Health ‘invisibles’ report burnout and discrimination

Nursing technicians, family health agents, stretcher workers, ambulance drivers, cleaning, kitchen and maintenance personnel, burials. Essential in health services and present on the front lines of the Covid-19 pandemic, 80% of these workers at the technical and auxiliary levels report professional burnout related to psychological stress, anxiety and mental exhaustion.

In the largest study ever carried out to assess the mental health and working conditions of those considered “invisible” in health, researchers from Fiocruz (Fundação Oswaldo Cruz) show that the routine of most of them is marked by social inequalities, work overload, lack of labor rights and prejudices.

The survey heard 21,480 workers from public, private and philanthropic health networks, from 2,395 municipalities in all regions of the country. The contingent is made up mostly of women (72.5%), black or brown (59%), with 32.9% of them up to 35 years old and another 50.3% up to 50 years old.

A quarter (23.9%) of these professionals already have important comorbidities: 32%, hypertension; 15% obesity; 13% lung diseases; 12%, depression, and 10%, diabetes.

According to sociologist Maria Helena Machado, Fiocruz researcher and research coordinator, the study reveals that these workers, who number close to 2 million in the country, are victims of social discrimination within the hierarchy of health services and that managers need to of health look at them.

“They live in poverty, in suffering. They sleep poorly, eat poorly. They lack wages, infrastructure, minimum working conditions. They work in unhealthy environments, many do not have access to PPE [Equipamentos de Proteção Individual] recommended or, when they do, are of low quality or used outside the protocols. Some claim that they have already had to buy alcohol, a mask, with their own resources. Others had never used an N95 mask.”

An oral health technician who works in an ICU says that, in order to follow the required protocols, it would be necessary to wear appropriate attire and work conditions that do not exist in the hospital where he works. “We are required to wear an N95 mask for 15 days,” says one of the respondents to the survey.

According to the study, in the pandemic, the workday has become even heavier. For the vast majority (85.5%), it reached up to 60 hours per week. “They had to replace colleagues who were away or who died. Many saw their colleagues die and, even so, they worked sick for fear of not receiving their salary”, explains Machado.

According to the researcher, many of these professionals have no ties to health institutions that guarantee labor rights. “They are considered autonomous, but they don’t have the social ballast of doctors, nurses, that allow them to work in one or two places in the health area.”

Just over a quarter of workers (25.6%) need to work odd jobs to survive because they earn between one and two minimum wages. “After they take off their health care uniform, they become bricklayer, security, doorman, app driver, nanny, cleaning lady,” says Machado.

The results show that 53% of the “invisible” of health do not feel protected against Covid-19 at work. The generalized fear of being contaminated (23.1%), the lack, scarcity and inadequacy of the use of PPE (22.4%) and the absence of necessary structures to carry out the work (12.7%) were mentioned as the main reasons for unprotection.

An ambulance driver interviewed in the survey says, for example, that he is required to wear a single protective mask for two or three days, when protocol recommends changing it every two hours.

“Materials are scarce, we have to use them for two or three transfers of patients with Covid-19. Currently, the physical risk is even greater because we have to get the stretchers alone, without the help we had before. And when the paycheck we see that neither [o adicional de] complete unsanitary we received. The hospital only pays 20%.”

For 54.4% of the workers interviewed in the survey, there was also negligence in training on Covid-19 processes and the procedures and protocols necessary for the use of PPE.

According to the researcher, 70% complain about the lack of institutional support and 35.5% report having suffered violence or discrimination during the health crisis: 36.2% in the work environment, 32.4% in the neighborhood and
31.5% on the home-work-home route.

Machado recalls that these workers were also not prioritized in the vaccination against Covid. “The vaccination took place much later for the stretcher workers at the hospitals, the cleaning, cleaning, disinfection staff, family health agents. Some categories had to file injunctions to receive the vaccine because they were not considered health and much less essential.”

The survey results were presented in a live last Thursday night (23) to the two largest representative confederations of public and private health workers, the CNTSS and CNTS.

For Benedito Augusto, president of the CNTSS (National Confederation of Social Security Workers), the research draws attention to the race and gender of workers. “We have the health slave quarters [com mulheres pretas sendo a maioria desse contingente]. This research shows the face and soul of health working conditions in the country.”, he stated.

He states that, in conversations with workers from São Paulo about working conditions in the pandemic, the main demand was not a wage claim. “They were afraid of dying, of taking death home. These people feel dehumanized, they want to be seen in their citizenship.”

For Vandirlei Castagna, president of the CNTS (National Confederation of Health Workers), health managers, parliamentarians and the business sector need to protect the most vulnerable professionals and look more sensitively at the historical claims of the category.

He states that the research pointed to practices, such as the hierarchy in the use of PPE, which are inconceivable. “Some categories use PPE better than others. It can’t be that way. It’s everyone’s right regardless of their role.”

For Castagna, although the pandemic has brought more visibility and recognition by the population to health workers, this needs to be translated into concrete and objective acts.

In the perception of many health workers interviewed in the survey, the feeling is that there was no recognition of work during the health crisis by health managers. “The biggest lesson I learned from this pandemic was that the time we should have had the most professional support was the time we were most exploited,” said one of the interviewed burials.