By Maribon Viray, Anniesha Lyngdoh, Jochanan Diengdoh& Phibawan Syiemlieh
As we approach the end of 2020, we all hope that COVID will soon be history. Unfortunately, the new strain of the virus has been detected and the extent of its spread and impact cannot be underestimated.While many aspects of the economic activities have opened, and people have been trying to adjust to the new normal, the micro level of economy and the health system continue to bear the brunt of this problem. The healthcare workers continue to be under pressure to work round the clock for COVID management in different stages, because the fact is, cases are still being reported on a daily basis although numbers are in a downward trend.
The thoughtful gestures of giving flowers, candle lighting and air parade are an encouragement to the healthcare personnel. However, there remain other aspects that affect their mental health. Mental health at workplace is a crucial determinant of the overall health of an individual. Burn out, for instance, is a well-recognized psychiatric diagnosis, involving symptoms of emotional exhaustion (anxiety), cynicism (depersonalization) and reduced work efficiency (reduced accomplishment). Reports across the country also highlighted that healthcare workers are being stigmatised just for being exposed to patients. To determine the mental health and social stigma among healthcare personnel involved in the management of COVID 19 patients, the Indian Council of Medical Research (ICMR) conducted a research covering ten States which included Maharashtra, Delhi, Kerala, Assam, Odisha and Meghalaya among others in which Martin Luther Christian University (MLCU) was selected as the implementing agency. There were 92 Doctors, nurses, laboratory staff, X-ray technician sanitation workers, ambulance drivers, housekeeping, ward boys, and ASHA workers from both public and private hospitals in East Khasi Hills District with COVID 19 patients who participated in the survey and 55 among them were also interviewed.The national data analysis is still on-going, but permission was granted to share the highlights of the findings in the district.
Psychological distress and burnout
The highest percentage (71.4) who have shown psychological distress as per General Health Questionnaire (GHQ) were the ASHA workers followed by (68.8) of the doctors, (64.3) percent of the ambulance driver/staff/ward boys/security guard while more than half (58.3)percent included the auxiliary nurse/paramedical staff. However, a total of 64.7 percent of all the participants showed that regardless of their categories, they were facing psychological distress during the period of data collection – that is between September 15 to November 25, 2020. Records show that some are working 24 hours and 7 days a week. In the Burnout scores, nurses recorded the highest scores followed by doctors and auxiliary/paramedical staff. The interview revealed that the pre-dominant factors revolved around the workplace, family life, and experience of stigmatization.
Impact of COVID in work life and family life
All participants have reported that workload has increased during the pandemic. The results highlighted burden of work. One doctor said, “We have to juggle between COVID duty and our own normal duties,” while an ambulance staff mentioned, “We are exhausted because of overwork, and we sometimes get angry too because public don’t understand the situation.”
Feeling of inadequacy was expressed by a doctor, “I feel demoralized at time when people look at me with a question mark in their eyes. It was like the people are not trusting me anymore.”Worry over shortage of adequate supplies, lack of management appraisal, strained relationship among colleagues due to pressure, discomfort in using PPEs, and feeling of dissatisfaction in giving quality time to the patients are other highlights of work related stressors.
On a positive note, some of the staff highlighted the importance of teamwork. One staff said, “We work more as a team now than we did earlier when we were working separately performing our own duties.”
Impact of COVID on family life
The impact on family life underlined having limited family time and fear of infection. Statements like, “I miss home, because now I do not get a chance to go and my family every day.” Or “I cannot risk their lives so I have to keep my distance.” To, “I worry about them getting infected from me. I cannot be near my children/parents, etc.” resonated among the participants.
Experience of stigmatization
Stigmatization was found to be prevalent in the workplace, within the family, and in the community level. At work, comments like, “Non-COVID duty colleagues do not talk to us or mix with us anymore.”; patients or family of patients saying, “It is your fault,” when the patient gets worse or passes away. In the family, echoes such as, “Immediate family are somehow supportive, but relatives shun us so that we are not even informed nor invited to any family occasions. It is painful”
In the community, “Even the relatives who are healthy cannot come out to go to work just because they are related to me. At that time I really felt discriminated.” Another person says, “In our village, we were told not to enter the village, even though were not COVID positive” Others said, “We are exhausted from long hours of duty yet could somehow replenish our strength for the next day. But when we are blamed or shunned, the struggle is worse – we have to fight emotionally and mentally.” Someone said, “I just hope that people will understand that we are humans too, and that even we are new to this virus.” Many participants, however, expressed that the intensity of the stigmatization was worse in the beginning of the lockdown compared to the time of the interview.
Coping strategies
The most prominent coping strategy recorded was the “expression of faith” and “spirituality” across religions. Praying, meditating, reading the Bible and Holy books, listening to spiritual teachings and songs gave solace. Receiving family and social support which also included prayer were sources of encouragement. Engagement in recreational activities such as indoor exercises, reading, watching movies, social media, and music while in isolation like in hotels or quarantine centers, were found helpful.
At the work place, occasional team building exercises, venting of emotional and psychological stresses to colleagues, and sessions conducted by a Psychiatrist were found helpful. However, the participants expressed hope that a full-time Psychiatrist would be employed in all the hospitals. One of the hospitals reported that only a part time Psychiatrist comes once in a while which does not meet the increasing need for mental health care.
Suggestions from the healthcare personnel
Wide awareness programs at all levels on the concept, prevalence, and manifestation of stigmatization, improvement of infrastructure and increase of essential supplies, increase of human resources including training were suggested. Training should include recent updates on the pathogenesis of COVID 19 (and the new strain of the virus) and also psychological coping mechanism. They all voiced the need for appointment of full-time Counselling Psychologist, Clinical Psychologist, and Psychiatrist for public and private hospitals and CHCs. They also voiced the need for enhanced salary packages for all healthcare workers, clearer communication between the government and community leaders for dissemination of new guidelines and notifications and transparency of the government on the management of COVID 19 which would increase the trust of the public in the health sector. Above all they aspired for development of community based strategies for psycho-social care in both rural and urban areas.
A tribute message
Charles Glassman said “Kindness begins with the understanding that we all struggle”. As the team researchers for this project, we acknowledge the fear and anxiety that may arise towards our healthcare personnel in the process of battling with COVID 19, and this article reflects the very need for encouragement, trust, respect, and kindness towards them.As stated by Daniel Goleman, “True compassion means not only feeling another’s pain but also being moved to help relieve it”.
A conscious effort, as individuals and communities, will promote positive mental health which will in turn enhance our own wellbeing.
On behalf of the patients and their family members who were the recipients of care, we salute all the healthcare personnel who were involved in the management of COVID 19 patients in Meghalaya in particular as well as the rest of the country and the world. We pay tribute to the healthcare personnel who have lost their lives in the war against COVID. For your sacrifices and commitment to uphold your calling to serve the humanity, we thank you.
The authors are faculty members of the Department of Psychology, Martin Luther Christian University, Shillong and may be contacted through [email protected]