration has only given us a certificate, a pack of 100 ml lassi, and a piece of traditional Punjabi sweets as an incentive,” claimed the NHM employees in Chandigarh. “Despite being COVID warriors in front, neither us nor our family members are covered under any health insurance.”

Some of the ANMs working for NHM in sector 45 Civil hospital at Chandigarh also told Huffpost India they had faced difficulties when they sought leave after developing covid-19 like symptoms. 

As per Jaswinder kaur, an ANM, four of her colleagues began to feel feverish on August 30 while working in the OPD clinic having a daily footfall of over 200-250 people. Next day, they developed high fever and sought a few days leave from the SMO which was denied. 

“It was very risky as two of them were doing immunization of children in the injection room. The other two were also working in the Antenatal check-up department which would pose a huge risk to the expectant mothers and newborn babies. It was only once they were unable to work further, their antigen test was taken which turned out to be positive,” said Kaur. She informed that out of the ten ANM’s working in the hospital, eight were tested positive.  

Another NHM employee Amit, presently deployed at a local dispensary, went to the  Civil hospital at Manimajra on August 31 and got tested for COVID-19. After three days, he was told that his result got misplaced along with many others. 

“I was asked to join duty. However, after working in the dispensary the whole day on September 3, I again underwent COVID test on September 4 at another government hospital and tested positive,” Amit told HuffPost India who was later sent to 17 days quarantine. 

These case studies from Punjab and Chandigarh indicate a worrying new trend in India’s faltering attempts to contain the coronavirus: Resource-strapped public hospitals are discouraging their NHM staff members from getting tested for covid-19 as they fear that a positive test could result in crucial staff shortages. While HuffPost India has been able to verify the case studies based on their test reports, NHM health workers from other states say they have faced similar hurdles to getting tested.

As a consequence, health-workers are continuing to perform their duties despite displaying covid-19 symptoms at the cost of their own health, and at the risk of exposing patients to the deadly virus. 

RT-PCR test results delayed by PGI harass NHM workers 

Dr Amandeep Kang, Director, Health Services, and Mission Director NHM, Chandigarh when contacted told HuffPost India that the initial shortage of testing facilities in the area has indeed posed a serious health challenge to the frontline workers in the initial months of the corona outbreak. 

“Since only PGIMER had the RT PCR testing facility initially in the region, it was flooded with test samples from Punjab, Haryana, Himachal Pradesh and Chandigarh. Even today, there is a minimum delay of three to four days to get a RT PCR test report. This was causing a serious health risk to our frontline health workers and also to the outpatients, so we have now begun to take rapid antigen tests of our employees,” said Dr. Kang. She further added that only those who test positive in the rapid antigen test were asked to get tested with RT PCR facility at PGI. 

While refusing to comment on the scarcity of health workers and forcing them to work despite being symptomatic before she took over as DHS this month, the newly appointed DHS  said that as per the government guidelines, they should have been admitted to the designated government hospital before the corona test. 

Except the Government Medical College, none of the other government hospitals in Chandigarh have an RT-PCR facility till date.  However unreliable results of Antigen test are indeed causing serious health risks to the frontline workers like SK and patients visiting the public hospitals. 

“After I turned symptomatic on August 31, they took my antigen test which came negative. I kept on working in the labour room on that day and assisted in over five to six delivery cases. My RT PCR result came positive after two days following which I was sent into quarantine,” said SK. 

No waiver in OPD fee for NHM workers 

Since the outbreak of the Covid early this year, reports of protests by the NHM and outsourced employees have emerged from various states including Uttrakhand   Karnataka , Punjab, Nagaland , Jammu and Kashmir and many other states. 

“Until the outbreak of the COVID 19 pandemic in March this year, we were even asked to pay Rs 10 as OPD charges at all the government hospitals where the majority of us are working for more than ten years,” said Sarabjeet Kaur, an NHM worker from Punjab. “We wanted to make the government’s “health for all” vision a reality. But a decade later, our enthusiasm has lost steam.”

NHM workers say the leave policy of NHM workers is also amongst the long list of discrimination at work.

“As NHM workers, we only get 12 casual leaves in a year. Since the outbreak of the COVID 19 in March this year, the ANMs working in my hospital have not taken even a single casual or medical leave,” said Jaswinder Kaur. 

Rihan Raza, President of the All India NHM Employees Union blamed both, the central government and various state governments, for the plight of his union members. 

“While the union government turns down our concerns repeatedly by calling it a state’s matter, the state governments do not pay any heed by terming us as central government ‘burdens’.” Raza said. “They feel that we would become a permanent liability if the union government closes the mission in the future.” 

Stretched System

India has over 223,000 contracted health mission workers pressed into service to prop up  India’s faltering public health system. As the novel coronavirus pandemic has surged through India, NHM workers increasingly find themselves in the frontlines, despite being paid less and having far fewer benefits than their peers who have regular permanent government jobs.

State governments periodically announce vacancies for permanent positions, but NHM workers with years of experience must compete for these vacancies with inexperienced candidates who have dedicated years to simply preparing for competitive examinations to land a government job.

In July this year, for instance, the Chhattisgarh government in July this year had advertised open recruitment for approximately 2100 regular posts in the health department which includes medical officers, staff nurses, and multipurpose health workers. NHM employees held multiple strikes in the state. Over 178  NHM employees were terminated to date. 

Hemant Kumar, a former data entry worker with NHM in Chattisgarh said the Congress government in its manifesto had assured to regularise the contractual workers in the state but is yet to fulfill its poll promise. 

“Why has the government advertised new posts when it could have absorbed NHM workers working on similar posts from the last many years,” said Kumar. He claimed his services were terminated after he refused to join duty during a protest held in September this year. 

Dr Suryakant Narsai Bhai Patel, a contract government employee in Gujarat, said the fact that the NHM mission has been running for the past 15 years was proof of the need for a permanent cadre of workers. 

“Despite the fact, the government has neither created nor sanctioned our posts in any of the  state or the central government level. Instead of installing GPS devices on government vehicles, the state health authorities have even begun to track us live in some places through our personal mobile phones,” Patel said.