Against Sacrifice: Health Workers Beyond Heroism

Written by a daughter of two health workers and first published in Passa Palavra

I) An x-ray of health work

The daily life of those who work in hospitals has never been easy. Due to low wages, many workers have two jobs or do temporary work with home care and, between one shift and another, not always it is possible to return home. Because of this, when hospitals do not offer a resting room, a common practice is to improvise beds with cardboard or sheets in hidden warehouses, deactivated rooms or even in the changing rooms.

I am a daughter of two health workers, a nursing technician and a radiology technician graduated in nursing. My mother and father have two jobs, both working in a public and a private hospital. At home, we never had holidays and very rarely we did family trips. It is rarely possible to coincide the leaves of the two jobs, and every year one has to choose to celebrate Christmas or the New Year. Sometimes you don’t celebrate either. So that it doesn’t become a battle where only the chiefs favorites win, in many hospitals it is common to create a rotation scheme within the teams. In this way, each employee is able, once in a while, to match his holidays with those of the rest of the family.

The long workdays and the psychological pressure of daily responsibilities generate a high level of stress which in turn leads to the very high rate of accidents at work, making the health sector in Brazil the champion in this respect. According to the most recent data published by the Secretary of Social Security this year, there was an increase of 7% in the number of accidents in the sector compared to the previous study, made in 2017, going from 70,537 to 75,520 cases. Most of them take place in in-patient care activities and mainly affect nurses, technicians and nursing auxiliaries.

In fact, it is these health workers who more directly take care and deal with the patients from the moment they step foot in the hospital. They also represent 70% of the 3.5 million workers in the sector. Women are the overwhelming majority – there is only one man for every six nurses, auxiliaries and nursing technicians. This explains why the iconography used in the communications made by the health workers unions dialogues with a “feminine” aesthetic, which in general reinforces the idea of “working for love” and self-identifying with work that, in practice, are an obstacle to the processes of struggles that question the conditions of exploitation.

II) Rough times and struggles in health work: None of it started today

This photograph looks like a record of a struggle taking place during the pandemic. But it is not. It was taken in September 2019, in Manaus, during a protest by outsourced nurses from the state of Amazonas. About 11 service providers were in debt with approximately 6,000 workers, who at the time had been without paid for the last four months.

This is not the only case. Rio de Janeiro, Pernambuco, Amapá, Rio Grande do Sul, Mato Grosso, Ceará and Bahia live through very similar processes. Last year was marked by demonstrations, stoppages and strikes in several states of the country with a strong presence of the unions. This is the scenario that precedes the arrival of the coronavirus in Brazil: lack of employees, delayed salaries, insufficient hospital supplies, freeze on hiring and terrible working conditions.

Many still haven’t yet received their salaries. On March 28, 2020, the outsourced nurses of Manaus protested again in front of the union, this time claiming not four, but eight months of delayed wages. Incidentally, the state of Amazonas, despite having a low population density, is one of the regions most affected by Covid-19 in Brazil.

The mobilizations pass almost unnoticed by the media and remain isolated, at the mercy of the decisions of the union boards. A striking case is that of resident doctors. They fulfill the precarious function within the SUS (Unified Healthcare System) of replacing the hiring of permanent doctors. In the beginning of the year, the federal government announced a discount of R$100 in their salaries for social security. Without receiving a salary readjustment since 2016, the medicine graduate students, organized around the National Association of Resident Doctors (ANMR), had scheduled a national strike for March 20.
The adherence to the call was large and the strike was a certain. But with the arrival of the coronavirus in Brazil, ANMR’s management, without talking to anyone, said in a statement:

“ANMR understands that, as doctors, we are committed to help our country in the containment of the virus and to continue doing our indispensable work for society – taking care of people”.

They state in the text that the strike is postponed, without giving any precise date. The decision divided the students, and is said to have displeased the majority of them. One of the comments on the note said: “Deplorable 👎👎👎 They will never get to mobilize that many residents again.”

When the day that was set for the beginning of the strike finally comes, resident doctors receive a note that their vacation would be suspended and their elective internships cancelled. On this day, by chance, people around the country had scheduled an applause for all healthcare professionals. These did take place. A resident doctor then questioned:

“Today, March 20th, 2020, you applauded us from your windows (us and all the healthcare professionals). Tomorrow, when it’s time to demand the valorization of the resident doctor (and all healthcare professionals), will you continue to be on our side?”

The ironic coincidence of the two events is almost suffocating. The call for an applause from the balconies puts health workers on a place of heroism, reinforcing the already mentioned idea that they work for charity, for love, for courage. The capacity of this gesture to neutralise the concrete agendas of the workers is such that, while they struggle for better conditions and salary raises, even politicians and businessmen go out the windows to participate in the applause movement.

III) The coronavirus arrives in Brazil

While many health workers on work leave due to Covid-19 and several deaths are beginning to be recorded, the demand for work only increases. My father, for example, who used to do his shifts with four people, now works alone some days and in pairs in the others. This because seven of his twelve colleagues in the radiology department are currently hospitalized. It has been weeks since he hasn’t slept properly, having nightmares. In one of these, his job at the hospital was to put human heads to sunbathe. Without bleeding, the heads would talk to him the typical dialogues of a routine in the ICU.

Every day the area of contaminated patients is getting larger. And the workers are scared, exhausted. There are countless reports of those who cannot rest at home, of nightmares like those of my father. The routines have been absolutely transformed so as not to infect their relatives, and if before the problem was not attending their child’s school meeting, today they anguish because many choose not to go near their children.

The sectors that do not deal directly with the treatment of the coronavirus await for the possible relocation of personnel to the emergency department and the ICU. But what worries them most is not having the proper protective equipment and knowing that what they have won’t be enough for everyone. In order not to waste material, once the nurses get dressed, they must stay for six hours without eating or drinking water, and wearing geriatric diapers because they cannot take their equipment off to go to the bathroom.

At all times a different orientation of flows, conducts and protocols concerning the coronavirus arrives. They all aim at rationing the use of PPEs and lowering the level of individual protection, relying on arguments that do not concern the contention of the coronavirus, but, in fact, reinforces the precariousness of the work. Because of this, every day employees of countless hospitals, from the north to the south of Brazil, make complaints in the social networks, take reports to their unions and seek the media every day to talk about the lack of structure to attend to cases of Covid-19.

Mobilized even before the arrival of the coronavirus, the nurses from Pernambuco threatened to go on strike on March 23 if masks, gloves, aprons and goggles did not reach public hospitals. The day after the announcement of the strike by the Union of Nurses of the State of Pernambuco, the judge of the Court of Justice ordered a fine to the SEEPE of R$100,000 per day of paralysation. The strike did not happen, which does not mean it did not force some effects: right after that, the government announced the distribution of 1.2 million items of individual protection in state hospitals and also to municipalities.

It is difficult to know for certain how many health workers are already away from work, how many are interned, how many have died. The choice of numerous health care institutions is to hide the number of cases, which causes indignation among those who continue to work in the hospital. A survey conducted by UFRJ (Federal University of Rio de Janeiro) showed that the contamination rate of health workers in Rio de Janeiro is 25%, much higher than those seen in European countries, such as France and Italy.

Assuming the high risk of contamination that health workers are subjected to, the Minister of Health, Luiz Henrique Mandetta, launched the program “Brazil counts on me”. The project works on two fronts. The first, directed at class councils and labor entities, stipulates the registration of health professionals so that this labor force can be redistributed throughout the Brazilian territory in case of need.

The second front is aimed at students from various areas of health, so that they work directly with patients who have contracted coronavirus. On the other hand, the government offers the derisory minimum wage of R$ 1,045 (201 USD) for those who work 40h a week, and half of that, R$ 522 (100 USD), for those who work 20h a week. In less than 20 days, about 3,000 students had registered. And the reaction in the social networks was one of excitement: the students, in their overwhelming majority, were happy with the possibility of helping with the treatment of the sick and with the contention of the virus.

The students’ celebration, contrary to what the applause through the windows says, was not a burst of courage and heroism. The real situation of most of the young people who graduate from higher education in Brazil is that of unemployment. According to the most recent data from the Higher Education Census, in 2018 alone, more than one million two hundred thousand students finished undergraduate courses in Brazil. But the labor market is not capable of absorbing this labor force that is being produced. And the situation is no different with health students. Thus, graduating from college with a work experience involving coronavirus patients in the curriculum may mean for these young people an advantage in selection processes in the future.

Unemployment does not only affect recent graduates. The latest research on the health situation was conducted in 2015 by Cofen and Fiocruz. According to the survey, 65.9% of nursing professionals were already having difficulty finding jobs at that time. The pandemic, however, knocked on the door and forced hospital, public and private, to increase their contingent of workers. To get an idea, only Catho, a platform for job offers, announced that in March the demand for health professionals increased 281%. For those who have bills to pay and can no longer get along with freelance jobs, the coronavirus was, in the words of a nursing technician, a “light in the midst of all this chaos”. But it was also synonymous of a new concern: the fear of contamination by the new virus given the precarious working conditions.

It is certain that the hardships in the health area grow in proportion to the number of cases and deaths of coronavirus. If, on the one hand, the isolation and loneliness of work within an ICU means the extreme degradation of the worker’s subjectivity, it may also be what drives them to dialogue and to get closer to others. In addition, we still do not understand the depth and the consequences of the pain of experiencing the death of a coworker. The scenario indicates that it will be recurrent among Brazilian health workers, the difficult is to know if it will bring even more fear or provoke revolt as it exposes the limits of the bearable in the experience within capitalism.

IV) I take care of you, you take care of me

This is a picture that countless health teams have replicated. Certainly the most unified movement these workers have made. The posters that say “I’ll take care of you, you take care of me,” not only reinforce the quarantine campaign, but are also a call for solidarity. Not by chance, its form has become a symbol that allowed for it to be used to denounce the lack of PPE and the working conditions in hospitals. This text, in a way, tries to fit in with it; siding with teams like that of my mother, which draw attention to the pressing needs of health workers.

While researching to write this text, facing the astonishing amount of reports that denounced the tragedy of the lack of PPE, I asked myself what was necessary to tell differently. Unlike the tragedy told by the newspapers – a shrewd and rich source of audience – I wanted to point out the following: none of the problems they face, even less the struggles that emerge in response, are new to the health workers. Despite adding new elements, the pandemic has done nothing but blatantly reveal the precarious working and health conditions that were already there.
However, the future presents itself incognito. It is not possible to know what will happen from this point on. After all, here we have not yet reached the point where health workers are forced to choose between the diabetic and the asthmatic, between the young and the “old”.

A few days ago, I was reflecting with my mother on the strange and sometimes immobilizing sensation of living in a state of a catastrophe foretold. One of the definitions for catastrophe that Benjamin uses in his Arcades Project, instead of “an abrupt turn” as the etymology of the word says, is “to have lost the opportunity”, to let the opportune time pass. In a silent dialogue with him, my mother wrote some verses with the hope that we will learn something by then:

These are times of learning in the time of the pandemic
We were touched by something invisible to the cradle of consciousness
Those who stop to see where they are, understand:
We were stopped.
The time is here. The place, now.

Time to stir up our wills
To get to life
In which to look right into the other’s eyes
Is our common

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