1 nurse for an entire ward? | ‘Caring for Filipino nurses, a step toward improving public health system’

Infographic by John Aaron Macaraeg/Bulatlat

“It is not easy to see your patients suffering. Our profession demands that we provide holistic care.”

By JANESS ANN J. ELLAO
Bulatlat.com

MANILA — The year 2016 was a dark time for Marylou Anto.

Just three months into finally becoming a regular nurse for a government hospital in Camiguin after nearly a decade of working as a volunteer, all of the fruits of her hard work seemed to have shattered.

Anto earned the ire of their provincial governor after a photo she took of a referral note that patients need to secure to access public health care went viral. She was consequently dismissed from service.

Read: A nurse’s plight under health care system ruled by patronage politics

Her plight did not only put a spotlight on how public health care is at the mercy of local politicians under a devolved system but also of how nurses are least cared for even as they are expected to carry out the best service to their patients.

Read: Philippines- The unhealthiest of poor countries

This week, Anto joined a group of nurses, the Filipino Nurses United (FNU), in calling for a just pay increase. Incidentally, the Supreme Court, in its en banc ruling this week, declared Section 32 of the Republic Act No. 9173 or the Philippine Nursing Act as valid. The law states that nurses are entitled to a minimum monthly salary of P30,531. However, the high court did not grant the prayer to compel its implementation as it would “require a law passed by Congress providing the necessary funds for it.”

However, instead of increasing the health budget, the Department of Health will be cut by P9.4 billion in 2020. As it stands, Sen. Ralph Recto estimated that about 10,000 health workers, of whom 7,000 are nurses, stand to lose their jobs.

For Anto, the recent developments in their struggle for better working conditions and just pay show the imperative of unity and solidarity among nurses and health workers group — both here and abroad.

Working conditions

In 2009, Anto worked as a “trainee” at the Camiguin General Hospital, where she received a measly salary of P2,000 ($39) a month. Without a union and working in a deeply politicized environment, Anto said she endured the long wait to finally either become a “job order” or contractual nurse, or become a regular nurse should one holding a plantilla position resigns or retires.

During the press conference, FNU president Eleanor Nolasco said nurses in public and private sectors are receiving a monthly take home pay of at least P18,000 ($349) to 21,000 ($407) and P8,000 ($155) to P12,000 ($232) respectively. This, she added, is a far cry from the government’s own data, saying that a Filipino family needs at least P40,000 ($775) to live decently.

The benchmark P30,000, she explained, hailed from the existing law from over two decades ago, saying that nurses should receive at least P25,000 ($484) a month.

“It is not unreasonable to ask for P30,000,” Nolasco said.

Welcoming the Supreme Court’s decision over the validity of their base pay, the group said a P30,000 entry-level pay should be implemented for nurses working in both public and private sectors.

Nolasco said the poor salary that nurses are receiving compels them to either leave for abroad or work in non-nursing related jobs. As such, she said, the country is losing its skilled human capital “and the ones who suffer the most are the people, especially those who do not have access to quality care.”

Take care of the nurses

With 40 years of nursing experience, Zenei Cortez, president of the US-based National Nurses United, told Bulatlat she was surprised over the stark difference in their working conditions with their Filipino counterparts.

Cortez deplored the long hours of work, low pay, and the seeming absence of their right to free speech and voice out their complaints among issues.

“Hopefully, they will start (addressing these). As nurses, we take care of ourselves last. Patients go first. But if we don’t take care of ourselves, there will be no one to care for our patients,” she said, adding that nurses are the “first and last line of defense.”

FNU noted that the Philippine government has yet to fill in vacant plantilla positions for nurses. Instead, it has resorted to hiring contractual or “job order nurses” that the government may temporarily employ with little job security and limited benefits.

In 2019, about 13,000 plantilla positions have not been filled.

The US-based nurse was shocked to learn that there were instances when the nurse-patient ratio is one for the entire ward, referring to San Lazaro Hospital in Manila, where its ward has about 50-bed capacity.

“What kind of care to patients can you give if you are too stretched?” Cortez said.

Cortez added, “Filipino nurses have suffered long enough. It is about time that they are appreciated.”

Do not pit nurses’ plea for better pay vs. public health care

In a speech during the second day of the FNU congress, nurse Jaymee de Guzman of San Lazaro Hospital assailed how the poor public health system is being blamed squarely on health workers.

“We may not be posting it on social media, but we chip in funds for our indigent patients,” she jested in her very emphatic speech.

Read: Gov’t hospital workers respond to dengue cases amid limited resources

Anto, for her part, said she has witnessed how indigent patients are forced to beg for local government officials for help. At times, when they are known to be a supporter for another political clan, they return to hospitals empty-handed.

Nursing, too, has become an “art” as they often tap their creative juices to “find ways” and improvise for certain equipment that are not provided to them such as the case of oxygen hoods for babies, where they use water gallons.

“It is not easy to see your patients suffering. Our profession demands that we provide holistic care,” she said.

Instead of pitting their calls for better pay and working conditions with the uplifting of public health system, the FNU said “improving the worklife conditions of nurses will contribute to the overall goal of achieving people’s equal access to health care.”

In a statement, FNU said nurses, as part of their experience and training, have become familiar with patterns of health and disease conditions that affect the population, including control and prevention.

Through the years, the group said health has become the least priority for both national and local governments under the devolved system, resulting in a “deteriorated and weakened public health.”

Budget cuts to make health care more inaccessible

Public health facilities, they added, remain lacking in equipment and suffer from poor nurse-patient ratio, and dire working conditions of its health workers.

As such, the resurgence of the likes of polio, diphtheria, and the surge of measles cases did not come as a surprise “given the underfunding and decades-long neglect of the public health system.”

Finding support in the midst of a difficult struggle

If there is anything Anto learned from her struggle for reinstatement is that there is power in collective action.

Going against the tide in a province long-considered as bailiwick by its then governor has made Anto lose friends. Even some of her relatives have distanced themselves from her, fearing reprisal from mere association with her.

The help and support she needed the most came from people she least expected. Some she did not even know personally.

“They reached out to me,” she told Bulatlat, referring to the FNU, “they gave the moral boost I needed.”

The recently-concluded two-day Congress held here in Manila has provided Anto a deeper appreciation of the need to form unions, where nurses can negotiate with their respective employers on various concerns affecting their productivity, safety, salary, among others, either through collective bargaining or negotiations.

She said, “it has been very inspiring. I hope to learn more from my colleagues.” ()

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