Common sense has not prevailed | Paul Pace

The Malta Union of Midwives and Nurses has been under fire for issuing directives for nurses not to administer the influenza vaccine. But president PAUL PACE argues that government’s intransigence – coupled with a nursing emergency – left the union with no choice

MUMN Head Paul Pace
MUMN Head Paul Pace

From the beginning of the COVID-19 pandemic, the main health strategy was to ensure that the healthcare system is not overloaded. We are now averaging over 100 new cases a day; and the Medical Association of Malta has warned that ITU is close to maximum capacity. Your union represents nurses – on the very frontline of the war on COVID-19 – so can you tell us what the real situation is? How close are we to being ‘full up’?

We’re getting there. Just yesterday, for instance, there was an article stating that the number of ventilator beds in Maltese hospitals is set to go up to 100: 75 in Malta, and 25 in Gozo. But the reality is that we don’t have enough trained nurses to man that number of beds. We are still very, very far from that target.

This is why, as a union, we were the catalyst to get the theatre nurses into ITU, to support the nurses there. And they needed support. In fact, the ITU has been running on almost full capacity for some time. Now we have additional COVID areas, with extra beds. But for all the political hype, we still need to train more nurses on ventilators. It’s a very specialised area, and training takes time.

Besides, the situation in ITU has had a knock-on effect throughout the hospital: and people are paying a high price for it. In an ideal state, we would have been able to add more nurses in ITU, without disrupting the operations in other departments. There should be enough nurses in the country to allow operations to keep on going, whilst also transferring more nurses to ITU: where they are needed more.

As things stand, however, we are disrupting all the waiting lists for other operations - which had already been stopped in March, because of the first COVID outbreak. Now, that list is going to get bigger, and bigger, and bigger.

There is a very appropriate Maltese saying, for what is happening right now. ‘Tħott knisja, biex tibni ohra’ – to build a new church, we are dismantling another one.  In this case, we disrupted half of the planned surgeries in Malta, in order to address the ITU nursing crisis. And people still need operations. People suffering from hernia are still in pain… they cannot wait forever.

Some people might see a contradiction in what you’re saying, however.  As a union, you also issued directives (which were later withdrawn) to stop nurses from administering the influenza vaccine…

… but that has nothing to do with the situation at Mater Dei. We didn’t disrupt any operations…

Operations, perhaps not. But the MUMN was still ready to deny a medical service to patients, over what was ultimately a labour (not a medical) issue. Isn’t that a case of unnecessarily bringing out the heavy guns?

Let me put it this way. Nurses are on the frontline. So when the COVID outbreak started, it was a tough road for us. And I don’t mean just in the sense of ‘hard work’. Hard work is expected, in our line of duty. We were ready to make all the necessary sacrifices.

But this crisis brought about a new scenario. People were being put into quarantine… and nurses were the largest category: at one point, there were around 1,000 nurses in quarantine.

Now: quarantine means 14 days. And that, in turn, means losing the Sunday allowances. And if you also contract COVID-19 in your line of work: that’s your sick-leave gone, too. You end up without pay. For while it is true that there is what we call ‘injury on duty’ leave… because we are still so far behind the times, ‘injury’ only refers to physical harm: and not to ‘contracting a virus’.

But to get these things – and I’m not talking about gaining more money; but simply, not losing what we already had – we had to fight every step of the way. Nothing fell into our lap. And I don’t blame [Health Minister] Chris Fearne. He works at the hospital; and therefore understands us much better than others within Cabinet – or in the Civil Service – who never worked in a hospital, and therefore have no idea what the real issues are.

I’m not disputing that the problems you mention exist: but was it really necessary to threaten to withhold a medical service?

Everything has to be gained through directives in this country. The funny thing, for example, is that when you go into a meeting to discuss such issues… no one ever tells you: ‘You’re wrong. We disagree’. They always tell you: ‘Yes, you are right. We have to evaluate this’. Then you wait a week; then another week; three weeks, four weeks… and they will still be ‘evaluating it’, without ever coming to a decision. But… people are losing money, all that time …

So you felt you had to do something drastic?

No. That’s the impression everybody got; but it’s not the case at all. The truth is that, when it came to issuing allowances… I don’t know why, but all of Malta got their allowances: except the people who work in primary healthcare; the people on the front-line.

All the same, we did not start with the flu jab directive. This is what everybody seems to be missing out on. They think we woke up one morning, and said: ‘That’s it – No flu jab!’.

But no: we actually started by not taking blood samples in night health-centres, for four weeks. That was our first directive. We didn’t ‘bring out the big guns’, as you put it, straight away. We started with the small things.

Another thing is that, according to industrial law, a union has to give at least two or three days advance notice, before issuing directives. We gave government four whole weeks.  And yet, in all that time, there was not even one single meeting. So government could very easily have avoided the flu jab directive, simply by calling us into a meeting. But instead, they totally ignored us for four weeks.

This is why I was surprised by Chris Fearne’s comment: ‘Common sense has prevailed’. No, it wasn’t common sense at all. ‘Common sense’ would have been not to allow matters to reach a stage when directives became necessary in the first place.

It was only when we ‘brought out the heavy guns’ – I like that expression, by the way – that we suddenly saw 100% compliance. We met the next day, and all our demands were met. So the question now is: why did it take them so long?

What’s your own answer to that question?

The truth is, I don’t know. I never understood why the rest of Malta got their allowances, while the nurses were denied. To be fair, it wasn’t Chris Fearne’s fault. He was not the one who was blocking our demands. He agreed with us, all the way through. And it wasn’t the Prime Minister, either.

All I can say is that nurses, in this country, are treated as second-class workers within the Civil Service. Not just by government, or the head of the Civil Service; but also by the people.

In the UK, for instance, there was a time when people came out on their balconies, every Thursday, and clapped for the nurses. But the moment the nurses protested outside Whitehall, demanding better pay… people stopped clapping. Suddenly, nurses were no longer ‘heroes’.

It’s the same here, too. The only difference is that we didn’t clap as much as they did in the UK…

Going back to a point you mentioned earlier: there is a shortage of trained nurses at the moment; and with the impact of COVID-19, the few nurses we do have are getting exhausted. What is MUMN suggesting to address this problem?

At the beginning of this year, we insisted that government should issue a call for TCNs (Third-Country Nationals). Why? Because this year’s intake from University was very poor. And to make matters worse, 30 of those newly graduated nurses – as is their right, of course – chose to further their studies to become medical doctors.

It was clear from the outset, then – even before the pandemic – that there was going to be a shortage. So we insisted on a call for TCNs… and the call came out. By March, the situation seemed to be back under control. But then, when COVID-19 broke out… the funding for this call suddenly became a problem. They did not want to employ any more TCNs.

But we need those nurses: now, more than ever. In fact, the situation is so serious that we are recalling all former ITU nurses, who have meanwhile moved on to other departments. And this is causing problems in other parts of the health service.

Just yesterday, I got a call from the Renal Unit – which is no joke: that is where dialysis takes place; and without it, patients die. Now: in my day (I was renal nurse, at the start of my career), the ratio was one nurse per patient. Until recently, the ratio was one nurse per three patients… which was already serious enough.

Today, there are seven vacancies in the Renal Unit… because nurses are resigning, or leaving the country altogether. They are getting burnt out. And this means that there are not enough nurses to provide dialysis treatment: a vital, life-saving procedure. And that’s just one example. There are ripple effects throughout the rest of the health service: such as the oncology hospital, for instance. We have more than 30 vacancies in the cancer treatment sector. That’s how serious the situation has become…

Meanwhile, Chris Fearne has (rightly) filled up the corridors of Mater Dei with oxygen points and beds. But he also knows that, if – God forbid – those beds are filled up with patients… there will be no nurses for them. Where are all the nurses going to come from?

What about the recruitment drive for TCNs?

Government is dragging its feet on that. Out of 265 foreign nurses who were available, we managed to employ only three.

But the way it works in Malta is that, usually, it is not government which employs nurses from overseas: it is private contractors. What government does, generally, is poach those nurses from the private sector: issuing calls, offering better conditions, etc.

What is happening now, however, is that private contractors are getting wise to the government’s game; and are making it difficult for government to poach their staff. Meanwhile, we are also facing competition from other countries. 

In this sense, Identity Malta was not helpful at all. One thing government can’t seem to realise is that, unlike bigger countries, we don’t have the luxury of recalling nurses from other, less-affected parts of the country… like Italy did, by transferring nurses from the south to the north. We can only recruit from other countries… which means that we are in competition with the rest of Europe.

Unlike when I started out – when the nursing staff was 100% Maltese – today, 20% are foreigners. And we rely on them. God forbid they were to leave: because we’d have to close down.

But they are leaving. The UK, for instance, is now targeting Malta directly: for instance, by making prospective nurses from ‘English-speaking countries’ – and let’s face it: Malta is the only one – exempt from the language proficiency test. They are also offering citizenship, for both nurses and their families.

Here, on the other hand, Identity Malta is making things harder, instead of easier. Meanwhile, the Renal Unit is collapsing; the oncology department is collapsing… it’s an emergency, and something has to be done about it.