Healthcare workers vs. the virus: an interview with a hospital janitor fighting at the front

Janitors are essential workers yet they are at the often the most underappreciated and least paid in the healthcare system hierarchy. Here, Norell Martinez interviews a healthcare worker who is battling COVID-19 daily, but is one of the thousands of front-line, “essential” workers—many of whom are immigrants—whose labor and stories of sacrifice go unrecognized.

While much attention is being paid to doctors and nurses working on the frontline of Coronavirus crisis, little attention is being placed on the cleaning staff that work in medical facilities. In an environment that must uphold the strictest standards of cleanliness to control the spread of infections, these workers are just as essential yet they are often the most under-appreciated and underpaid in the hierarchy of the healthcare system. They are not only responsible for traditional janitorial tasks such as mopping, vacuuming and dusting; they are also required to properly handle, clean and dispose of biological waste such as body fluids and used needles.

The resilience of this virus has shown how crucial it is to disinfect all surfaces that come in contact with human hands. Janitors at medical facilities keep patients and medical workers safe by maintaining a clean and sterile environment, preventing the spread of  the virus and allowing healthcare professionals to do their job. Though they work alongside janitors, oftentimes they are looked down upon as being “unskilled.”  Furthermore, with  near-universal shortages for all healthcare workers, they are even more likely to lack personal protective equipment, such as N95 masks, even though they are also at the frontlines of fighting this pandemic.

Below is an edited and translated interview with a woman who works at a large medical clinic in a major US border city. She is a Mexican immigrant who has worked for nearly 30 years as an Environmental Service Technician, the official job title for the cleaning staff at medical facilities. The job is rigorous and exhausting under normal circumstances, yet in the midst of the Coronavirus crisis, the workload has increased and work conditions are riskier. This person’s experience not only shows how essential these workers are in the healthcare system, but also how little their lives are valued, particularly by management and other staff. However, her story also shows the importance of union representation, which has given a voice and collective confidence for workers to stand up against unfairness and injustice without fear of reprisal.  

To protect the worker's anonymity, will not use her name. R = response.

What are you your work responsibilities?

R: On a normal day I am in charge of doing a number of tasks. My shift starts at 6:30am and ends at 3pm. I am responsible for cleaning and disinfecting the pharmacy. This is very tedious because since medications are made there, the space has to be cleaned in a particular way and it is really important that everything is disinfected and cleaned very thoroughly. The space is very small and there are a lot of people working there, it is becoming very harder and harder to be in there lately because it is a small space. I have to take out 30 sacks of trash a day just from the pharmacy. I have to clean the break room and the lobby and waiting room chairs. There are 52 chairs in the lobby and over 1800 patients visit the pharmacy each day to get their medication.

I am also in charge of cleaning the public restrooms. I have to scrub over 150 toilets a day, refill supplies such as toilet paper and soap, clean and disinfect all surfaces.

I also empty all the shot containers where used needles are thrown out. These shot containers are in departments all over the clinic. They are really heavy and sometimes I need help picking them up because sometimes IVs are in there with fluid and that weighs more.

On Mondays, Wednesdays and Fridays I have to dismantle cardboard boxes and I have to load them and transport them to a cardboard compacter. I also pick up the dirty linen from eight different departments. So for example, when a patient gets an MRI, a CT scan or an ultrasound they have to use the hospital gowns and linens. They are thrown into a dirty laundry bin. I pick up all of the linen used all over the clinic and put them in a container and then transport that container and put them in another container where they will be picked up by a laundry company.

Aside from cleaning, I am the only public attendant on duty during my shift in the whole entire clinic and it is a big clinic with several buildings. A public attendant is the person who is in charge of cleaning the public areas and is called to clean if, for example, someone has vomited or urinated. I have to drop what I’m doing when I get paged and go clean.  

Since the Covid-19 crisis began, what has changed in your work conditions? Are they asking you to do more work beyond what your responsibilities are?

R: It has definitely been more stressful. It is already a busy time of year because of the flu season. Many people come to get the flu shot but also come down with the flu so it is busier. But now with the Coronavirus it has been a total change in the dynamic.

From the time a patient who might have the virus first enters the building to the time the patient leaves there needs to be a terminal cleaning. (Terminal cleaning is a cleaning routine used in hospitals and medical clinics to control the spread of infections and eliminating contamination). So anywhere a patient sits there has to be a terminal cleaning. Where the patient gets their vitals signs taken, the exam rooms where the patient waits to be seen by a doctor, anywhere else the patient goes there has to be a terminal cleaning done. This has been the most difficult because it has tripled my workload. I have to stop what I’m doing and go do the cleaning.

The first week I did 5 possible cases, the second week there were 3 during my shift and this week it’s been a little more controlled because now they do not allow the patients inside the building, they screen them outside before letting them come in. They are doing a drive-thru method and they are only allowing small amounts of people to come in the building at a time. At first they were not taking any measures. There would be tons of people in a small waiting area.

What measures have administrators taken to protect the janitors who work at your clinic? Are these measures the same, more or less strict then other healthcare workers? 

R: The administrators did not know how to handle this situation at first. At other clinics they were already screening all patients before they entered the building. Here they were slow to act and were making a lot of errors. It was when the Governor gave the shelter in place order that they began to take more serious measures. Finally they set up outdoor screening area and it has made it a little easier on the cleaning staff.

When all of this began, I would wear a mask, especially in the areas where there were a lot of people. My supervisor came up to me and told me I couldn’t wear a mask because she said it gives a negative image to the clinic and the patients could be disturbed by it. She showed me an email from the director of our department that said that we didn’t have to wear a mask, even when the clinic was packed. I have to go in and clean the waiting area in the pharmacy where it is small and packed with people, and I can’t wear a mask? I told her “I can’t wear a mask because the hospital doesn’t want to give a bad image to the patients? Because of that I can’t protect myself?” We don’t know who has the virus and if I’m next to someone who has it without wearing a mask I could get exposed. Now they began to take stricter measures and everyone is allowed to wear a mask, but before they weren’t letting us.

My supervisor came up to me and told me I couldn’t wear a mask because she said it gives a negative image to the clinic and the patients could be disturbed by it.

As far as training and protocol goes, everyone is required to take a mandatory training on Covid-19. This includes the cleaning staff, nurses, doctors, everyone. In this training they taught us that a room where a Covid-19 patient has been has to be isolated for one hour. No one can enter, including cleaning staff. We cannot enter when the patient is still there. After the hour the cleaning staff can go in to clean and disinfect. We have to wear a mask and protective gear but there are a lot of contradictions in the way this is executed. I apply the training to protect myself and I have to take responsibility of the training I received to do my job correctly.

When I am asked to do a terminal cleaning I wear a mask but I am not provided with an N95 mask, I am provided with a surgical mask. They tell us that after 2 hours there is no more risk and we can enter a room without a mask but I still wear mask. They won’t give me an N95 because, as you know, they are scarce. I have an N95 that I have put away in a plastic bag and I reuse it if I need one. I can’t get a new one. Even if they say that I can’t reuse it, I still reuse it.

Can you talk about a time since this crisis began that you feel was unfair or that you felt that your well-being and safety was not important because of your position?

R: Since the coronavirus crisis began, I have felt a lack of support from the staff, mostly from the nurses and the nurse assistants; I don’t really interact with doctors.

When they had the first case in the clinic, the nurse who called me to clean did not know what to do. She asked me how to clean a Covid-19, saying did not know how to do it. They are the nurses and they are asking me what to do? So I asked her, “Didn’t you take the mandatory training [on Covid-19]?”  She told me she had not taken the training and after that several nurses told me they did not take the training. How am I supposed to believe that a nurse who deals directly with patients did not take the Covid-19 training? But me who is a cleaning staff did the training? I don’t think they want to even get close to the room or get close to the area where a patient with the virus has been so they say that they haven’t done the training so they don’t expose themselves.

In another instance, they wanted to me to do a terminal cleaning when the patient was still in the area. This was the tented area set up outdoor to pre-screen patients before allowing them to go into the building. It was an insult to me because they wanted me to go clean even though in the training they told us we could not clean when the patient is in the room. They had moved the patient to the left side of the area and asked me to go and clean where the patient had been sitting previously. I told them, “The protocol says that we have to wait one hour before entering.” And she said, “We can’t do that right now because it’s an emergency, there is a long line of patients waiting to get screened.” The administrator said, “We moved the patient.” All the nurses were far removed from the area, all the way on the other side but they wanted me to go in and clean. But I did not clean the area because the patient was still there. I said I will be back and I communicated with my supervisor and told her about the situation and I did not return. I did not want to take a risk. They ended up calling cleaning staff from another building to do the cleaning. These are some of the contradictions between what the protocol says and what the staff and administrators ask me to do.

Is there anything else you would like to add?

R: Yes, I would like to say that what bothers me the most is that I have 28 years working here. I have done a lot of terminal cleaning. I have cleaned human body fluids from patients with HIV, Hepatitis and other contagious diseases. When the nurses page me to do a terminal cleaning, I have the right to ask what is the infection the patient has so I use the right cleaning and disinfecting methods. I need to know because there are some very contagious diseases and there are certain methods that bodily fluids are cleaned from a person with an infectious disease. Of all the years I have been working here the nurses have had the courtesy of warning me of the type of infection, they would tell me, “Be careful because the patient has HIV or Hepatitis, take precautions.” And now with the pandemic, no one tells me when they page me to do a terminal cleaning. I will ask what it is, so I know what procedure to take and they just say, “It’s a terminal cleaning, just protect yourself.” Now they don’t tell me, it’s like very mysterious. It makes me so upset that they don’t want to tell me what the patient has. I insist and insist.

The supervisor is just sitting there giving orders and doesn’t know the protocol. It was then that I realized that they care very little about the cleaning staff, whether we are exposed to this virus or not. They just want to see us work like donkeys, they don’t care; we are just the cleaners.

One time, a Covid-19 patient got an x-ray done and the staff person called me to do a terminal cleaning and said, “My supervisor wants it cleaned now” and I asked “What does the patient have, I need to know,” and they said “I don’t know, just clean it.” The supervisor is just sitting there giving orders and doesn’t know the protocol. It was then that I realized that they care very little about the cleaning staff, whether we are exposed to this virus or not. They just want to see us work like donkeys, they don’t care; we are just the cleaners. That time I was so stressed, I was mad and I had to talk to the supervisor of the department. I told him the protocol. “The room has to be isolated for an hour, then I go in and clean and you have to provide me with the mask.” That is what bothers me. The way they don’t have consideration.

Are you part of a union?

R: Yes we do have a good union representation.

Does being part of a union make you feel like you have more job protection or that you have a voice about your job conditions especially during these times? 

R: Yes we have more protection with the union. The union has helped us fight in the past and will defend us now if need be. Since there have been a lot of complaints, the union is now getting involved. If a supervisor would take disciplinary action against us for refusing to do a cleaning if it goes against protocol, the union would get involved. The day that I said that I would not do the cleaning because the patient was there, the union would get involved and defend me if they would have taken disciplinary action against me. 

Norell Martínez is a Chicana fronteriza from the San Diego/Tijuana border region. She is Assistant Professor at San Diego City College in the departments of English and Chicana/o Studies. She holds a Phd in Cultural Studies from UC San Diego’s department of Literature.