“My family found a house that has an independent room with a separate entrance so that I could isolate myself,” says S. N. Gopala Devi. That was in May 2020, when some families first decided they would go that extra mile to shield the rest of the household – while also easing the load of those of their family members in her high-risk profession.
Gopala Devi, 50 years old, is a nurse. A highly trained professional with 29 years of experience, who has spent considerable time during the coronavirus pandemic working in the Covid ward of the Rajiv Gandhi Government General Hospital in Chennai. She was also in charge, for a brief period, of a special Covid Care Centre at Puliyanthope, a neighbourhood in the same city.
Now, even after the phased lifting of the lockdown, with many activities slowly moving back to normal, Gopala Devi will still often have to spend time in quarantine when serving in the Covid-19 ward. “For me, the lockdown continues,” she laughs. “For nurses, it is far from over.”
As several nurses told this reporter: “For us there is always a lockdown – and work.”
“My daughter got married in September and I took leave only the previous day,” says Gopala Devi. “My husband Udaya Kumar took the entire responsibility of the wedding on his shoulders.” Kumar works in the accounts section of another Chennai hospital, the Sankara Nethrayala. And, she says, “He understands the demands of my profession.”
In the same hospital is 39-year-old Thamizh Selvi, who has won an award for her work – without taking leave – in the Covid ward. “Except for quarantine days, I had never taken leave. I worked even on my days off because I understand the seriousness of the issue,” she says.“The pain of leaving behind my young son, Shine Oliver, for days on end, is deep. Sometimes I feel guilty, but I think in this pandemic it is important that we stay in the forefront. The joy when I know that our patients are going back to their families – it makes staying away from our own worth all the trouble. But for my husband looking after and taking good care of our 14-year-old boy, and understanding what my role is, this would not have been possible.”
But not everyone was so understanding, as nurses returning after work to their residential buildings learned the hard way.
“Every time I came back home from quarantine, I saw people pouring turmeric and neem water on the path I walked. I could understand their fear, but it hurt,” says Nisha (name changed).
Nisha is a staff nurse at the Institute of Gynaecology in a government hospital in Chennai. She had to attend to pregnant patients who tested positive for the coronavirus. “It was very stressful because we had to protect the mothers as well as their babies.” More recently, Nisha herself tested positive. Three months ago, her husband suffered from Covid-19 and recovered. “At least 60 nurses in our hospital contracted the coronavirus these past eight months,” says Nisha.
“The stigma is tougher to handle than the virus,” she adds.
Nisha’s five-member family, including her husband, two children and mother-in-law, have had to leave one locality for another in Chennai. Pushed out by fear and hostility amongst their neighbours.
And each time she had to quarantine after working in a Covid-19 ward, Nisha, who is a lactating mother, had to stay away for several days from her one-year-old child. “My mother-in-law took care of the child when I was busy helping Covid-19 mothers deliver their babies,” she says. “It was and continues to feel strange.”
The guidelines of the Indian Council of Medical Research (ICMR) do exempt lactating mothers and those with co-morbidities from working in Covid wards. But a severe shortage of nurses across the state leaves many like Nisha with little choice. A native of Virudhunagar district in south Tamil Nadu, she says she had no relatives to turn to in Chennai. “I would say this has been the toughest period of my life.”
Shyla, 21 years old and just starting out as a nurse, would agree. In October 2020, she had begun a two-month contract job as a temporary nurse at a Covid-19 care centre in Chennai. Her tasks involved taking door to door swab tests in contamination zones, and creating public awareness about the importance of wearing masks and adopting other safety practices.
“In many places, people refused to be tested and argued with us,” says Shyla. There was also the ever-present stigma. “I had gone to a home for conducting tests where we realised that we were not carrying a pair of scissors to cut open a new pack of swab test kits. We requested people there for a scissors and they gave us a really bad one. It was difficult to cut open the pack with it. When we were finally done, we returned the scissors to them. They refused to take it back and told us to trash it.”
Also, wearing a PPE suit for 7 to 8 hours in Chennai’s heat and humidity meant great discomfort. Besides which, she says, “We would have to work without food or water, nor could we use the restroom in people’s homes.”
Yet, she hung in there. “It was my father’s dream that I become a doctor. So when I first wore the nurse uniform and the PPE kit, I know I was closer to his dream despite the discomfort,” she says. Shyla’s father was a manual scavenger who died while cleaning a septic tank.
Besides risk and stigma, nurses are fighting on a third front as well. Appalling conditions of work and very poor pay. Shyla, as a beginner, earned all of Rs. 14,000 each of those two months. Nisha, after working as a nurse for 10 years, including six as a contract employee at a government institution, takes home Rs. 15,000. After three decades of service, Gopala Devi’s gross salary stands at Rs. 45,000 – not much higher than that of an entry-level clerk in a nationalised bank.
While official figures are not available, health activists put the number of nurses in government and private hospitals across Tamil Nadu at anywhere between 30,000 and 80,000. Admitting that nurses have it tough, Dr. C. N. Raja, Tamil Nadu president of the Indian Medical Council, says the IMC had tried to organise counselling for them. “Especially for those working in ICU care. They come forward to discharge their duty knowing fully well that they are vulnerable, and I think we have to take good care of them.”
The nurses don’t think they’re being taken good care of.
“There are over 15,000 temporary nurses in this state,” says K. Sakthivel, a male nurse from Kallakurichi district, and president of the Tamil Nadu Government Nurses Association. “One of our major demands is proper salary. Neither recruitments nor promotions are done as per the standards of the Indian Nursing Council.”
“Of more than 18,000 temporary nurses, just 4,500 have been made permanent,” says Dr. A. R. Shanthi, general secretary of the Health Workers Federation, an umbrella organisation of healthcare workers in Tamil Nadu. “The remaining nurses take home Rs. 14,000 a month while having to put in the same amount of work, if not more, than the permanent ones. They cannot avail leave like permanent nurses do. If they go on leave even for emergency purposes, they suffer loss of pay.”
And that is the situation at the best of times.
For nearly a year now, Covid-19, says the experienced Gopala Devi, who has worked in both government and private hospitals, has brought on a situation never seen before. “India’s first HIV case [in 1986] was found in Chennai at the Madras Medical College [affiliated to the Rajiv Gandhi Hospital],” she recalls. “But even when treating HIV patients, we were not this alarmed. We never had to entirely cover ourselves. Covid-19 is far more unpredictable and requires enormous courage.”
Fighting the pandemic has turned life upside down, she adds. “When the entire world was shut under lockdown, we were busier than ever in the Covid-19 wards. It is not like you can walk into a ward just as you are. If I am on 7 a.m. duty, I will have to get ready from 6. a.m. Getting into a PPE suit and making sure I am nourished till I step out of the ward – you see, I cannot drink water or eat anything in a PPE suit – the work starts from right there.”
“It happens this way,” says Nisha. “You work for seven days in a Covid ward and isolate yourself for seven days. The roughly 60-70 nurses in our ward work on a rotational basis. Between 3 to 6 nurses work for a week at a stretch, depending on the number of patients. [Which means 3 or 6 other nurses would be in quarantine at the same time]. Roughly, each of us would be put on Covid duty once in 50 days.”That means two weeks of every seven in a nurse’s calendar are spent in the high-risk part of the battle against Covid-19. Shortages and emergencies could make that load worse. Nurses on Covid duty are provided quarantine facilities by the government.
A work shift technically lasts six hours, but most nurses end up working twice as much. “The night shift,” says Nisha, “is inevitably 12 hours – from 7 p.m. to 7 a.m. But even otherwise, we never stop at six hours. Mostly, any shift extends by an hour or two at the least.”
Flawed recruitment practices worsen everyone’s load.
As Dr. Shanthi points out: “Instead of recruiting new nurses, the new [Covid] centres draft them from other hospitals. In which case, you have to hugely compromise. If six nurses are needed for a shift, many hospitals are forced to manage with just two. Also, except in Chennai, no other hospital in any district follows the mandatory one-nurse-for-one-patient in the Covid-ICU. All the complaints you hear about delays in tests and in securing beds, is precisely because of this.”
In June 2020, the state government had recruited 2,000 nurses for four districts – Chennai, Chengalpattu, Kanchipuram and Thiruvallur – on monthly salaries of Rs 14,000, especially for Covid duty. This number, says Dr. Shanthi, is nowhere near enough.
On January 29, nurses across the state held a day-long protest. Their demands included bringing salaries on a par with nurses working with the central government; bonus for nurses working in Covid wards during the crisis; and compensation to the families of nurses who had died in the line of duty.
Health activists are equally worried about nurses working in other wards. “The degree of exposure might vary, but those working in non-Covid wards too are exposed to the threat. I believe nurses working on Covid duty are relatively better off because they get PPE suits and N95 masks – they can demand those, it’s their right. But others obviously cannot do that,” says Dr. Shanthi.Many point to the case of 55-year-old Anthoniyammal Amirthaselvi, who worked as a nursing superintendent at Mandapam Camp in Ramanathapuram district, which had an outpatient service for Covid patients. On October 10, Covid-19 claimed the life of Amirthaselvi, a cardio patient. “Even when she was slightly unwell, she kept doing her job,” says her husband A. Gnanaraj. “She thought it was a normal fever, but she tested positive for Covid-19 – and after that, nothing could be done.” Amirthaselvi had been transferred from Madurai General Hospital to Mandapam Camp just a year earlier.
And there is always the stigma – which, in the case of nurses who are also Dalits, is a double burden.
The award-winning Thamizh Selvi ( in the cover photo on top) is no stranger to it. She is from a Dalit family originally from Lalapet village in the Walajahpet taluk of Ranipet (formerly Vellore) district. The family has always known discrimination.
And now a new layer to the stigma – being a nurse fighting Covid-19. “When returning home after quarantine carrying a bag,” says Thamizh Selvi, “the moment I step into our street, even familiar faces shut the door on me. I feel bad, but I also try to understand, they are obviously worried about their own safety.”
Sukirtharani, celebrated Tamil poet and Thamizh Selvi’s sister, recalls why her three sisters chose nursing as their career: “It is not just ours, many people from Dalit families have opted to be nurses. When my eldest sister became one, people who would otherwise hesitate to come to our place, came home seeking help. We had people from the oor point to our house in the cheri , saying they wanted to educate their kids like my father Shanmugam did. [Traditionally, villages in Tamil Nadu are segregated into oors , where the dominant castes live, and cheris , where Dalits reside]. I am a schoolteacher myself, and another brother is also a teacher. My sisters are nurses.
“Except for one brother who is an engineer, the rest of us are in the duty of setting this society right. From our kind of background, this is a matter of immense pride for us. When my eldest sister donned that nurse’s uniform, it lent her grace and respect. But it was just one of the reasons why they chose to be nurses. The fact is, like Dr. Babasaheb Ambedkar, we want to be of service to the entire society."
Even if that means a few anxious moments when sister Thamizh Selvi gets tested for Covid-19 after her turn at the ward. “I was more worried that she cannot continue to do her duty” smiles Sukirtharani. “But well, we were anxious the first few times, now we have got used to it.”“To step into Covid duty is like stepping into fire, knowing its perils” says Gopala Devi. “But it is natural to the choice we made when we decided to pursue nursing. It is our way of serving society.”
Kavitha Muralidharan reports on public health and civil liberties through an independent journalism grant from the Thakur Family Foundation. The Thakur Family Foundation has not exercised any editorial control over the contents of this reportage.
Cover photo: M. Palani Kumar