Heal the Healers

 

A recent study by the Indian Journal of Psychiatry says around 30% of Indian doctors undergo depression, and almost 80% face the danger of burnout within the early stages of their careers. The covid-19 pandemic, however, is resulting in an entire new level of stress.

 

Even in normal circumstances, healthcare workers show above-threshold levels of stress. “Around 25% compared to 15-18% within the general population," says Radhika Bapat, a Pune-based psychotherapist. This is true not just for doctors except for the whole caregiving team—ward boys, nursing staff, ambulance drivers, sanitation workers. “You can only imagine what the amount must be like immediately. Treating covid-19 isn't just physical but emotional labor also ," she adds.

 

Doctors are human too

There are a selected set of anxieties, as Kishore Kumar, founder-chairman and neonatologist, Cloudnine group of hospitals, lists: worry for self and family, shortage of kit, social stigma.

Already, several instances of resident welfare associations ostracizing doctors are reported from cities like Kolkata, Delhi and Pune. Just before the nationwide lockdown from 25 March, the Resident Doctors’ Association (RDA) of the All India Institute of Medical Sciences (Aiims) in Delhi wrote to Union home minister Amit Shah about forceful eviction by landlords scared of infection. round the same time, a house surgeon from MGM Hospital, Warangal, put up a post on Facebook: “One owner said that we were dirty...did I study 14 hours each day for this?" The post went viral.

“There is additionally the fear of being bashed up by relatives if things worsen," Dr Kumar adds. A doctor on duty at a government hospital in Hyderabad, as an example, was reportedly attacked by the relatives of a 49-year-old who died of covid-19.

There are reports of doctors being attacked in cities like Bengaluru, Hyderabad and Indore. Consistent with a 3 April Hindustan Times report, residents of a neighborhood in Indore pelted stones at healthcare workers who had gone there to screen people for covid-19. Two female doctors suffered injuries. An identical incident was reported from Munger, Bihar. More recently, during a video doing the rounds on social media, a doctor working in Surat Civil Hospital was harassed and abused by her neighbor.

The shortage of private protection equipment (PPE) and N95 masks leaves them even more vulnerable. Some, who are diabetics or suffer from autoimmune diseases, are particularly in danger.

Doctors have vented their frustration on social media. A medic at a government-run hospital in Gandhinagar posted on 24 March: “Working at Corona OPD today. No special protective gear provided. No basins to scrub hands periodically. I can only hope that nobody sneezes on my face." A later tweet noted that change was coming, slowly and steadily.

 

Rajeev Ranjan, ex-general secretary, RDA, AIIMS, and a laboratory physician, talks of 85 resident doctors at the Nalanda Medical College & Hospital, Bihar, who weren't provided PPE. They’re beaten self-quarantine now. “Healthcare professionals are at the battlefront of this war. If you don’t give us ammunition, how will we fight?" he asks.

The Union government says it’s working to spice up PPE availability.

It’s a crisis, for one infected doctor is worse than five infected patients, with the danger of spread increasing exponentially. By 3 April, there have been reports of fifty doctors and medical staff having tested positive for the coronavirus. Several cases have emerged from the Capital itself, in hospitals like Aiims, Safdarjung, the Delhi State Cancer Institute, also as mohalla clinics. In Mumbai, a 35-year-old doctor from Dharavi has tested positive, as have doctors and nurses within the Wockhardt and Jaslok hospitals. News of the death of a doctor thanks to covid-19 has come from Indore.

Rajeev Ranjan, ex-general secretary, RDA, AIIMS, and a laboratory physician, talks of 85 resident doctors at the Nalanda Medical College & Hospital, Bihar, who weren't provided PPE. They’re beaten self-quarantine now. “Healthcare professionals are at the battlefront of this war. If you don’t give us ammunition, how will we fight?" he asks.

 

Unprecedented situation

It is imperative, then, for people to know that it’s a replacement situation for healthcare staff too—and one they're still learning to grapple with. As 27-year-old KD, a Mumbai-based senior resident in critical care medicine at a government hospital, puts it: “Medically speaking, nobody has seen covid-19 before. Doctors and nurses are trained to spot pneumonia and respiratory failure." The doctor didn't want to be identified.

This particular infection is being checked out as a game changer; its accelerated course defies the traditional practices of managing severe pneumonia. Not only are physicians struggling to think outside the box, they have to try to so in deeply distressing circumstances. “Many have moved to a different accommodation on rent to avoid going range in this crisis, to avoid transmitting infection. This is often proving to be very difficult, especially when members of the family, like the elderly or newborn babies, are hooked in to them for care," says Dr KD.

Families of healthcare workers are browsing the emotional wringer also; say Bapat and Priyamvada, who have seen a surge within the number of calls. Priyamvada, as an example, recently received a call from a doctor’s son. His father, a diabetic, is volunteering with hospitals. When he comes home, he locks himself during a room and therefore the family leaves food outside the door. “His son told me that it seems like they need a prisoner within the house. That line has cursed with me," she says. Often, the son sits outside his door to possess a talk. “At times it feels to him as if the father’s voice is breaking," she adds.

 

A psychotherapy plan

The situation needn’t be this dark. For one, hospital administrations can help alleviate stress through proper delegation and sensible decision-making. “Triage is most important—it is that the process of assessing if a patient requires ICU, non-ICU, or home care. This way, we will allocate the limited resources to people that need it the foremost ," says Dr KD. Since the decision-making is completed by senior doctors, it takes the strain off the juniors.

Mindfulness and relaxation techniques are recommended. Zirak Marker, psychiatrist and adviser, Mpower—a centre and foundation for holistic psychological state services—says secondary traumatic stress can impact anyone helping families through a traumatic event. Being within the hospital, witnessing the eerie emptiness or offering consultation to countless patients with flu-like symptoms can cause anxiety. Doctors must seek help if this is often impacting their work and families.

What’s also needed may be a real-time psychotherapy plan. “This includes group cohesion sessions, during which small groups get together during a 5- or 10-minute break once each day . A team coach—a fellow doctor, head of the institution or someone within the management—then motivates the team," says Bapat. an equivalent coach should make sure the doctors take an opportunity to talk to friends and family. Offering a quiet room would help. “A place where an individual can just sit to urge relief from the noise and provides them a breather. this is often called caring for the carers," she says.

Doctors, in turn, got to make a sensible estimate of how far they will push themselves. Priyamvada suggests controlling interaction on social media as, with people in emergency mode, there are countless requests for medicines on WhatsApp. “You got to know what's in your control. Government policies aren't . If your hospital has only two ventilators and therefore the government isn't providing more, there's nothing you'll do about it. it's not your guilt," she says.

Not everyone needs psychological intervention, just someone who can listen are often enough, says Priyamvada. to make sure this, hospitals like Cloudnine have installed internal helplines for the staff, to enable calls with experts and seniors. There also are regular meetings on Zoom to stay the conversation going.

“A lot of the resident doctors stay within the hostel or share a flat. We share our problems with one another . At this point of need, most are helping. Because together we will , and together we'll ," says Dr Ranjan.

 

Handy tips for healers

 

Zirak Marker, psychiatrist and adviser, Mpower, suggests some easy solutions to manage your anxiety at work

·    Take an opportunity from the news.

·    Hearing about the pandemic repeatedly are often upsetting.

     Create a constructive routine for private self-care activities that you simply enjoy, like spending time with friends, family and children—online or over the phone, exercising diligently reception , with floor workouts or using Therabands /resistance bands.

·    Speak to other doctors about how they're coping.

·    Understand that this phase will end.

 

 

Ask for help if you are feeling overwhelmed or concerned that this is often affecting your ability to worry for your family and patients as you probably did before the outbreak. Monitor yourself for symptoms like difficulty in sleeping and concentrating or a way of fatalism.