Saturday, June 27, 2009

An epidemic of health care worker strikes

This seems to be a summer of strikes among health care workers, raising again the ethical issues surrounding hospital strikes, particularly in resource-poor countries. On the one hand, state-paid doctors often work in abysmal conditions for relatively meagre wages, and when a strike breaks out, it is often a matter of doctors and nurses finally reaching the end of their tether. On the other hand, patients suffer when health care workers strike. They must wait longer or seek alternative care -- if such care is available and affordable. In many poor countries, the alternatives to health care in state hospitals are few. Traditional healing is one. No care at all is another. The impact of such strikes on patients are rarely the object of scientific study, but surely long and lingering strikes, where only the bare minimum health services remain in place, must be a source of avoidable morbidity and mortality. In the middle of all this you have the Ministries of Health: sometimes acting as mediators, and sometimes (because they are arms of government) the origin of the dispute and an obstacle to its resolution.

The provinces of Kwazulu-Natal and the Eastern Cape in South Africa are in the midst of a prolonged strike. State health care workers in Zambia are facing dismissal by the government if they do not show up to work by next Monday. In Adamawa state in Nigeria, health workers have started an indefinite strike and patients seem to be leaving the abandoned wards of clinics and hospitals in droves. And in the Democratic Republic of Congo, a health care workers strike has been going on for ages, though generally unreported in the press. Our sister blog, The Francophone African Bioethics Blog had a piece about this (in French) back in May, and the strike is still unresolved.

Each strike has to be judged, from an ethical point of view, on a detailed and (ideally) balanced account of the relevant facts. But some basic principles should be followed. Urgent medical services should always continue to be provided during a strike, and those providing them should not be regarded as 'scabs' or strike-breakers. Health care strikes should be regarded as qualitatively different than strikes in other labor sectors, due to the special value of health. For that reason, a as-swift-as-possible resolution of the strike should be the top priority of the health ministries involved, because of the impact that every day of the strike has on the ethical core of the issue: patient health.


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