The coronavirus has exposed all the old ulcers of the Ukraininan health care system. Radical medical reforms have led to cuts in the number of health care facilities and staffing, as well as changes in funding procedures. And although the country has declared a state of emergency, the launch of the second stage of the reform has not been postponed.
Women make up the majority of secondary and junior medical staff in Ukraine. They, as well as their families, have been hit hardest by the government’s controversial anti-epidemic measures. For many years, public health care has been one of the Ukraine’s most neglected and underfinanced sectors, with a significant degree of internal gender segregation.
The health care sector is viewed as service-oriented – and held to be of secondary importance. It is also seen as "female", both due to its staff composition and the gendered symbolism surrounding care work. There is considerable gender inequality in the Ukrainian medical sector: doctors, who are well-paid and often highly respected, are mostly men, while middle and junior medical staff, whose work is not considered highly qualified and therefore poorly remunerated, are mostly women.
Nursing is still considered a female profession, as the general public still believes that women’s “naturally” caring personality traits make them good nurses, while such traits are not expected of men. The public expects nurses to care for patients at any cost, including the cost of their lives and the well-being of their families. Care is perceived as their calling, their mission and their obligation – and there is a distinct gender dimension to it. For example, the Code of Ethics requires nurses to have an "organic alloy of high moral qualities", to protect human life “starting from the moment of conception", to demonstrate humanism and compassion. In addition, patients’ recovery is expected to be nurses’ most valuable remuneration for their work. Apparently, it is also the only remuneration, because the extremely low salaries of 174-222 USD per month (the average salary in Ukraine being 355 USD as of January 2020) can hardly be considered a reward.
Gender inequality in the predominantly female sphere is reflected in the way nurses are treated, which mirrors overall attitudes towards women in society. Therefore, nurses are often perceived as embodiments of common gender stereotypes: low-skilled servants or motherly “ big sisters” (the term “nurse” in Ukrainian literally means “medical sister”), respectively extremely competitive persons who should not give up in the face of stress or danger.
Although nurses, paramedics and midwives make up the backbone of any health care system and the majority of service providers in medical sectors worldwide, in Ukraine they seem to be viewed as commodities.
Nurses lack personal protection supplies more than doctors, though they are under a higher risk of infection due to longer contacts with patients. In addition, nurses still have to take care of their families. Multi-day work shifts, flawed transport logistics, and wages that equal 50% of the average wage – such is their reality in these hard times. Many medical staff have never seen a protective suit except on TV or are forced to share one suit among all. Hot meals are not available to hospital staff; at best there are buffets with tea and cookies.
A map that indicates the availability of personal protection supplies in 40 “stronghold” hospitals in the oblasts shows a striking picture (see razomukraine.com - RAZOM.ua being a public platform). Most health care facilities have not yet been provided with necessary supplies like protective masks and goggles, while volunteers are becoming key providers of necessities.
The government’s anti-epidemic measures included a complete shutdown of public transportation both within and between cities. This has effectively cut off junior medical staff, who mostly live outside the city and do not have transport means of their own. Thus, whoever has not been forced to take vacation days needs two to three hours to get to work. As a response, volunteers have launched a “give a medic a ride” initiative.
The situation is becoming increasingly difficult, as many nurses are in the high-risk age group, with many younger trained medical professionals having left the country in search of better-paid jobs and environments with a better attitude towards their profession and their gender.
Although it is impossible to obtain accurate statistics on COVID-19 patients, 15% of all infected Ukrainians are estimated to be hospital staff. Because of the described conditions in medical facilities and a lack of personal protection, medical staff are leaving collectively. This has been the case in four oblasts out of 24.
The health care union is not prepared to accept that medical staff be “sacrificed” during a pandemic, without a change of attitudes, without provision of protection, and without salary increases: "We will not allow the health and lives of medical professionals to be put at risk."
Dr. Marfa Skoryk is a feminist researcher and director of the Kyiv Institute of Gender Studies. She is a certified trainer-consultant on gender equality and holds a certificate of the Ministry of Social Policy of Ukraine. Since 2000, she has specialized in gender issues in public policy and governance, methodology of gender analysis and intersectionality, as well as advocacy for women's rights.