Health Workers’ and Students’ Perspectives on the Situation in Rio

By: Some comrades from Rio de Janeiro

As a healthcare student under quarantine, I cannot report from the front line, but the following notes are from discussions and Whatsapp groups with colleagues and classmates who are working.’

We’ve had a lack of Personal Protective Equipment (PPE) for a while now in the state of Rio de Janeiro, even before the pandemic. Here, the state and municipality’s health departments are in conflict: the first one believes we should be more careful, and announced an order of PPE, and the second one is denying the existence of the problem. The situation also became complicated in the private hospitals and, even in places that have the equipment, there’s a lack of training for its use. Workers were supposed to be following a different protocol than the usual one, but without that training they are following their regular work practices, therefore increasing the chance of contagion.

In Rio there is a different culture regarding the university students’ participation in health units. It is usually much more active than in other states, with academics doing invasive procedures and performing most of the care, only getting the signature of the doctor at the end. This is why many services end up depending on the students’ participation to keep things going, and opening their doors without any type of agreement with the university departments. Formally, students are prohibited from participating in any service during quarantine, but this cannot be guaranteed in practice, because without them some places could even come to a halt. Those which are the most dependent on students’ labor are the most precarious and worst resourced, without any link with the colleges: something that complicates things a lot. A great example is Salgado Filho (I don’t know how things are there, with regard to receiving students), but that’s the hospital where they were using garbage bags for lack of disposable aprons.

Some managers are adjusting the official protocols, saying certain kinds of masks (especially the n95 type, which is the safest and most expensive) are not necessary (the same managers are working from home and yet claiming that contact with someone possibly or actually infected is not enough for contagion). This has spread all kinds of doubts, and a lot of professionals don’t know exactly what are the formal safety guidelines for each type of procedure. In most cases, even when they know what to do, they can’t because the unit won’t provide the equipment.

Another big problem that many who are in the high-risk categories don’t have any support to get leave from work during the pandemic. Some places have dismissed these employees, but as far as I know it is always through some internal regulation of the institution itself, hence it happens in the more structured places. There are some workers who live and have direct contact with people from high-risk groups, and most of them are relying exclusively on personal hygiene when they get home, which is hardly adequate considering they are coming from healthcare facilities. There were some reports of doctors and nurses that opted to stay in hostels until the end of quarantine so they would not put their family at risk – I don’t even need to say how unthinkable this is for most people, and absurd even for those who have done it, because they shouldn’t have to pay the price of the shortcomings in their workplaces.

On measures in relation to healthcare students

The announcement that came out recently speaks of registering all students in the federal system of education. Apparently everyone would fit inside this category, because even private universities are part of this network. Workers’ registration during the pandemic is not mandatory. This point generated a lot of doubts, because the announcement explicitly says it is, but in online discussions the lawyers from the courses’ representative entities have said the opposite. Only those who want to register should do it, and the criteria has not been defined regarding the order in which students will be called to do it. Only those who are called will receive a scholarship and a bonus in the form of points in their residence exams.

What’s been generating the most controversy about this issue is the bonus in residency exams. It would only be for those universities associated with the Health Ministry for the time being, but nothing prevents the Ministry of Education and Culture – MEC 1 – from accepting this as well. The discussions have been about whether or not it is appropriate to offer any kind of bonus to a job that would be voluntary, because it puts pressure on those who didn’t want to participate to apply. And the measure also doesn’t consider students who are in the high-risk groups.

There was also a Provisional Measure 2 discussing the possibility of bringing forward the graduation of students in their 12th (last) term. Some colleges had already carried out early graduations at the beginning of the pandemic. Some students left on the condition that, having graduated on a preliminary injunction, they would enroll in the Mais Médicos program 3. The above-mentioned Provisional Measure doesn’t talk about mandatory enrollment in any Federal Government program.

About early graduation

Those in favor of the measure since the beginning of the quarantine were arguing that these healthcare services were very precarious, so sending students who have been working for one or two months as volunteers would contribute to making it more precarious; therefore, the best decision would be to have students graduate beforehand. I wanted a less crude way of saying it, but the argument was basically: you’ll get fucked, but at least you’ll get paid.

The ones who were against the students graduating early also argued that it was a form of precariousness, in the sense that it is cheap labor reaching the job market (at the same time that the demand for doctors increases, there are more doctors looking for jobs, making it possible to hire specialized labor for a lower price). New graduates tend to accept any job, with super-low pay, without adequate conditions, which would worsen the epidemiological situation of the pandemic. They also argued that this early graduation would do nothing to improve disease control, because the number of qualified doctors is sufficient, just underrecruited due to the government’s own incompetence, and poorly distributed throughout the national territory. They point out that several other measures should be taken first (hiring new professionals, adequate distribution of doctors throughout the country, strengthening of basic care), which has not been done due to the political/economic choice of not allocating money to SUS 4.

1 In Portuguese: Ministério da Educação e Cultura. Currently headed by Abraham Weintraub.
2 Medida Provisória is a legal act in Brazil through which the President of Brazil can enact laws without approval by the National Congress. There are two requirements for a provisional measure to be used: urgency and relevance of the matter to be regulated.
3 Mais Médicos was started in 2013 with the promise of increasing the SUS’s (see note 4 below) workforce. See more here
4 Sistema Único de Saúde is the chain of public hospitals and clinics around Brazil.

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