WHAT KIND OF HEALTH TOMORROW? PROFITABILITY LOGIC, POLITICAL INDIFFERENCE AND COVID-19…

INTERVIEW WITH MOUNA CHOUATEN, SPECIALIZED NURSE, ACTIVE IN THE ASSOCIATION « LA SANTÉ EN LUTTE⁽¹⁾

Alexandre Penasse: How long has the association existed and what does it do? In the framework of Covid-19, what is being done in particular and what do you claim?

Mouna Chouaten: The first general assembly of Health in Struggle was held in June 2019. It was born from a strike movement that took place on the Iris network in Brussels. The goal of Health in Struggle is to get the voice of the field. We are not at all associated with nursing profession representations, such as the FNIB or the CN, nor with the unions. We are field people (nurses, workers, stretcher bearers, orderlies, physiotherapists, etc.). We had already started strike actions and demonstrations almost a year ago, but they were not well publicized. There was a little bit of talk about it on the radio, it was small groups demonstrating, but there was not a large national movement that could be heard. Since then, the Covid-19 crisis has exacerbated the difficulties on the ground and it has also exposed the rather despotic face of our politicians. We were completely abandoned, we were considered as cannon fodder. The entire health care system was angry. The movement, we follow it very closely to update the reality of the field killed in the news. A concrete example: we have coronavirus deaths that are counted and reported in the media, and at no time is there any mention of health care personnel who are infected or who have died. We count them so that we can put numbers, names and faces behind these sacrificed personnel. While today it is not normal to die as a caregiver of Covid-19.

Paradoxically, Covid-19 has allowed you to make your struggles known. I recall, as you also say, that Maggie De Block has postponed a bill to reduce aid to hospitals by 48 million € and recently, on May 4, there was a bill to requisition hospital staff⁽²⁾. All of a sudden, you are the heroes, while just before you were cutting health budgets, reducing hospital staff. Now that it’s calming down, you’re being requisitioned. You were very obedient in the end, since you were prevented from taking time off until the end of June, you accepted many constraints… What is your perspective on this situation and these inconsistencies?

For most, accepting these constraints was fairly normal. We saw what was happening in Italy, we did our job. But at the moment, Covid services are being closed down in care institutions, so intensive care requires less work because there are fewer Covid patients, knowing that these treatments are still quite heavy. And today, when we discover this decree that talks about requisitioning… We are in the process of deconfining abnormally: we don’t check the parameters, we don’t wait 2 to 3 weeks between each step, we deconfine from week to week, it’s a mess in many stores where there are lines… I’m sorry, but we see this and we think,  » My God, what’s going to happen to us? 

A second wave will fall on us. There was no consultation, no discussion and Minister De Block is lying to us when she says that she has collected the opinion of the field. The « field » for her is the recognized nursing organizations such as the FNIB or the CN. However, they were asked if they had been contacted, but they never were. This is something that De Block decided on her own. On a TV show, she said she didn’t understand why the nurses were so shocked. We are lied to and taken for fools. So, you are obliged to go to work and if you can’t, if you refuse, you risk imprisonment and a fine. But where are we now? It’s just not possible! This is unacceptable. So, we don’t give a damn about the recognition of politicians! They have never recognized us, it is not today that they will recognize us. They thank us, but it’s manipulative, it’s to look good in front of the public. It’s like saying,  » Oh, we understand what you’re going through, thank you, thank God you’re here ‚ » but they don’t give a shit, we’ve never seen Mrs. De Block come and see what’s going on in a hospital. We didn’t see Mrs. Wilmès come to see what was going on in the field, they don’t care⁽³⁾. They make global decisions, and in their global vision I think that what is most important is the economy of the country, the money. But in the end, the human lives and what is really at stake in the care institutions are not taken into account at all.

This order refers to requisitioning, but also to the fact that nursing acts can be delegated to unqualified care personnel. The profession is being sold off at the expense of patient safety. And all this without a framework, without rules, we don’t know what can be discharged or not. The consequences? If a patient files a complaint against an unqualified caregiver, we don’t know who it’s going to fall on: the unqualified caregiver, the nurse, or the physician who mandated? There is nothing clear. And you can’t provide care without being qualified. We really feel a gap between us and them.

There is a real divide that you highlight between politicians, the media and the people on the ground. They seem to be off the ground. Premier Wilmès said that masks should be subject to the logic of supply and demand. Are hospitals currently buying masks at market prices?

Yes, but the hospitals are a mess! There are businessmen who have economic relations with China, who used to trade in real estate or textiles and who have now turned to masks. And so the care institutions try to find masks as they can. The population was called upon to sew the masks, and these people are trying to sell them to institutions at incredible prices! And what scares us is that now supermarkets sell masks. Where did this come from?! Because since the beginning of this epidemic, we were in search of masks, victims of the incompetence of management of the politicians. We talk about decontamination, about the fact that the mask is more and more recommended and compulsory in public transport, then a few days later we learn that these masks will be sold in supermarkets, at prices between 35 and 70€. Even today in the hospital, we do not have enough masks, some departments work without masks.

Does this paradoxical situation allow a political awareness among your students, do you feel that something is taking place? Do they realize that trusting politicians and the mass media no longer seems possible?

Yes. Hospitals have not been doing well for a while, but this has been compartmentalized within the hospital institution. We can almost speak of a dictatorship and harassment regime, you have to follow the movement with submission. The logic of profitability puts pressure on the nursing staff. So, this anger, we had it especially towards our directions. We didn’t dare express ourselves too much. Today, Covid has come to show, in a general way, that the problem does not necessarily come from the management of the care institutions, but from much higher up. Health care managers are also required by politicians to adopt this Taylorian, technocratic management , based on the budget, on money and not on care itself. Even though we are led to believe that the human being comes before everything else, this is not true. And it’s become really useful to point out that it’s because of policy decisions that we’re in trouble.

What about two-tier health care with private and semi-private hospitals, think of the hospital industry that has just been created in Delta? How do you mobilize staff in private hospitals, for example? What is your vision regarding this?

It is very complicated. We already have a different way of working. Private hospitals are under even greater pressure, which is now reaching public hospitals. But to mobilize nurses, they would have to have the courage to come forward. I had a discussion with a friend who works in Delta in a large department. I tried to bring her into Health in Struggle, and she said,  » No, look, I’m on Facebook, anonymously because I’m scared. I know that our management is monitoring Facebook « . But for that, you don’t have to go to Delta. I myself, in a public hospital in Charleroi, was monitored on Facebook and was also cut off from my colleagues in the hospital. I had to leave, having become the « head to cut ». I spoke out loud about what others were thinking and I was called to the management. I think you need even more character in the private sector than in the public sector if you want to show off. What is also unfortunate is that alongside Health in Struggle, there are other groups, such as Take Care of Care and Oxygen, that are emerging separately. The ideal would be to have a single movement that can take over the entire staff, to have more strength. Overall, the various groups make more or less the same demands, but not necessarily. So, ideally, we should have one movement to block.

Beyond the applause, do you think that the population will support you, especially when you talk about demonstrations, wouldn’t it be the moment to call for a big demonstration with clear demands, everything we are saying here? And, as a sub-question, don’t you think that in this clapping there is some confusion that puts doctors and nurses together? It is important to know that 90% of doctors vote for MR, and that they are the ones who supported the numerus clausus.

If I have one message, it’s to stop cheering for us and come out to support us on the field when we need you. I think it’s mostly for themselves that they do it, they applaud themselves. Because they are confined, there is a virus circulating reminding you that at any moment you can get sick or die. Does the applause come from the gut or from the fear that all this engenders? What we want today is a big demonstration, which will probably take place in September, to be verified. But where we are quite suspicious and very attentive, is that here we are disconcerted, but how our dear politicians will authorize our groups? Will they allow demonstrations, after bars and discos? Or will they say « no demonstrations until November, December, January? Because they know it’s boiling over on the ground. So they figure they’ll back off these assemblies and allow the demonstrations to go on as late as possible to cool the pot down and hope it dies down again. The stores will be open, the terraces with friends… As a result, we’ll be a little bit out of this dynamic we’re in today. Right now, we’re discussing what position to take if that happens. I think we’re going to defy the ban.

I was going to ask you, is there a disobedience question that is going to be asked?

Several questions arise. Do we defy the ban to demonstrate? Will there be enough of us? Do we create movements for example in Brussels in different places with distancing in order not to be arrested? At some point we will have to decide. Our goal is also to be in agreement with other European nursing movements, in France, Italy, Spain, etc. What we want to do concerns Belgium, but the problem of austerity is in the European Union. So we are in touch.

Do you have a media strategy too? Will the media play the usual game? Today you are dedicating an interview to us. Did you say to yourself  » at a certain point, you should no longer play their game « ?

Today, those who give us the floor, we take it to say who we are and what we want. But we don’t really have a strategy for that. I think what gets us known is social media, Facebook especially, Twitter and Instagram too. After that, we’ll wait and see. I am quite surprised that there is never a nurse on the sets of C’est pas tous les jours dimanche on RTBF, only politicians and doctors. But then, if a nurse is needed, he or she should not come from the FNIB, because the latter has a more moderate discourse. We are just much more realistic, we really reflect what we live! At FNIB, there are many people from hospital management. A nursing director going down to the wards to tell his staff,  » Oh yeah, but you know, the occupancy rate is that much in cardiac surgery, the rate has gone down that much … » Who gives a shit about bed occupancy! We want to know if you have anything to tell us about the quality of care, infection rates, patients complaining about care, etc. I don’t know if you know, but hospital institutions have entered into a logic of quality badges. They have spent thousands of euros, even millions, to have a fucking badge that we will put at the entrance of the hospital to say:  » We are recognized as gold badge or platinum badge « . And all this required financial investment within the care institutions because it was necessary to re-examine the management, the equipment, the efforts of the care staff. So Covid comes at a time when caregivers had to invest in this to make all these changes and protocols. And if there is a 2nd wave, it is not finished! After that, we will suffer again by having to make all the losses profitable. The technical rooms, like an operating room, usually have 10 rooms and can have up to 20 rooms. Per unoccupied room, we are at 100.000€ per day. 100.000€ times 10 or 20 rooms, and we are at millions of euros of losses. We’re going to start all over again, with a lot of pressure because we’re going to have to make it profitable, even more than before, to be able to recover all these deficits. But where is the state? Where are the politicians? What are we going to do for ourselves? Will we help the institutions? We have released 1 billion € to help the institutions, but they will have to pay them back! We’re the ones who are going to struggle. We are going to take again for our grade, and on top of that, if at some point we want to stop, we are requisitioned! So no other choice, you walk or you die, unless…

You’re going to work hard,  » unless « , and this  » unless  » would be what?

Unless the state decides to financially support the care institutions, without reimbursement, of course. In order to make up for the losses, millions, if not billions, will have to be made available to help institutions make up for the shortfall.

Why is it that the State, which just before the Covid crisis was working meticulously to privatize health care, to take away resources, but also, as you say, to put in all the hospitals expensive systems of identity recognition, of data verification, why is it that the State would suddenly become the guarantor of the interest of the public and the hospitals?

But because we see today that hospitals and the health care system are a pillar of our society. And that when our health care system is not good, nothing goes right. How would we have done it if we hadn’t been there?

We’re still in Covid and they’re putting in place requisition laws, postponing a 48 million project… Why would they suddenly care about the common good?

I don’t know, maybe with a system like in France where doctors have resigned. Maybe blackmail or be more aggressive? Because they can’t be said to be gentle, can they? Maybe hold them by the neck and say,  » We need you, or as many staff will resign . And again, I’m not even sure it would work!

I feel like we keep asking, « Please, politicians, help us . Isn’t this a waste of time and a form of delegation of power? If we want to politicize the medical profession, shouldn’t we say that there is not much to expect from « political representatives »?

You know, the medical staff has had an awakening. In 2020 in Belgium, anaesthetists have been working in Covid units, in intensive care, for not a bullet, they are not paid! So they put their lives at risk, can be contaminated and don’t get paid. It’s amazing. Nobody works for free. There are also doctors, surgeons, like my husband (he doesn’t vote MR!) who went to work for free in Covid tent. Since he doesn’t operate anymore, well, he doesn’t make a living. He asked for the right of way like everyone else. And yet all these people are educated, they are there to care and save lives… and they are not recognized. Hospitals hire volunteer nurses, nursing homes have been bought out and are now on the stock market, privatized and taken over by shareholders, who demand volunteers to go to work! And they want to requisition us to go and work in these nursing homes, too?

So, private nursing homes, because they have a business, hire volunteers?

Yes, these requisitions may be requisitions for public nursing homes, but they are also for the benefit of the private sector. We don’t make distinctions… When Maggie De Block says « It is not normal that the army goes to work in these rest homes « … Yes, but it is also not normal to go looking for volunteer or requisitioned personnel for private hospitals, when we know that they are financial hubs. It’s just business .

You said at the beginning that the Covid crisis allowed us to get out of the hospital’s own context and to look higher up. Doesn’t this raise the question of where our money is going? We know that in Belgium billions are going to tax havens… And that this is once again the way to say « The people will pay, the nurses will pay at the risk of their health, it doesn’t matter, we don’t care. The capital, the businessThe private hospitals are not to be disturbed.  » Does it percolate through the labor community, the nursing community?

To hear the reality of all these tax havens, of tax exile, well yes, necessarily. The bigger the company, the less you are taxed. You are richer because you give less, in fact. We will always take from the pockets of the workers. Nothing to do with those billionaires who are above us. So we have the impression that it is still us, « the little ones », who will be hit. As if having a lot of money could buy our politicians. But we can’t afford to buy politicians. We would like to see a humane policy, close to the people, to the citizens, that listens and makes fair decisions for all, but we are really not there today. There is this little people of small citizens, then the politicians, and above them the multinationals, who exercise power over the political. So, yes, we are demanding, yes we are going to demonstrate, yes we want a more just, citizen, democratic policy, but we know that the problem is much higher.

The anger is rising, I hear it, it is justified. Let’s go back to the issue of requisitions. For the hospital staff, the requisition procedure already existed before, we could in cases of force majeure oblige the hospital staff to intervene. How is it that the government comes back with this?

When there was the H5N1 flu, they had already voted that, but we had not heard it, and this flu did not cause all this outcry, this containment, this media coverage around Covid, which is still much more virulent and deadly. With the special powers, they take advantage to do what they want, without ever consulting us. First of all, we didn’t learn about it from the media, but from a union, when it was under discussion. They never came to us, maybe because politicians need to know that things are swarming on the ground, that movements are being created. You’ve seen that we exist. Why wouldn’t they know? And so this requisition is also an opportunity to prevent us from demonstrating or going on strike. This is completely contrary to our most basic rights. They do not formally forbid us to demonstrate or to strike, but by this requisition, they prevent us from doing so.

Interview by Alexandre Penasse, May 11, 2020