By Prisca Zwanikken, KIT Senior Advisor
Dutch home care workers look after many of the people most vulnerable to COVID-19, often without the protection afforded to other health care workers. They deserve better.
As the pandemic swept through the Netherlands in early March, I was seconded to help in the fight against COVID-19.
It quickly became clear that, like elsewhere, COVID-19 was most dangerous to society’s most vulnerable, such as those with pre-existing illnesses, the elderly – who are most frail and often living in care homes – and the physically and mentally handicapped in institutions. It remains one of the most painful realisations of this pandemic.
Less recognised is the extreme vulnerability faced by the thousands of “home care workers” that care for our country’s elderly.
Home care workers, or caretakers, comprise nearly one third of the 1.3 million health care professionals working in the Netherlands. 98% of these caretakers are women. Often with fewer qualifications, less educated and lower paid than their colleagues in other health care professions, they perform the day-to-day care-taking tasks. And sadly, their work is typically under-valued.
Ill-prepared for the pandemic…
During my secondment, I talked with some of these women caretakers, who will remain nameless to protect their privacy.
From the beginning, it was clear that they were not well informed about the risks. They often lovingly attended to COVID-19 patients without any protective gear. This equipment was in short supply, and what was available was distributed to the hospitals, despite requests from home care directors and doctors.
“Before they were sent to the hospital, I cared for two elderly people suffering from COVID in the same day, holding them in my arms. They were so ill, and I took care of them. What else could I do?” a caretaker told me. She added that two of the three elderly she ultimately cared for didn’t return. They died in the hospital.
Two weeks later she also tested positive for COVID-19. Her diagnosis was likely delayed because care workers were not deemed a priority group for testing at the start of the epidemic in the Netherlands.
What is clear now is that these caretakers didn’t have a voice in the priority setting process that dictated the acquisition of protective equipment. As a consequence, most of this equipment went to hospitals and intensive care units – units often run by male doctors. These male doctors were often interviewed on one television show another other about the heroic work that they were doing, saving people’s lives, and their desperate need for protective equipment, understandably so. But what about nursing and elderly homes?
On 20 May, Dr. Bert Keizer, an elderly care specialist, highlighted the problem in Medisch Contact, a leading journal for Dutch medical doctors.
“Elderly care specialists tried to get their personnel and patients tested, they were flat out refused,” he wrote. “And then there was the lack of protective material. They provided rain ponchos, not enough gloves, reused masks. On 8 May there were still deficits in the elderly care homes, while KLM was handing out masks to passengers.”
An impossible choice
This inequity continues. Having tested positive for COVID-19, and recovered, another caretaker told me: “I will have to go back to work. One of my colleagues tested positive as well, but as she no longer has symptoms, she had to start working again, contrary to the advice of the company doctor.”
Her manager apparently pushed her colleague to do so, saying that if 24 hours had passed without symptoms, she should start working again – according to her interpretation of the prevailing national guidelines – because they were already missing too many workers.
“So I will go to work. Someone has to take care of the elderly; they can’t be left alone, but I’m dreading that I will infect them – what can I do?”
We can and must do better
When it became apparent that the vulnerable and frail were most threatened by the virus, more should have been done to also protect the women and few men who care for them.
It still can and needs to be done. We need to make sure that caretakers receive adequate protective equipment so that they can continue to serve their clients – who are our parents, grandparents, uncles, aunts – and curb the epidemic.
Women caretakers should be better heard, raise their voice and have stronger participation in health care management in the future to prevent these inequities from happening again.
About the author: Prisca Zwanikken, MD, M.Sc.CH, PhD is a Senior Advisor in international public health, human resources for health, curriculum development and accreditation. She is also involved in capacity building and training programmes in Africa and Asia.