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COVID-19 and the health sector: vulnerability, occupational precariousness, and excess of mental load

Workers from 10 careers participated in the study of sector 1: nursing, physiotherapy, surgical instrumentation, speech therapy, occupational therapy, bacteriology, dentistry, respiratory therapy, medicine and nutrition, assistants, technicians, and other professionals in administrative duties and support in healthcare services.
 

Associations, professional schools, and trade unions designed an electronic survey of 45 questions and answered by 1,562 workers of a large portion of Colombia. The survey questioned individual and working information as well as biosafety conditions and the impacts over their healthcare and occupational precariousness.
 

Among the results, regarding the biosafety conditions–including, delivery personal protection equipment (PPE), use of safety protocols, reorganization of processes and spaces and structural improvements–just 65% of the workers with a contract and stability say these conditions are fulfilled, and just 54% for workers with services provision contract or other types of contracting modes.
 

Read more: Has Colombia complied with international WHO recommendations for managing COVID-19?
 

Given that in the healthcare sector 6 of every 10 workers have precarious contracting forms; we can conclude that most of this workforce is working under critical conditions.
 

Lack of protection


A heartbreaking sample of this situation is the scarce fulfillment of 10 elements of key protection in times of the pandemic such as gloves, surgical masks, and garments; aprons; medical gowns; leg protectors; caps; eyeglasses or eyes protectors; and N95 respirators. According to the study, in no case, 100% of these elements are guaranteed, being gloves and medical aprons and uniforms the most critical with a report of 5.4, 23, and 36% respectively.
 

84.4% of the participants were members of Positiva, Suratep, Colmena, Colpatria, and Bolívar occupational risk administrators, which should take action to remedy this situation. In this respect, the report of July of the Comptroller General of the Republic 2 indicates that delivery of personal protection equipment from ARL’s such as Sura and Positiva is insufficient, complying with only between 15 and 20% of their obligations.
 

This situation opens the door to question the additional funds the government allotted specifically for the submittal of PPE to the ARL’s, which is 5% of the total membership fees plus other additional funds.

Read more: Pandemia, pandemonium, and pananomia (in Spanish).
 

Mismanagement of positive cases


In regards to the management of COVID-19 positive cases, the healthcare organizations engineered a second instrument directed to characterize the impact of the health conditions and its management during pandemic care. This instrument was answered by 1,869 workers, identifying 264 cases with symptoms or confirmed diagnosis for COVID-19.


The discoveries indicate that there has been inadequate management of these cases, highlighting situations such as the lack of an ARL report (42%), a continuation of working activities despite the presence of symptoms (21%), and quarantine without guaranteeing salaries (16%). Among one of the conditions that increase the risk of infection are working in highly complex situations, increasing the risk by 40%.
 

High workload impacts mental health


A large portion of the surveyed referred to stress and mental suffering, and it was established that being in contact with COVID-19 patients increases the risk of having mental health issues by 47%; working without individual protection 25% and without protocols, 29%. These aspects, plus the fact that during the pandemic, workers complained of increased workload (31%), of increased work hours (21%), and diminished salaries (20%), making the working conditions very critical for workers, again, with worse conditions for the workers with an indirect contract and without work stability.
 

Another group with greater exposure is for workers who carry out home delivery activities. This situation requires special attention from companies and employees responsible for these services, as many assume that exposure in home delivery and communitarian services is less than in clinical areas, which ends up underestimating the risk.
 

Besides, they discovered that a high percentage of these workers have precarious contracting conditions, therefore, as mentioned before, increasing the exposure.


Read more: Where is the pandemic going?


Based on this information, worker organizations have begun to file lawsuits and perform social protest and will continue to carry out the strict follow-up of the actions and allotment of funds to guarantee dignified working conditions. Furthermore, they demand the control entities carry out a similar process, particularly in regards to the actions taken by the ARL’s, which in words of the Inspector General of Colombia, Mr. Fernando Carillo, “they have been negligent, provoking the contagion and death of healthcare personnel” 3. Also, these organizations promote the establishment of a national pact which includes the introduction of complete guarantees for working in the healthcare sector.

 


1 Asociación Latinoamericana de Medicina Social y Salud Colectiva; Asociación Colombiana de Fisioterapia; Colegio Colombiano de Fisioterapeutas; Asociación Colombiana de Estudiantes de Fisioterapia; Asociación Nacional de Enfermeras de Colombia; Consejo Técnico Nacional de Enfermería; Organización Colegial de Enfermería; Asociación Colombiana de Facultades y Escuelas de Enfermería; Asociación Colombiana Estudiantil de Enfermería; Colegio Colombiano de Terapeutas Respiratorios; Asociación Colombiana de Estudiantes de Terapia Respiratoria; Asociación Colombiana de Facultades de Terapia Respiratoria; Colegio Colombiano De Instrumentación Quirúrgica; Colegio Colombiano de Fonoaudiólogos; Colegio Colombiano de Terapia Ocupacional; Colegio Nacional De Bacteriología; Asociación Colombiana de Facultades de Odontología; Asociación Nacional de Entidades de Formación para el Trabajo y el Desarrollo Humano; Sindicato Nacional de Salud y Seguridad Social; Federación Odontológica Colombiana; Asociación Colombiana de Profesionales en Atención Prehospitalaria- ACOTAPH; Nutricionistas Unidos y Actualizados (NUYA).

2 Contraloría General de la República. Comunicado 090. ¿Cómo trabaja el personal con exposición directa al COVID-19? Contraloría recibe y tramita múltiples denuncias ciudadanas por deficiente o nula entrega de elementos de protección personal.

3 Gossain, J. Esta es la verdadera situación que vive el médico en Colombia. El Tiempo, 12 de agosto de 2020.

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