Working and Organizing on the Front Line in a French Hospital

Originally published on Classe en lutte.

In the context of the COVID-19 crisis, this document seeks to relay an experience of everyday life within the hospital. Although the conditions in which we practice our professions are changing a great deal on a daily basis, there are nevertheless several key elements that merit fuller consideration, as they help shed light on the effects of capitalism and class exploitation on the healthcare professions.

A small clarification: the hospital we are talking about is not one which has been designated as a COVID-19 hospital, and thus we should not be expected to receive many COVID-19 patients. It instead receives non-COVID-19 patients from other departments (however, in the absence of testing, their uninfected status remains hypothetical).

Class struggle in the hospital

There is continued relevance and explanatory power from reading the situation from the perspective of class struggle. The health system remains a site where the dictates of bourgeois hierarchy rule. At the top, there is the management of the hospital, then the doctors, and finally the care and maintenance staff.

The right to speak follows the same hierarchy which is all the more visible in a situation designated as a “crisis.” While nurses and other caregivers are very often in the best position to testify about the difficulties and needs of the sector in question, their opinions have been rejected in all the meetings we have held during the COVID-19 pandemic. As soon as we caregivers ask concrete questions, the management brushes off the question (to which they probably don’t have an answer) and treat it instead as a matter of a personal anxiety: “you are just afraid of the unknown;” “this is just the manifestation of your anxiety,” etc. It is as if the lack of treatment protocols at this particular time is only a matter of personal anxiety and not something we need to think about and prepare for, even though we are lucky enough to have more time than many– not being a COVID-19 designated hospital.

Beyond this refusal to listen to the caregiver’s input (and sometimes its outright disqualification), there is also the withholding of information. The information is provided in a fragmented form and is disseminated first of all in the higher spheres by management and doctors before being adapted and disseminated sparingly throughout other departments. The rationale for this takes the form of a sledgehammer argument offered by the care director that “the teams do not need to know all the details, they need to be given something positive.”

The class struggle also plays out at the level of the material conditions of existence since, in the absence of protections, for example, it is up to the workers to wash their street clothes (worn at work). Those who have a washing machine therefore face less difficulty. This is just one example among others.

Finally, the decision to work remotely is sometimes chosen but also sometimes imposed by the management. Management has acquired more and more power due to the decrees enforced by the government which have a single goal: to allow employers to more easily exploit the workers.

The class struggle also concerns the patients, of course. The population is now forced into the most precarious conditions of life under capitalism, without housing and/or income for food. We must today contend with an even more complex situation, as many charity organizations and shelters have been closed. In our hospital, closing the substitution therapy center is currently under discussion. Doing so would leave patients without access to care, since the doctors will no longer be able to receive them as they usually do. For the time being, appointments with psychologists and social workers have been cancelled due to the lack of safe premises to receive patients without risk of contamination.

Lack of organization

Another striking feature is management’s lack of organization in this time of crisis. While we are fortunate enough to have a precious amount of extra time to organize patient care, management does not seem to want to hear it. To date, we still do not have a care protocol or standard care pathways for the COVID-19 situation.

While several caregivers have pointed out that the university hospital will not be able to handle everything and that we will most likely receive COVID-19 cases, management only answers with “yes we will,” apparently not worrying about the staff who will have to improvise when the time comes.

It is important to know that management has surrounded itself with close friends, creating a solidarity of the bourgeois class that allows it to rely on a team that will not dispute its decisions. This team does not hesitate to express its contempt for the workers, while attempting to clear its name when it comes to its own work. There are two rather revealing examples of this. The treatment director, after one year on the job, still does not know where the day hospital is located. The same director wants to install a tent for sorting patients at the entrance—which is where the ambulances pass through. In addition to despising the staff, the bourgeois class thus puts the caretakers in a dangerous and difficult position due to its own incompetence.

The planned disappearance of the public hospital

It will come as no surprise to say that the hospital has been suffering for several years now from the lack of financial investment necessary for quality care and the real protection of the workers on duty.

Today this can be seen, for example, in the lack of protective equipment. Masks are lacking.

Although there are about 500 employees on site, the Regional Agency for Healthcare sent us only 150 masks. We also need gloves, body protection, and even over-shoes, since they are also a vector of contamination. To date, the staff has not been trained in dressing and undressing, even though this is a moment of high contamination risk.

At the material level, as far as we are concerned, there is also the lack of an intensive care unit which was closed 6 years ago to save money. Staff also lack a “Mobile Care Unit” and a “Mobile Protection Unit,” two units with portable care kits containing what is necessary for care or protection, e.g. gowns, gloves, masks.

The lack of masks also affects the most precarious professions, especially the maintenance staff. While caregivers are allowed one mask every 8 hours, maintenance workers are only allowed one mask per day despite the fact that a mask only normally works for 4 hours. It should also be noted that maintenance has been privatized and is now managed by a company that imposes an extremely difficult daily work rhythm on them without even bothering to protect them properly. As a result, those who work this job are at high risk of exposure during the current pandemic.

We are especially lacking tests, without which it is in fact impossible to comply with the standard healthcare pathways that we have arranged, as symptoms can appear quite late.

Lastly, workers have also not been trained in other important practices either, including handling deceased COVID-19 patients.

The lack of adequate protection equipment not only puts the staff in danger but the patients are as well, especially populations that are vulnerable due to their treatment and medical pathology.


So as not to solely report the negative conditions of work in the hospital, we should also mention that in order to cope with the management’s incompetence, the caregivers are organizing, discussing, and calling each other’s departments, learning of each other’s needs and exchanging advice. The knowledge that is built up is valuable, as are the bonds that are formed. The hospital pulls through because of this, while capitalism, the state and exploitation remain the enemies to be defeated.

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