Covid-19 and Frontline Workers

23 May 2020


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Dr Antoinette Miric, specialist psychiatrist


This webinar was hosted by the Mail & Guardian and Dr Reddy’s in association with the South African Depression and Anxiety Group (SADAG) and featured Dr Antoinette Miric, specialist psychiatrist; Zamo Mbele, clinical psychologist; and Cassey Chambers, operations director and board member, SADAG.

The online seminar unpacked the psychological effects of Covid-19 and the lockdown, with particular emphasis on the frontline workers, including health professionals, who daily face the danger of contracting the virus and of transmitting it to their families. Over 450 people attended the seminar.

Dr Antoinette Miric said that the psychological health of healthcare workers in South Africa is severely neglected; there is very little funding or attention focused on this, but “there is no health without mental health”.

Zamo Mbele said for himself and for many people who have been working during lockdown — people running stores, for example, and essential services — it has been incredibly stressful, and there is a lot of fatigue out there. These people have had to look after themselves while they were working, but there have been no guidelines, as this is a new crisis.

“It has been a long, hard slog,” said Miric. Healthcare and essential workers have experienced a huge change in schedule, which is in itself an emotional trigger. There is also a lot of loss: people have had to without the usual support they get from others. In addition, there is also the stress of uncertainty, and constantly changing information.

c96fd983 zamo picture 1024x676Clinical psychologist Zamo Mbele

We are fortunately a little behind on the trends of other countries; if this is a series, we are in episodes three and four, and Europe for instance is in episodes six and seven, so we are slightly more prepared than they were. This will help us to realise just how long this is going to take, and we can pace ourselves better with what we have, because adrenaline can only carry you so far. Our colleagues have to had to be stoic and not display anxiety, which is double work: you are attending to people but also pushing down your own fears. If healthcare workers can attend to their own anxiety, it will give them more long-term strength.

Things to look out for in healthcare workers are: how much energy do they have? Adrenalin can keep you going, but if this “combat energy” does not subside, a crash will follow. Symptoms include irritability and impatience; shifts in sleep patterns; people not looking after their physical health, and not even eating. When there are big shifts in emotions, then we need to become concerned.

Frontline workers cannot get away from the stress, so it is affecting them at work and at home. Our colleagues are worried about things like their kids’ education, about vulnerable family members, about bringing the virus home, and about infecting their patients. So there is a lot of anxiety. Many healthcare workers feel lonely and vulnerable; some have even moved out of their homes as they fear contaminating their loved ones.

There is still a huge stigma around mental health issues. There is no space to admit vulnerability in services like the police force, which is a big pity. The media is calling healthcare workers heroes, which is a dangerous narrative. They don’t have capes, and there is a pressure for them to not be scared or to show it. But if you can show vulnerability it allows you to go further.

This “heroic” label is dangerous. Healthcare workers are not soldiers going into the frontline, they are humans. The problem with labelling is that health workers feel like they are frauds, because they are being called heroes but many don’t feel that they are doing a good enough job. “How can I be a hero if my practice is closed, or if I am sick and sitting at home?” asked Miric. Healthcare workers need support, and we need to understand the struggles they are going through. “The clapping at 7pm is great, but rather give me PPE.”

Regarding posttraumatic stress disorder (PTSD): those who are experiencing the most stress are those who tested positive, had symptoms, had to self-isolate, and had to endure the stigma when they were trying to reintegrate. Similar things happened with the Sars virus in the US previously. When these all come together, they can have long-term effects. PTSD is very hard to treat: it can be intractable, so we need to be very aware of this.

Journalists have also had to go onto the frontline: some have lost colleagues etc. SADAG has a strong partnership with journalists historically, and there is a lot of opportunity for collaboration between SADAG and the press. We need to adjust the narrative of healthcare workers being heroes; we need to inform people of the conditions they are working under. When a major media house lost a journalist recently it underlined that the press is also vulnerable, that journalists also need to look after themselves.

Chambers said: “One of the magic things about Covid-19 is that it has brought people together — over 500 doctors, social workers, counsellors have volunteered to come forward and help their colleagues, which is amazing.”

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Cassey Chambers of SADAG

A care network has been launched for frontline healthcare workers in Gauteng and the Healthcare Workers Care Network (national network) will be launched in June. This network is a collaboration between the South African Medical Association (SAMA), SADAG, the South African Society of Psychiatrists (SASOP), the South African Society of Anaesthetists (SASA), and is supported by the Psychological Society of South Africa (PsySSA). The Healthcare Worker Care Network will have a 24-hour helpline and an SMS line manned by mental health professionals, and will have a website with online contact points. At this stage healthcare workers can go to this form co-ordinated by SAMA and request help. Or they can sign up for either the EMGuidance app or Vula app and follow the prompts on those platforms, which will enable them to contact our team.

There are now directives in certain hospitals that people with certain conditions or of a certain age should not be put on ventilators. We are asking our healthcare workers to make this call on people of the same age as them, or who have the same condition as them, and that goes against their internal moral code, which is what we mean by moral injury. It touches on guilt and shame, and we are seeing this across the world, and more of it will be coming to South Africa as the pandemic increases.

For companies and leaders, remember that looking after your staff begins with looking after yourself. Some of the suicides we have seen among healthcare workers is a direct result of moral injury. “If we have compassionate leadership, we are going to do better in this crisis. When things get hard, you soften.”

The Gauteng team has trained about 600 leaders in different areas. It is trying to do preventative work, supporting the leaders who support the healthcare workers. There are resources on the website in terms of leadership — what is useful and what isn’t, such as being honest — if you don’t know about something, tell them. Be interested in your staff, and try to bring them together, for instance if you have a big team of nurses.

Accessing mental health must be made easier for South Africans. Companies must take both a preventative and a reactive approach. They must find out what resources are available and use them.

This crisis is a leveller; we are all facing a lot of stress and possibly distress. For many people this is the first time they have experienced psychological distress, but soon, out of 60 million South Africans, almost all 60 million will be experiencing some form of distress. This crisis will touch everybody. Those who are experiencing distress will not be prioritised: those who are having difficulty breathing will be. This is the future that we need to start preparing for.

Psychological wealth, like all wealth, requires investment; resources must be put into maintaining it. Building mental resilience requires understanding what resilience is. Self-care is not selfish; healthcare workers need to focus on themselves first, not just the other, for a change. “Healthcare workers must do more to look after themselves than usual. They must have a dedicated, deliberate, symmetrical response to self-care — we need you to get through this,” said Mbele.

Use the SADAG helplines if you need them! SADAG Helplines providing free telephonic counselling, information, referrals and resources seven days a week, 24 hours a day. Call 0800 21 22 23, 0800 70 80 90 or 0800 456 789 — or the Suicide Helpline 0800 567 567.

The next Dr. Reddy’s webinar is about empowering teachers and parents as children return to school.

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