By Musheera Ashraf, TwoCircles.net
A new report by Ashirwad: Centre for Social Concern, Bengaluru has called for policy makers to be held accountable to ensure that the frontline workers are not invisibilized and ‘are able to demand their rights and dignity at the very earliest.’
Dr. Sylvia Karpagam, Dr. Siddharth KJ and Dr. Alwyn Prakash went across Bangalore, meeting, listening to and documenting the issues and concerns of this ‘invisibilized’ community of workers in the form of a report.
The report is an attempt in the direction of making their work visible and bringing to public knowledge the nature and condition of their work as well as the range of issues and challenges faced by them.
The pandemic, over the last several months, has made it clear that while the Coronavirus itself may not discriminate, different sections of the society have been impacted in different ways. While many transitioned seamlessly from office-based work to home-based work, a large section of society ended up losing their livelihood, partially or wholly, as well as losing access to essential services like the anganwadi, mid day meals, pensions, Public distribution system (PDS), education, healthcare etc. The category of workers, whose services were not only deemed essential, but central to the response to the pandemic, are referred to as the ‘frontline workers’.
While some of them are visible and even appreciated by clanging plates and lighting lamps, there is an invisible section of frontline workers who have tirelessly contributed to the management of the pandemic but neither do they find any mention in media reports and appreciative speeches by political leaders nor are they provided any special compensatory packages in case of injury, infection, disability or death.
These are the workers who handle bodies in mortuaries, crematoria, burial grounds etc.; those, like auto/tipper drivers, who handle household solid waste; rag pickers; and non-medical healthcare facility staff like housekeeping staff, ward assistants etc.
Municipal solid-waste management
Two work chains: municipal solid-waste management and disposal; and hospital waste and dead body disposal were selected for the study. The rationale behind selecting these specific work chains was because both these work chains fell within the definition of essential services during the lockdowns, and the workers involved in these two work chains have largely remained beyond the public purview.
At the facility level, the work of collecting and segregating the bio-medical waste generated is performed by housekeeping staff and non-nursing allied staff, who should be equally recognized as frontline workers but their role generally goes unrecognized. The workers falling into this category are in general the lowest paid employees in a healthcare facility. Apart from handling the bio-medical waste, the housekeeping or non-nursing allied staff is also required to clean and wrap dead bodies in the event of a patient passing away at the hospital. After this process, the dead body is either sent to the home of the deceased through an ambulance or shifted to the mortuary. From the mortuary or the home of the deceased the body is then shifted to the burial ground or crematorium either in an ambulance or in a hearse van.
At the burial ground or crematorium, those working at these sites are involved in burial or incineration processes. Although handling of a dead body doesn’t involve any additional risk of COVID infection, the work performed by the workers involved in the dead body management and disposal chain requires visiting sites with other COVID-19 patients and their family members, which exposes them to a risk of infection requiring strict adherence to standard infection prevention control practices. To ensure this adherence,availability of appropriate safety gear, training on how to use them as well as the need for strict adherence is required. But the invisibilized nature of the work of those involved in this work chain, their marginalized locations within the workplace settings and the insecure terms of their employment raises doubts regarding the seriousness with which their health and safety is dealt with.
The management and disposal of bio-medical waste in India is governed by the Bio-Medical Waste Management (BWM) Rules, 2016 issued by the Ministry of Environment, Forest and Climate Change under the Environment (Protection) Act, 1986.
The team visited three healthcare facilities: a Urban Health and Family Welfare Center (UHFWC) located in L R Nagara; HBS Hospital located in Shivajinagara, which is a privately owned COVID-19 treatment facility whose work has received lot of public appreciation; and Ghosa Hospital which is a government maternity hospital dealing exclusively with COVID-19 positive patients. While they were allowed access to the L R Nagara UHFWC and HBS hospital, we were not allowed to observe the waste management and disposal processes at Ghosha Hospital.
Housekeeping staff at healthcare facilities
In the context of the COVID-19 pandemic and the response of the health system to it, housekeeping and allied staff employed to clean premises healthcare facilities including fever clinics, CCC, DCHC and DCH would also come under the category of high risk and would need to be protected from exposure to infection. However it appears that the needs and demands of this group have been largely overlooked.
“We get no benefits. For Ramzan, the hospital only gave us some rice in a box. We both get the same salary. Initially they were giving me just Rs. 4000, so I quit and went to Santhosh hospital. Then they called me back saying they will pay me the same amount as Santhosh. Now they said they will give 10 thousand. We clean the bathrooms, we clean patients. Sometimes the patients and their families give us something if we look after them well.” Tells one of the staff member while they were a bit apprehensive about speaking as they felt they could get into trouble for speaking , the team mentions in the report.
The head of the housekeeping department at HBS hospital, who has been working there for the last 9 years, said that “the staff found the protective clothes uncomfortable to wear.” Adding “The hospital has recently acquired a tempo traveller to pick up and drop staff. Staff remove all the protective kits in the hospital before leaving. Housekeeping staff have a bath, wash their clothes and wear the clothes they came in with. By the next day the clothes would have dried. We asked them to gargle and steam inhalation when they go home”.
Mortuary workers
Dead bodies are shifted from hospital wards to mortuaries when there is an expected gap between the time of death and handing over to the family of the deceased. This could be if the death is suspected to be unnatural and hence police intervention is awaited, possibly requiring a post-mortem or if the family members need time to arrange for the transportation of the body to their home or burial or cremation grounds.
The mortuary workers are all from Dalit communities. They feel that this kind of work is always done by this community. “All of us are SC. It is always SC who do this work. Anyone can do it, but you need to be brave to do this work. Some people just see blood and faint. Some people can’t eat if they do this work, some feel that infection can take place. They can’t do the work. People working in chambers (Manual scavenging) are also SC. We are also SC
Although there is a separate set of staff members for cleaning the dead bodies, sometimes the mortuary workers are asked to clean the bodies and prepare them for post mortem.
Even the post-mortem which includes cutting open the body, taking samples from tissues or fluids, suturing the body etc. is sometimes done by the workers themselves. The doctors stand at a distance and make observations to put into the post mortem report, as reported by the workers we interviewed. “We cut the bodies. The doctors come and do the reporting. We don’t know what they write in the reports. They are educated. We are not.”
If the mortuary workers fall sick, they can go to the BBMP hospitals and this is free of cost for the staff. But they don’t use this facility and prefer going to a private clinic or hospital. “Even if we fall sick we don’t get treated properly by the staff of the hospital. We are staff here and yet we have to wait so much. Imagine how many problems the general public would be facing. So we just prefer to go to private 31 hospitals. I always go to a private clinic for treatment. The government hospital is crowded. We can’t just go and stand in front because we are staff”.
Hearse van and ambulance and drivers
Dead bodies are transported from the hospitals directly or from the hospital mortuaries, to either the home of the deceased or to burial grounds or crematoriums. In the former case, after the rituals, the hearse van provided by BBMP are utilized to transport the dead body to the final burial ground or crematorium. In case of death that occurs at home as well, after the death is certified to be natural, the dead bodies are transferred to the burial grounds or crematoriums via hearse vans.
Burial ground and crematorium workers
The nature of work performed by the workers includes hard physical labour in terms of digging the graves, carrying the bodies from the ambulances or hearse vans to the grave, lowering the body into the grave and then filling up the grave. The cemetery receives both physical body as well as ash for burials. They have been accepting both COVID as well as non-COVID-19 bodies. There is no separate protocol for burial of bodies/ashes of those which had tested positive for COVID. The workers have been provided masks but they said that they felt suffocated while doing digging work, and hence are not wearing masks inside the cemetery. The workers have not been given any specific training or awareness about Covid and the precautions to be taken. Most of the information they get is from phone messages and television. The supervisor mentioned that since COVID-19, the number of burials have increased at the cemetery. Usually they get 80-90 burial requests per month, but by the 20th of this month itself, they have already received 100 burial requests.
Pourakarmika workers
Pourakarmika literally means municipal worker. The Karnataka Municipal Corporations Act 1976 defines pourakarmikas as “a person employed in collecting or removing filth, in cleansing drains or slaughter-houses or in driving carts used for the removal of filth excluding night soil” Since the Corona started, BBMP officials have not done routine check ups which they are supposed to do every 3 months. They haven’t given workers good quality masks. Their health has to be protected, but this is not taken seriously by any of the officials. None of the officials or medical officers talk to pourakarmika workers. Whenever there is a BBMP scheme the focus is on how to make money but not on how the workers can be protected. Workers are told to segregate but they are not told about how this impacts their health. BBMP gets money in crores and they spend it also. There is no data on how much is given to BBMP hospitals.”
Pourakarmikas are predominantly women. Working women need access to toilets, water and sanitary napkins during their menstruation. If these are not available, women may not be able to change their sanitary napkins/menstrual cloth over long periods of time. This, if occurring repeatedly, can put people at risk of pelvic inflammatory diseases (PID), and in younger women, infertility and other pregnancy related complications.
A pourakarmika working in the Shivajinagar area said:- “We are SC. Only SC people come for this work. All our people are SC. We do all the work without any hesitation. The big people should understand this.. Before people were nicer to us. Now they treat us badly. Even if we ask for water they leave the bottle as though we will infect them. This makes us very upset.”
Auto-tipper drivers and helpers
The auto-tipper goes around collecting waste from households in the area. Usually, a pair of workers comprising a driver and a helper are assigned a block of 700-750 houses. They go around the block, stop at street corners, blow a whistle signaling to the residents that they can bring their waste. Since there is no segregation of the waste at source, all kinds of waste is dumped in the auto. The helper standing at the back of the auto, in the middle of the mixed waste, keeps pressing the waste to make space for more. The waste thus collected is then transferred to the compactors which are located at fixed spots. Since there is no segregation at source, the segregation is usually done by the auto-tipper drivers and helpers and the compactor drivers at the transfer points (between 67 auto-trippers and compactor trucks) before the waste is loaded on to the trucks. However, after COVID outbreak, segregation at the transfer points has been discontinued. Sometimes, while collecting the waste from the households, the helpers keep separating the waste while standing or sitting in the middle of the garbage on the autos.
The workers have not been given any training on what kind of additional risk they are exposed to because of their work during the pandemic. In fact the Standard Operating Procedure released by the Department of Health and Family Welfare doesn’t include auto-tipper drivers and helpers among those requiring protection. On inquiring about whether they were aware of Covid contaminated waste being disposed off with general waste, the workers expressed their lack of awareness.
The team suggests identification of occupational hazards, putting in place mechanisms to protect workers from these hazards and monitoring the implementation of these measures has to be a continuous process and not a knee-jerk, ad hoc and temporary reaction to an emergency situation like a pandemic. Hence, we recommend setting-up a permanent mechanism with adequate funds and representation from all these categories of frontline workers to monitor working conditions, labour rights issues, grievances and occupational hazards and take corrective action.