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Who is a health-care worker ?
I am one of about 60 million health-care workers in the world. That makes me among less than 1% of global population; a good enough reason to celebrate. Professionally trained doctors, nurses, pharmacists, and paramedical staff constitute about three-quarters of us, and others could be helpers, trolley-bearers, support and security staff. Historically Health-care-workers (HCWs) work out of physical facilities, but this constraint is changing fast. There are many other individuals, linked to health-care delivery such as ante-natal midwives, community health workers, and health volunteers together identified as front-line-workers (FLWs). During COVID-pandemic we woke up to many more front-line workers, such as policemen, teachers, bankers, transporters, and many others. During COVID-pandemic, HCWs were only about 17% of all FLWs. Indeed health is a collective responsibility, especially during times of a crisis.
What it really means to be a HCW ?
There is no better contemporary learning than COVID-19 pandemic to understand what being a HCW means. In March 2020, when the pandemic had already struck elsewhere in the world, there was a mixed bag of emotions. While, some felt stuck in health-care profession worried that they would be first to fall prey, most identified it as their calling. Initial fears blew away in first weeks, and eventually all HCWs braved unknown disease and uncertain treatments with conviction and resolve to do good.
In first nine months of first wave, before any vaccines were administered in India, it was a tiring time doing good to patients, and protecting self and families too. We failed a countless times, but invigorated ourselves soon to prevent another failure. As imbibed from ancient times, doing-good is what being a health-care worker really means. While we deal with sadness more often, bringing a smile back is what we strive for.
Health-care role in community
Health and education complement each other, and these two are key ingredients for a prosperous society. While HCWs have required a facility to anchor themselves to, it is always a matter of pride to reach-out (or outreach) beyond. Physician outreach, for remote dwellers evokes a desirable socialism in HCWs. Often yield of outreach is debated, if frugal means and flying visits would do any good. At the least, it inspires confidence that health-care is accessable.
Concept of outreach care has grown from short-lived disaster relief, mobile dispensaries and regular clinics to community engagement in health. Current outreach programs focus on specific needs (such as maternal and child health, de-addiction, alcohol, hypertension etc). Outreach HCWs interact through FLWs for better health-education and confidence building.
Health care worker in primary care
Primary care is when first symptoms and signs of disease are identified. It is typically delivered in a facility, closest to the community, that exclusively caters to out-patients. Most ailments have simple solutions, and may not need diagnostics beyond basic senses of a HCWs – To see, to hear, to touch, and to smell. Ancient HCWs also used fifth sense of taste at times, which today is replaced by simple chemical testing of body fluids.
In post-world war era, World Health Organization has championed primary care, as a pivot for entire health-care system. Current ambition of universal health-care stands on the shoulders of effective primary care. Unfortunately, most HCW shortages are in primary care, especially in remote and rural locations of low-income economies.
Health care delivery is a team work by various HCWs
Effective health-care delivery does not rest on shoulders of doctors alone, who barely make about 15% of total HCW workforce. While early postal stamp images dominantly depicted a physician with a stethoscope. more recent issues have focussed on a team of doctors, as well as nurses. This teamwork is represented in operation theatres, as well as other patient-care areas. Effective health-care, especially in secondary and tertiary care settings is delivered by a team of doctors, nurses, pharmacists, laboratory staff, physiotherapists, trolley bearers, and support staff.
Nurses represent more than half of all HCWs. They also stay longest with a patient, either with hospitalised patients in the wards, or patients undergoing surgery in operating rooms. Nurses are also most vulnerable to acquiring infections such as tuberculosis or hepatitis as an occupational risk.
First half of twentieth century established science of diagnostic laboratories, initially for infections, and thereafter for cancers and chronic diseases. What HCWs could never see under a naked eye, could now be seen under a microscope. This breakthrough now engages about 10% of all HCW workforce as pathologists, microbiologists and other laboratory personnel.
Stereotypes among HCWs
In almost all stamps above, there is a clear gender stereotype. Women are nurses, and men are doctors. These stereotypes are fast fading. In India proportion of women studying to be a doctor is around 51%. Similarly, in South Africa about 40% of doctors are women. In India, nursing was an exclusive female domain, and recent estimates suggest proportion of men to be rising to 16-20%. It is heartening indeed to see women doctors depicted in postal stamps, and expecting a similar gender-balance among nurse-depictions too.
