Hong Kong hospital workers strike

Violet Bell describes a hospital staff strike last week in Hong Kong, putting it in the context of the coronavirus outbreak, ongoing political protests, and an explosion in union membership. With reporting by KW Wu in Hong Kong.

Last week in Hong Kong, more than 7,000 medical staff went on a five-day strike for the first time in the territory’s history. For many, it was their first industrial action—and their first action within a union. The Hospital Authority Employees Alliance (HAEA), a public hospital workers’ union which did not exist before December, went from 0 to over 20,000 members in about a month, precipitated both by the past seven months of protest against an anti-extradition bill (that has since morphed into five broad “democratic” demands) and the outbreak of a novel strain of coronavirus in neighboring China, which has killed 900 and infected over 40,000 in the mainland. Although only one person has died in Hong Kong out of more than two dozen infections, medical workers fear that their already strained public health system won’t be able to handle the outbreak. So nurses, doctors, administrative staff, and medical assistants have all joined the union, which is independent from the existing trade union confederations, which have shown less militancy in the past half-century than this new union has shown in the past week. It now represents about a quarter of the total staff employed by the Hospital Authority (HA).

Many people who were politicized in the protest movement perceive union power, and possibly strikes, as a way to sustain pressure on the government as the intensity of protest on the streets fades. The government hasn’t substantially responded to the protesters’ demands even as their strategy has escalated, and months of weekend riots have left the city in a somewhat permanent state of trauma. As Anna*, a patient care assistant on strike, said, “We’ve seen that all these marches and protests over the past six months did not make the government listen. A strike may not be able to reach its target. But at least we have initiated some action for those working on the frontlines.” And the HAEA isn’t alone: more than a hundred new unions, many of them quite small, have formed in the past two months. (To form a union, a minimum of seven workers must file a form with the department of labor, which decides whether or not to approve the application. There is no employer certification and no legally specified formal bargaining process.)

The Hospital Authority Employees Alliance have publicized five concrete demands addressed to their employer, the Hospital Authority that governs all of Hong Kong’s public hospitals:

Regarding the below two points, the HAEA urges the Hospital Authority to issue a public statement to pressure the government into actions –

1. To forbid all travelers from entering Hong Kong via China

2. To implement constructive measures to ensure a sufficient supply of masks

Regarding the below three points, the HAEA urges the Hospital Authority to ensure a safe working environment for its staff –

3. To provide sufficient isolation wards, and to stop all non-emergency services

4. To provide sufficient support and facilitation for healthcare staff caring for patients under isolation

5. To publicly commit to not taking any disciplinary action in retaliation for striking

The demand getting the most attention is the call to close the border, and it’s likely that a large percentage of the public support for this demand (80%, according to one poll) has at least some basis in anti-mainland sentiment. Xenophobia against mainland Chinese has been increasing for the past several years in Hong Kong, and has grown exponentially during the protest movement’s delineation into pro-government/pro-mainland and pro-movement camps. The Hong Kong government’s line on the call to close the border is that it’s “discriminatory.” It’s true that a lot of calls to close the border are directly linked to anti-Chinese sentiment, but the phrasing of the HAEA’s demand is significant: they would like to ban all foreigners who have been to China in the last 14 days from entering Hong Kong, and to quarantine any returning permanent residents for two weeks. More localist (i.e. nationalist) groups in Hong Kong have been calling for the deportation of all Chinese visitors, similar to what has been happening in Macau, which is going through hotels and deporting all visitors from Hubei Province, the epicenter of the outbreak, or Taiwan, which prescribes different procedures according to passport. The subject of xenophobia deserves its own essay, but it’s important to note that it’s complicated: we’ve also seen footage, lauded in some social media channels on the Telegram app (widely used in coordinating the Hong Kong protests), of a Wuhan-born permanent resident out with her neighbors protesting the government’s planned quarantine site in their residential neighborhood. Not all support for closing the borders is phrased in xenophobic terms. “Closing the border is a good strategy,” Anna, the patient care assistant, says, “because we can better locate possible carriers, making further plan to treat these patients.”

The results of the strike vote on Saturday, February 1: 3000 in favor, 10 opposed, and 23 abstaining

Though the demand getting all the attention is the call to close the border, medical workers are also protesting meager working conditions that predate the virus outbreak. Public hospitals in Hong Kong are notoriously underfunded, and a global run on protective medical supplies like face masks and protective suits has only made the situation worse. Particularly enraging to the general public, and health workers in particular, is the government’s failure to secure enough masks for the population, while maintaining for themselves an exclusive supply of face masks, made for them by prisoners within the Hong Kong Correctional Services department (who are now working overtime, in worsening conditions). “It started with face masks,” said Lucy, a physiotherapy nurse who’s worked for the HA for 15 years, “because no one seems to be able to get any. This is something you cannot avoid even if you say you are apolitical.” Protective suits, or PPE, are an issue too: “Those we are using can only protect us from dirt—they’re not even water-proof,” said Mara, a registered nurse also on strike. “The police have PPE which can conceal their entire bodies. But the nurses’ aren’t to that standard—we are not as well-protected as the police.”

Even before the panic over the coronavirus created an uptick in patients seeking care, hospital wards were overcrowded and understaffed. An August survey showed that the nurse-to-patient ratios in public hospitals are three to four times higher than statutory ratios in comparable Western hospitals. “We have a 16:1 patient to nurse ratio,” said Mara, “We need to ask for more manpower and less workload.” Patient beds spill over into the corridors and neighboring wards, where they might be a 10-minute walk from their assigned medical team. The government has even initiated a Voluntary Health Insurance Scheme to encourage people to use more expensive, private hospitals in lieu of public medical services, which they might wait years to receive. “People are buying insurance because they know they might not make it into the public hospitals before they die,” said Alice, another nurse.

These conditions have been exacerbated by the coronavirus outbreak. “I’m responsible for taking spit samples from ICU patients, and I perform this high-risk duty every day without an adequate supply of protective suits or N95 masks for the number of patients I’m treating,” said Lucy. “Management simply told us to count out the face shields and N95 masks we had left.” Medical workers have apparently been drawing lots to determine who will staff isolation wards, which are already at 60% capacity in many hospitals. “The newly opened isolation wards do not meet the standard because they are merely converted from general medical wards,” said Mara. “This is like pushing us to death.” They fear that allowing more inbound travel will further overburden an already teetering healthcare system. Border crossing statistics back up the claims that mainland travelers to Hong Kong have increased in the past two weeks, after months of declining visitors due to the ongoing protests. “It’s not that we don’t want to be on the frontline, on the dirty team,” added Lucy, “but we’re not provided with enough equipment or enough information to bear such a huge risk. That’s why we’re on strike.”

A striking medical worker stands in front of a miniature “Lennon Wall” of supportive messages. These walls are widely used to show support and distribute information within the wider protest movement.

Her entire department—about 20 people, and half the entire unit—went on strike. More than half of the wards of all the nurses interviewed for this article were on strike; Anna was on strike with her mother, also a patient care assistant. “We openly discuss it,” said Mara. “We ask each other, ‘Hey, do you want to join the union?’ Because every ward needs to send people to isolation wards, to the frontline.”

Early on the morning of Monday, February 3, before the strike even began, Hong Kong’s chief executive, Carrie Lam, announced that all but three borders would close—the airport and two busy bridges—but insisted that her decision was unrelated to the imminent strike. The union didn’t seem to buy it: more than 3,500 medical workers walked out and hundreds of supporters wearing white ribbons turned out to hospital entrances to show their support; the union signed up strikers at the door. Even Hong Kong’s largest television broadcaster, TVB—known for its pro-Beijing and pro-government stance—aired an interview with a cancer patient showing unconditional support for the strike: “Even if the entire medical force decided to go on strike, I will continue to support them. Because the lives of both the patients and medical staff are equally precious.” 

The strike doubled overnight in response to Lam’s continued refusal to join the HAEA’s meeting with management. The HAEA reported that over 7,000 people (at least 4,500 nurses, 360 doctors, 1,200 allied health professionals, and numerous support and administrative staff) were on strike—close to 10% of all staff members within the Hospital Authority.

Despite further announcements of mandatory quarantines, the strike continued into a third and then a fourth day, with barely a drop in attendance. On the fifth day, striking workers occupied several areas of the Hospital Authority Headquarters Office, seeking a meeting with the chief executive. In response the HA locked the elevators and blocked the staircases.

Why unions, why now?

Hong Kong does not have a radical history of union action—or much union action at all. It does have a history of protest, including a number of large-scale demonstrations, most notably the 2003 protests for democracy, the anti-development struggles of the late 2000s, Occupy Central in 2011-12, the Umbrella Movement of 2014, and whatever you want to call what’s happening now. Prior to the British handover of Hong Kong in 1997, there was only one major labor event, in 1967, when a minor labor dispute in a single factory (over paid holidays), fanned by pro-communist organizers, blew up into massive strikes and demonstrations across the territory against British rule.

Striking medical workers pinned signs to their backs

Though there have been dozens of unions, some of which have been around for decades, the vast majority belong to one of two trade union confederations, which are seen as either politically inert (the “pan-democratic” Hong Kong Confederation of Trade Unions, or HKCTU) or pro-Beijing stooges (confusingly, the Hong Kong Federation of Trade Unions or HKFTU). The general consensus before this year seemed to be that most of the unions were only good for planning social events and offering shopping discounts. The HKFTU has a history of siding with, or remaining silent on, the government’s anti-worker policies—like not regulating the length of the working day, overtime, or breaks—though they were heavily involved in the events of 1967. By comparison, the HKCTU, founded in 1990, actually does advocate for workers’ rights (both inside and outside of the legislature), hold trainings, and represent their members in disputes. They’ve been providing some legal advice and information for the dozens of new unions that have formed, but what they have to offer isn’t exactly clear. Membership across their 91 affiliate unions is extremely low, and the confederation is sometimes seen as aligned too closely with the pan-democratic political parties, which sometimes means sacrificing militancy for the sake of appearances and political favors. There have been only two major strike actions since 1967: in 2007, when construction workers went on a 36-day strike for an 8-hour working day and better pay, and 2013, when the Union of Hong Kong Dockers went on a 40-day strike to win a 9.8% pay raise (they had originally asked for 20%). (During the latter, the HKCTU insisted on dismantling a physical blockade of the port for fear of being perceived as too violent and potentially losing liberal support.)

Throughout the current protest movement, the Hong Kong Confederation of Unions has done little to protect its 145,000 members beyond encouraging them to take part in the “general strikes.” There have been three “general strikes” in the past seven months, all of which were called to pressure the government in the anti-extradition movement: one in June, one in August, and one in November. The August actions, in particular, were by far the biggest and comprised the largest walk-outs since 1967. It’s hard to say how many participated in these strikes, but HKCTU put the number at 350,000. Protests all but shut down public transportation for the day and hundreds of flights were cancelled due to the absence of 2,300 aviation workers. But participation from the medical sector was low: only 50 nurses from one hospital “struck” and they didn’t suspend medical services. It’s hard to say what the strike actually won, beyond more stringent safety procedures at the airport. There hasn’t been industrial action on that scale since August—the November action was significantly smaller, and the strike aspect of it was much less successful than protestors blocking city infrastructure Certainly, these strikes were not perceived as industrial action targeted at employers, but rather at the government.

A neon sign announces the HAEA strike

A number of people were fired for participating, however, most of whom didn’t even have a union to represent them. Even the Cathay Pacific Airways Flight Attendants’ Union—one of the strongest in the territory—was unable to protect dozens of its workers from being fired for voicing support for the protest movement. Neither collective bargaining nor protection for political speech are enshrined in Hong Kong’s meager set of governing principles, the Basic Law. But as was widely reported even in the mainstream press, new unions have been sprouting up across the territory and collecting hundreds of members since January. They’ve even been recruiting at rallies and marches where the police have cracked down, and now they’re threatening actions left and right. It’s an open question whether these unions merely see labor action as another avenue to apply pressure to the government—and thus an extension of the protest movement—or whether there’s a strong will for building up labor struggle.

The political nature of the HAEA’s first two demands was underscored by the tidal wave of support they received from other sectors. Hundreds of new members across 48 of the new unions, and sympathetic legislative and district councilors, marched alongside the HAEA on the third day of the strike to the Central Government Offices to hand in petition letters and demand a public meeting with Lam. Previously cowed Cathay Pacific flight attendants called in sick. Popular protest Telegram channels were flooded with pro-strike memes and videos voicing support; a public opinion poll put support for the healthcare strike at 61%.

There were mass protests the summer after SARS broke out in 2003, too, both about the government’s response to the epidemic and proposed legislation that would alter the territory’s governing Basic Law. But notably, there were no industrial actions on the scale we saw last week—or on any scale, really. HAEA’s demands were targeted both at their boss, the Hospital Authority, and at the government (which funds the Hospital Authority, a public institution). Three of their five demands could be fulfilled by management while the demand to close the border is clearly targeted at the government. That’s why the union committee has repeatedly called off their meetings with management when Carrie Lam has refused to attend. It remains to be seen whether the HAEA will continue to demand improved working conditions, or whether their focus on “political” victories will drown out calls for material demands.

After five days on strike, the HAEA narrowly voted to end the strike and return to work. The organizing committee’s public statement on February 7 gives the strike credit for the (incomplete) border closures and quarantine procedures that the government initiated. They could take credit for inspiring other strikes, too: over the weekend, Cathay Pacific’s flight attendant union voted to strike to force the airline to stop all flights to China. Railway Power, the new MTR union, voted to strike for full closure of the border if their negotiations with management fall through. A newly formed union of speech therapists has committed to a five-day strike.

Despite the many open questions that remain for the future of labor struggles in Hong Kong—and how they’ll outlive the current political crisis—the recent wave of strikes has been nothing short of impressive. We’ll let Winnie Yu, chair of the HAEA, have the last word:

Without the endurance and hard work from everyone, this fight would never have happened. The so-called “reduction of cross-boundary people flow” or “partial sealing of borders” measures would never exist. Without this fight, the pressure on our healthcare system would be even greater. Hong Kongers are undoubtedly initiating a new battlefront for our protest—labor unions. In view of this new attempt, we could only wade through the stream by feeling our way. There [is] indeed [much] more we can do to improve. Yet it is our belief that with your continued support and participation, we will pave the road for even more labour movements.

Through our union, we are able to connect with 20,000 members. After this battle, we will always be brothers and sisters. In the future, we will begin to establish our foundations in every hospital, and to set up branches of the union at every district. We will aim to represent every cluster and every department, while continuing our fight for the safety of healthcare workers.

Finally, we hope that all of us will win this war against the epidemic. One day, we will meet again without our masks, breathing in the clean, fresh air of freedom.

Hospital Authority Employees Alliance

7 February, 2020

*All workers’ names have been changed.

Tomorrow, Organizing Work will run an interview with a nurse on strike on Hong Kong.

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