HEALING THE HEALER: Spare some thoughts for Covid Warriors too
Like in every pandemic-hit part of the world, health workers —doctors, nurses, aides, laboratory technicians, helpers, peons, and so on— in Kashmir have been on toes since the WHO declared a public health emergency of international concern (PHEIC), in January last year. Against all odds, they are working hard in these times of crisis. And while doing so, many of these frontline warriors got infected, and even some of them died.
With a spike in the cases, health workers —especially doctors and nurses— face tremendous pressure these days. They treat and care for patients at outpatient and inpatient departments of hospitals and Covid centers and they also provide them with online and telephonic consultations. With easy access to their contact numbers, the phones of the doctors on Covid duty remain buzzing most of the time with messages and calls from the patients and their relatives seeking advice and help.
As J&K’s health sector is already understaffed, doctors and nurses do not have any respite. Given the alarming magnitude of the pandemic, the authorities have barred doctors, nurses, and paramedical staff from going on leave.
Experts say that the constant workload for more than a year now is not only causing emotional and physical pain to the doctors and nurses but it also impacts their social and family lives. They say, sometimes these healthcare warriors face undue challenges as well. For example, in case of shortage of oxygen or medicine at the hospital or a Covid centre, doctors and paramedical staff become victims of the ire of patients and their attendants. Furthermore, the experts say that these fall guys also have, every now and then, to obey undue orders from the ‘babus’ in the administration. They put a recent order as an example, in which authorities barred doctors from speaking to media. A circular issued last week, warned doctors of a “strict disciplinary action” for circulating “contradictory and confusing massages” which “misinform the public and create unnecessary and avoidable panic”.
Since the pandemic has not shown any fading signs, and rather a third wave of the Covid is predicted; this question is being largely asked: How long would health workers be able to sustain the pressure of an unprecedented situation?
Mental health experts say that if the given situation continues for a long, many of these health workers might be risking psychiatric problems such as insomnia, anxiety, and depression. They emphasize taking care of the health of healthcare workers is of utmost importance.
How do these healthcare workers, particularly those who have been on Covid duty for the past more than a year, feel? How the pandemic situation does impact their emotional and physical health? Have their present-day professional challenges troubled their personal, family, and social life as well? What do they think the government must do to ease them out, or at least to boost their confidence, in this crisis? To know the answers to these crucial questions, KASHMIR IMAGES spoke to many healthcare workers.
Here are the excerpts:
Paramedical staff and doctors have been working efficiently as frontline workers since the outbreak of the Covid last year, across the world; and the same is true about health workers in Kashmir. Given the fact that medical professionals, by and large, are tough people; I am sure they will continue working with the same zeal.
That said, I would be lying if not admitting that there is some degree of fatigue. However, simultaneously, we fully understand that the given crisis demands our dedication and we cannot shy away from our responsibilities. Thank God, we have dedicated health workers in Kashmir who, despite threatening situations; do not budge from playing their role in this pandemic. During the past year, Kashmir lost about six doctors in government and the private sector to the Covid. Hundreds of doctors and health workers got infected. I got myself infected last year and was hospitalized for two weeks. I returned to my duty within a month. We have to accept the fact that this is entirely an unprecedented situation and we must face it with courage.
Thankfully, we do not feel alone in this crisis. The government is providing all the possible support to the healthcare workers. It took several masseurs recently, including announcing financial incentives for doctors and paramedical staff. Also, retired professionals are being reengaged to ensure there is no shortage of workforce. These elderly people will replace young staffers from various departments in health sector, so that the youngsters are deployed to serve the Covid patients. The government has also initiated fast-track appointments of doctors and paramedical staff.
As the pandemic has hit the whole world, healthcare workers are undergoing a tremendous workload everywhere these days, and they are facing challenges on multiple fronts.
Since humans are connected, doctors and paramedical staff usually get emotionally bonded with the patients while treating and taking care of them; and in the ongoing pandemic, we experience this bond much stronger. Sharing one of my recent experiences, I got emotionally overwhelmed after I saw some critically infected patients battling to survive in a Covid ward the day before yesterday. We keep the baggage of such emotions with us most of the time and go home with the same state of mind. Eventually, it impacts our families too. Even sometimes doctors and paramedics, of course unwittingly, carry viruses from their workplaces to their families. I lost my mother to Covid in July last year. My both parents had got infected, and it took my father three months to recover but I lost my mother. I am not sure whether I caused the transmission or someone else brought it to them. Since the passing away of my mom is a very personal tragedy to me, I do not want to talk much about it here. However, with this personal reference, I want to point out that doctors too are in the same boat when we talk of the pandemic. When I go home, I ensure my kids do not come close to me, but simultaneously, it hurts me seeing them craving to come closer to me. On one occasion, my son touched me with a stick, and then he resonated; “now I have met my papa.” We all are facing such a helpless situation. Perhaps such personal tragedies and experiences have strengthened the doctor–patient bond further in this pandemic, and that is why we feel tremendous pain while seeing our patients battle for life.
With my observation, I can tell you healthcare workers are going out of their way to treat the patients since the outbreak of the pandemic. Last night at around 11:30, I called my registrar to enquire about some critical patients and meanwhile I asked him if he had taken his dinner. He told me that he was busy seeing the patients and had not his dinner yet. You might say that these are small things but we face them on a daily basis.
To conclude, let me say that since the pandemic would be there for a long, we need to take some initiative to minimize the workload on the healthcare workers. A few things can be done easily. Firstly, the workload should be balanced among the available healthcare workforce. It is observed that some of the healthcare workers are tremendously overburdened while some are not. I am not saying people deliberately do not want to work, but this is how our system has been set. This system needs to be modified at least till we are in a pandemic situation.
Healthcare workers would serve efficiently if the workload is judiciously distributed. We require a well-devised system to balance the workload in hospitals, particularly in tertiary care centers. Secondly, the referral system needs to be reinforced at our district hospitals. However, these hospitals ought to be sufficiently well equipped, especially in terms of the availability of oxygen, so that patients with mild Covid infections can be treated in these hospitals. If all primary hospitals are enabled with required facilities, there will be less burden on tertiary care hospitals. Thirdly, ambulances should be available sufficiently at the major hospitals so that as soon the patients are out of danger, they are sent to their native district hospitals to keep them there for another week or so. I am saying all this because we have to accept the pandemic as a new normal until it vanishes away and we must evolve our system to tackle this new normal.
If the pandemic prolongs further, health workers are certain to face different physiological problems such as anxiety, depression, and so on. They will be burnt out due to the constant pressure at their workplaces. Eventually, they will lose interest and focus on their professional duties. Human minds have limited capacity to handle a challenging situation and when the trouble gets prolonged, mind capabilities starts fading.
In the given situation, the healthcare workers are not only facing work overload but they are also threatened with the vulnerability of getting infected by the disease. Also, they see deaths occur due to the virus every now and then. This entire situation impacts their mental health with each passing day. According to my observation, junior doctors and nursing staff are suffering more than anyone else.
In normal situations, standard working hours for a doctor or paramedical staff are set as eight hours a day. In crises like this, the work hours can be stretched a bit more but not beyond a limit. An exhausted doctor cannot provide proper focus and treatment to the patients.
As a mental health expert, I would suggest creating a workable mechanism to ensure doctors and nurses get sufficient rest. Taking care of health workers is imperative to get benefitted from their potential. Therefore, they should be taken care of. They should be served healthy food while they are on night duties. All possible measures should be taken to boost their confidence, especially in these times of crisis. This is a professional workforce that cannot be replaced. The entire health sector would collapse if this workforce collapses. So take care of the health workers. They are humans, not machines.
In a pandemic, all healthcare workers —whether doctors, paramedics, or nurses— are at a high risk of getting the virus, because of their proximity to the affected patients. Since the time span of this pandemic is unknown and unpredictable, it continues causing threats not only to the physical health of the healthcare workers but to their psyche as well. That is why in some cases tendencies of fear and anxiety in doctors and paramedics are evident. Many of them sometimes feel depressed. However, what motivates them for going on is the nature of the profession. It is not money or the so-called incentives but the professional ethics that keep health workers going on despite the looming threat.
This sprite could be boosted up further if capable management is in place at the hospitals. Frankly speaking, we lack managerial capacity in our health institutions. Those at the helm of affairs might be good doctors, but they are not good managers. Health workers will not feel overburdened if they are properly taken care of. We need to organize our hospitals according to the requirements of the pandemic. Any pandemic situation is like a war situation and healthcare workers are like soldiers, who need to be taken care of by the management of the hospitals so that they keep fighting with the disease. We need to boost up the morale of these warriors all the time, and only good managers know how to do it. We do not have that bad health infrastructure in Kashmir, but it is unorganized; and only the good managers, not the bureaucrats, can help organize it. Once this infrastructure is organized, we will have an enhanced outcome and capabilities.
I was the first healthcare worker who got infected by coronavirus soon after the virus reached the Valley, last year. I tested Covid-positive in February last year and got subsequently admitted at Chest Disease (CD) hospital for a month. It took me more than a month to recover and join back the duty. Since then, a number of healthcare workers fell prey to the pandemic while they were taking care of the affected patients.
However, despite the threat perception, health workers tirelessly provide help and care to the Covid patients. According to my experience and observation, most of the paramedical staff members in Kashmir are God-fearing, and thus, perform their duties honestly and with utmost dedication. However, I must admit that in the early days of the pandemic last year, some of our nursing staff was hesitant to serve the Covid patients. Due to the lack of awareness of the disease, they were terrified about it. It was the same kind of hesitancy that used to be seen when HIV disease was a new thing in our part of the world, a few decades ago. Similarly, in the case of Covid, everyone was hesitant earlier. Even the dead would not get a proper funeral in the early days of the pandemic, last year. Therefore, I don’t blame the nursing staff for their initial hesitancy. Even the WHO took months to find facts about the pandemic. Now, since there is enough awareness about the disease, healthcare workers serve fearlessly.
However, the nursing staff faces some undue problems as well. For example, we lack sufficient nursing staff in Kashmir that causes an overburden to the available workforce. Unfortunately, nurses are not appointed here according to the requirement. I saw a nurse for every single patient at All India Medical Institute (AIIMS) when I was there on a deputation recently. However, back home, we are gravely understaffed.