A FEW weeks ago, I wrote about the importance of psychosocial support in response to COVID-19. My daughter suggested I write something focusing on the mental health and psychosocial wellbeing of healthcare workers.
Reading and listening to the news everyday, I have realised there are so many unknown facts about COVID-19. No one knows when this pandemic will end or if we have seen the worst of it. The World Health Organisation (WHO) is still learning more about the virus and sharing information everyday. This set me thinking about what it must be like to be a health worker working with COVID-19 patients, dressed in white and expected to have all the answers.
Healthcare workers, our frontline soldiers are fighting with limited information on the enemy, poor amour and ammunition.
The world over we are seized with the need to prevent the spread of COVID-19. Governments are taking drastic measures to protect their citizens and economies are being sacrificed in order to save lives. Everything has been placed on hold. We hope and pray these efforts will be rewarded and we will break the chain of transmission.
In all this, there is a group of men and women who cannot take the measures we are taking of #StayAtHome because their services are needed by those who are ill.
These people are on the battlefront, waking up every morning, leaving their families and wading into spaces that are risky at any point in time.
Do we really stop to think about how it’s like for them? We expect to get good service and hold them accountable to the Hippocratic oath that they took when they chose their profession.
While understanding their duty to treat, health workers experience the same pandemic-related stressors as everyone else. In his article entitled What’s it like to be a healthcare worker in a pandemic?, Robert H Shmerling a senior faculty editor, Harvard Health Publishing identifies the following six stressors for healthcare workers:
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lthe fear and uncertainty of a heightened risk of infection,
lworry that they may carry the COVID-19 coronavirus home and infect loved ones,
la dwindling or already inadequate supply of PPE needed to minimise the risk of infection,
lever-changing recommendations from medical and public health experts,
lunusually high and increasing demands to work longer hours as their colleagues become sick or are quarantined, lbalancing their commitment to help others (which likely led them to their current profession in the first place) with an understandable commitment to protect themselves and their loved ones. Even where personal protective equipment is inadequate, the health worker will honour the duty to treat and hope to be spared possible infection.
In addition to these stressors, health workers who work in resource-constrained settings might have to make tough ethical decisions about which patient gets lifesaving care and which does not when faced with shortages of ventilators and intensive care beds.
WHO has identified fatigue and psychosocial stress as top among risks to the safety and health for healthcare workers. Against all these stressors they are always there for their patients, they will serve with a smile and try to give assurance where hope is faltering.
They will try to save dying patients and live with the memory of losing some patients.
In our culture that does not make it easy to talk about death and dying, the health worker will face the family of the patient who has died and break the news and immediately have to deal with mourners while at the same time trying to find a decent moment to extricate themselves in order to attend the other patients.
This becomes worse with COVID-19-related deaths where relatives could not visit the sick patient.
The denial, shock and survivor guilt that some relatives will go through as they hear the news are all issues that pile up on the health worker, particularly in settings where there is no social worker or bereavement counsellor attached to a health facility.
Oblivious of the difficult situation that the health worker is in when something goes wrong, we mercilessly blame them.
As part of our grieving process, we have endless lists of what could have been done that was not done. In all that confidence-shaking experience, the health worker will face the next patient with all the dedication and cheerfulness that they are supposed to have.
When we think of the support needed to prevent the spread of COVID-19 and to treat those infected, we think of commodities. It’s not on many occasions that we think of what must be going on in the health worker’s mind. We don’t normally consider what it’s like to be the only human contact for a possibly dying patient and at the same time feel the usual patient carer rapport diminished by the personal protective clothing that is necessary.
What it’s like to efficiently provide care when one knows there is always a possibility they might find themselves lying on that sick bed. Those of us who are not healthcare workers will never know what it feels like not to be able to show a reassuring smile to a patient because your face is covered by a mask.
We will never know how it feels to get home, have your six-year-old run for the usual hug and kiss and you have to rush to take a shower first because you are afraid of possibly infecting the child. We will never know what it’s like to get home and wonder if you have not brought the virus home stuck somewhere on you. We will never know how it feels to watch your colleague contract COVID-19 and watch them with bated breath hoping they will recover as this would assure you that if you get it you will also probably recover.
We will never know how it feels like to face stigma from your neighbours because of your work. Healthcare workers working in a pandemic go through all these experiences everyday, yet they are there religiously carrying out duties.
With all these stressors, it does not take much to realise health workers mental health and psychosocial wellbeing must be highly affected.
When we craft interventions we need to plan the healthcare workers’ psychosocial wellbeing for enhanced mental health outcomes.
They have to be mentally well or at least equipped to deal with stressors for them to efficiently save lives. We do need them in those wards, so we have to play our part.
In dedication to our heroic health workers, I urge all Zimbabweans to think of all the things highlighted above when we think of COVID-19. We will beat this!
Sibusisiwe Marunda is the Regional Psychosocial Support Initiative Zimbabwe country director. She writes in her personal capacity.
