Kerala’s Healthcare Story Through A Red Volunteer In White
Ushadevi P
A recently retired nurse in Kerala, Ushadevi P has for long been associated with the progressive political movement in the country. Post retirement, she currently serves as the President of the Kerala Nursing and Midwives Council, before which she was the the General Secretary of the Kerala Government Nurses Association.
Born in Chaliyar, a village near Nilambur in Malappuram, in 1964, Ushadevi was part of the students’ movement from her school days, and a member of the Students’ Federation of India (SFI) in college. “To become a nurse was my dream since childhood”, says Ushadevi to Student Struggle. “Whenever I was taken to a hospital by my mother, I always looked at nurses with absolute awe”. Having grown up in utter poverty, she thanks the public education system in Kerala for having given her an opportunity to complete her studies.
After 33 years of service as a red volunteer in white, today, comrade Ushadevi spends time reading, writing, and actively continuing her activism, presently being a State Committee member of the All India Democratic Women’s Association (AIDWA) as well.
Read on to know what she has to say about Kerala’s healthcare system and the state’s inspiring fight against COVID-19:
This is an attempt to forefront certain aspects of Kerala’s fight against Corona, by particularly bringing attention to the public health system, healthcare workers, and nurses.
As you all are aware, Kerala’s fight against coronavirus has been getting much recognition and appreciation. The first case of COVID-19 in Kerala was reported on January 30th. Around the same time, the first case in Italy was also reported and we know how COVID-19 affected Italy. It is here that we have to understand the effectiveness of the strategy employed by Kerala.
The first cases in Kerala were of students who arrived from Wuhan, but the Rapid Response Team was set up in Kerala at least a week before the first case was reported. All the contacts of students who returned from Wuhan were traced, tracked, and isolated. With the experience of fighting Nipah virus, Kerala stepped up to fight Corona immediately. Three weeks after the first set of cases fresh cases were reported in Pathanamthitta district, which is considered as the second phase. As of today, we can see that Kerala has had a successful fight against a pandemic in the first two phases. Each day the number of recovered cases exceeds the number of positive cases. The oldest patients who were 89 and 91-year-old have got cured. Under the leadership of the Chief Minister of the State, Comrade Pinarayi Vijayan and the Health Minister, Comrade Shailaja Teacher, Kerala today has flattened the curve. Let us look deeper into how Kerala could achieve this.
Health, in Kerala, is a social subject. The inter-sectoral approach of health wherein several departments come together in ensuring the health of the community is what makes Kerala unique. This is enabled by the people-centred and participatory governance policies. Even in the fight against corona, we saw the same approach work. The Panchayati Raj Institutions along with the community-based organisations such as Kudumbashree played a crucial role in the fight of Kerala against Corona. Right from running community kitchens to implementing several decisions, such a decentralised people-centred mechanism did not just assist the public health system but formed a part of it.
The public health system has two parts to it which are equally important: preventive and curative systems. When we talk about the public health system today, we do not give enough importance to preventive mechanisms or sometimes even forget about it. Kerala’s public health system has more than three thousand institutions in five divisions. This includes Primary Health Centres (PHC), Family Health Centres (FHC) or Community Health Centres (CHC), Taluk hospitals, District hospitals, and Medical Colleges. The Family Health Centres were formed by converting the existing Community Health Centres through a policy of the current left front government called ‘Ardram’. The Family Health Centres almost 700 in number are high tech centres known for its patient-friendly approaches and FHCs have revolutionized decentralized health care.
The community health system forms a backbone of preventive mechanisms. These include Junior Public Health Nurses (known as ANMs in other states), Junior Health Inspectors, Lady Health Inspectors, Health Inspectors, and Maternal and Child Health officers. They together form the backbone of the health system at the most primary level and are connected to the community everyday. ASHA workers and Anganwadi teachers provide all the necessary support to them. They identify patients, employ preventive measures, ensure immunisation and vaccination, inform about family planning methods, take care of pregnant women, identify malnourished children, take care of bedridden patients etc. The exact data of all these are kept by ASHA workers and Anganwadi teachers. The same is communicated to the community health workers. The work of the community health system along with ASHA workers and Anganwadi workers can be considered as the core of the public health system in Kerala.
It is through the decentralisation process that was initiated by the left front government in 1996 that we could form such a strong community health system. As a result, we today have one public health nurse for every two wards in every panchayat, municipality, and corporation of Kerala. That will be one public health nurse for every 5000 people. To give an example of their work, in the nine months of pregnancy of a woman, the public health nurse in the area at least visits them three times. As I mentioned earlier, public health nurses are similar to ANMs in other states and very often such positions in several states are just namesake. This system played the key role in fighting COVID-19 in Kerala. From the initial awareness campaigns to closely monitoring everyone in quarantine and isolation, there is no area they didn’t touch upon. It is only because of the effective involvement of the community health system workers along with others we could trace, track, and isolate people. Recognising the work done by Asha workers the government had increased their honorarium last month. Kerala is now preparing for a third phase of the virus. More than 6 lakh people have already registered so far in the Non-Resident Keralites Affairs (NORKA) website and thousands have already returned. We are now prepared to institutionally quarantine at least 3 lakh people. It is the said system that will be playing the most crucial role in the next phase as well.
It is the ineffectiveness or non-existence of such systems in other parts of the country that has caused the virus to spread massively in many regions. A similar system did once exist in most parts of the country. The complete destruction of such a Nehruvian vision started with the Rajiv Gandhi government and was formalised in 1991 through the then finance minister Manmohan Singh. Health care became something to be managed by corporations under the neoliberal regime. The near-complete withdrawal of government from health care is the core reason for the crisis we see in several parts of the country today. Even in Kerala, there were attempts by the Congress governments to bring similar changes. In those times it is the left trade unions and mass organisations in Kerala that resisted it. The health of people is not the responsibility of the government but of the individual is what that is being told to us by the neoliberal regime for forty years now. Under the Modi government, this has only worsened with added communal colour.
Let me now talk a bit about the institutional nursing mechanisms, an area in which I worked for 33 years. Curative medicine as we understand is a collective work. In Kerala, it is because of the collective work of those involved in curative medicine that we were able to control the secondary spread of the virus, cure many, and most importantly reduce mortality rate. Nurses form an important part of curative medicine. Around twenty thousand nurses work in the public sector in Kerala and more than two lakh work in the private sector. The foundations of the nursing sector in Kerala were laid down by the Christian missionaries. But for the long nursing sector in Kerala was subject to much discrimination and oppression. In 1957 the first communist government with EMS as Chief Minister brought some fundamental changes to the sector which was the beginning of the journey of nursing as a respectable position. It may be a piece of new information to many listening that until 1957 there were restrictions that prevented them from marrying. Kerala Government Nurses Association (KGNA) was formed in the same year. KGNA now is the organisation in the forefront to fight for the right of nurses. It was only in 1979 that male nurses were allowed professionally, which was another significant decision by the left front government. At the same time, we have to self critically note that the service conditions of nurses working in the private sector of Kerala is not satisfactory. Despite government regulations, even the basic principle of equal pay for equal work is not followed by the management. The private hospitals even violate the Supreme Court order of minimum wages of 20,000 rupees. The need for the private sector today is strong unionisation.
One reason why there are so many nurses from Kerala is the subsidised nursing and medical education that exist in Kerala even today. I completed General Nursing in 1986, with no support from the family, and a monthly stipend of Rs.100, which was enough for my mess money. This is the story of many nurses, particularly of our generation. It is said that of the 18 lakh nurses in India, 12 lakhs are from Kerala. Similarly, lakhs of nurses from Kerala are working across the world and they contribute a major part of our foreign remittances. It will be not an exaggeration to say that Malayali Nurses are in the forefront of the fight against COVID-19 across the world. Nurses from Kerala are part of the frontline work force across continents and their work is being acknowledged by governments across the world. Malayali nurses are the biggest contribution of Kerala to global health care, particularly in these times. It will only be fair to draw a comparison to Cuban doctors.
As the President of Kerala Nursing and Midwives Council, I get several calls from Malayali nurses across the world. Many of the frontline workers today across the world are working in very unsafe conditions and health care systems are on the verge of collapse. We have already seen several cases in hospitals in Mumbai and Delhi wherein nurses were not even allowed to enter quarantine. Calling nurses or any other health care workers as angels is of no use. In fact, it is counterproductive. Such glorification will only result in deviating from real concerns. What we need are not claps, lights, or showering of flower petals. The government should end the drama and get on to work. The need of the hour is the dignity of work and rights of the worker. This pandemic situation and the near-collapse of the health care system across the world should make us rethink. What we need is revolutionary changes in the healthcare system.
This is the transcript of the lecture delivered by Ushadevi P as part of an online discussion titled ‘Women, Work and Pandemic’, organised by Tricontinental: Institute for Social Research on May 4, 2020. Some parts of it were translated from Malayalam. The video recording can be accessed here.
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