Does it matter that for every doctor, you need many nurses and without them, hospitals will crumble? The contrarian stand of the doctors clearly demonstrates the power and class inequality in the healthcare sector.

The fast-spreading strike by nurses in Kerala has laid bare the inherent contradiction in India’s burgeoning healthcare sector: it is a highly exploitative industry dominated by money-minded corporates and doctors.

While the doctors and surgeons earn by the hour, sometimes running into millions of rupees a month, the nurses who form the backbone of patient care are thrown the crumbs. At best, on an average, Rs 4000-8000 a month.

While managements are trying every trick in the book to rein in the striking nurses, including court injunctions and new recruitments, the doctors asked for invoking ESSMA, the essential services maintenance act, the bogey that oppressive governments use against labour unrest. The state unit of the Indian Medical Association (IMA) and the Qualified Private Medical Practitioners Association (QPMPA), an association of private medical practitioners and hospital managements were united in this demand.

The QPMA even went a step ahead and asked the political parties and the government not to encourage the strike.

Does it matter that for every doctor, you need many nurses and without them, hospitals will crumble? The contrarian stand of the doctors clearly demonstrates the power and class inequality in the healthcare sector.

The nurses are now clear that even the doctors they serve 24/7, much less the management, will not support them. Their agitation is spreading to every part of the state threatening to cripple its private healthcare sector. It’s a “white-revolution” that is as spontaneous as the Arab Spring.

The demands of the nurses are very simple. They want decent salaries and better working conditions. Nothing more. In 2009, the state government has fixed a minimum salary of Rs 9,000. A majority of the hospitals do not pay this, although the nurses say that even this salary is inadequate and should be revised.

According to United Nurses Association, the newly formed organisation that galvanised the feeble voices of protest into a snowballing movement, only five per cent of the hospitals in the state pay the minimum wages. In a Kochi hospital where the nurses are on strike, a nurse with 16 years of experience is given only Rs 7,000. Most of the nurses are paid Rs. 4,000-6,000.

The worst off are the “trainees” or the straight-out-of-college nurses. They are usually paid Rs 1,000 or so and work under bonded conditions. This is widely prevalent in hospitals outside the state, where the managements even confiscate their certificates. The state of their bonded condition was brought to light, when a nurse committed suicide in Mumbai last year. The trainees suffer in silence in the hope of a few years experience so that they can shift to a bigger hospital or go abroad.

The flicker of protests first appeared at the end of last year with Keralite nurses going on strike in Mumbai, Delhi and Calcutta. Early this year, about 800 nurses from a “multi-speciality” hospital in Kochi and another 600 in a private medical college hospital in a southern district went on strike, followed by several other hospitals.

The organisational capacity of the nurses has strengthened considerably since they agitated in Mumbai and Delhi. They were so busy with enslaving work that they didn’t even know how to organise a protest without inviting criticism. The main charge against them has been that they didn’t give sufficient notice to managements and the patients suffered.

The labour minister of Kerala, Shibu Baby John, while supporting nurses advised them to follow fair labour practices, such as sufficient advance notice, so that they are on good legal footing. Now they serve notice and go on strike. The Association says that more hospitals have been served notice, including the one where they had reached an agreement last year. Apparently this hospital reneged on their commitment.

The doctor-management nexus that the strike has brought to light was not unexpected given their mutually beneficial stakes. “IMA seeking ESMA against striking nurses is only a ploy to protect hospitals, some of which are owned by its members.” according to Jasmin Shah, State President of the United Nurses Association. The doctors also came in for severe criticism from civil society because they went on strike several times in the recent past. “If the IMA can call for state-wide strike when doctors face a problem, why can't we agitate for minimum wages," is Shah’s counter.

Meanwhile, support is pouring in from all quarters. The CPM, the CPI, the women’s wing of the Congress and INTUC have openly supported the cause of the nurses. The labour minister remained categorical that he wouldn’t allow anybody to pay the nurses below the minimum wages and violate labour rules. The State Women’s Commission member T Devi said that the commission will intervene if the nurses asked for help.

Even the courts are on their side. While responding to a plea on the issue, the Kerala High Court said last week that nurses were being exploited. They were forced to work for low salaries and that is why they were on strike, the court said. Some private hospitals haven’t revised the salaries even in the past ten years.

It’s worthwhile to note that when the nurses from Kerala went on strike in Mumbai and Delhi last year, the politicians in Kerala hardly paid any attention since they were busy with a politically expedient Mullaperiyar.

However, the nurses didn’t wait for any patronage. Their working conditions were so exploitative, that they abandoned their fear of job-(in)security and anxieties about hefty loan-paybacks. The sincerity of purpose paid off. Now that their movement is gaining momentum, all political parties want a share of the success.

The doctor-management voice against them continue to demonstrate the class struggle in the healthcare sector.