OPINION | Showing support for our frontline healthcare workers more crucial than ever

22 May 2020

On 29 May to highlight the importance of the 2020 #CS4D Day, we are all urged to wear odd -matched socks. (Supplied)

If something needs to go viral right now, it’s to support our healthcare workers who put their lives at risk to save us from a viral pandemic.

Our frontline healthcare workers are bearing the brunt of a viral pandemic that not only causes a potentially deadly illness, but also unforeseen mental health issues.

For our healthcare workers fighting in the trenches the risks for the latter are even higher.

If Covid-19 was a war, our healthcare workers would have been in the firing line. They are the ones bravely protecting us against a lethal, but invisible, enemy.

We as the public cannot even imagine the 24/7 physical and emotional stress and pressures they are under in the fight against this deadly foe in the form of a never-foreseen viral pandemic. 

Medical professionals, already stretched to the limits under normal circumstances, now also have to focus all their time, energy and expertise on Covid-19.

This is also taking its toll on their mental health. Statistics already show healthcare professions are suffering most - and mostly in silence because of stigma.

Yet now they need to attend to us, the public, even more, and under much more stressful circumstances.

South Africa’s projection of cases and fatalities - and our lack of resources - means healthcare workers' own stressors are just increasing.

And that is exactly why we have to show we #Care4OurCarers with this year’s #CrazySocks4Docs (CS4D) Day on Friday, 29 May.  

It’s clear: Healthcare professionals need our support more than ever.

Lockdown or not, when you do your morning walk, jog or cycling on Friday 29 May between 06:00 and 09:00, show you #Care4OurCarers by wearing the most funky mismatched socks you can find.

Even better: Take a sock selfie and let it go viral to show you #Care4OurCarers. 

On a serious note, not only healthcare professionals need to be supported, but also our medical students and academic and administrative staff on South Africa’s medical campuses.

They are also suffering immensely under anxiety and fears. Despite this, they are still volunteering to work as extras in the fight against Covid-19.  

According to research the pandemic has already caused "striking rates of anxiety and depression" among healthcare workers.

One can - ironically - state that the most unsafe profession in terms of mental health is that of the health professions.

In the US, on average, one doctor dies of suicide every day. It is the highest suicide rate of any profession, with the number of doctor suicides in the USA more than twice that of the general population.

No such specific statistics for South Africa exists, but one can surmise that the same crisis exists in our country. International data also indicate that medical students are at higher risk of suicide.

This was corroborated by a South African study that found that almost a third of South African medical students experienced suicidal ideation and almost 7% attempted suicide - three times higher than peer-related statistics.   

Globally, statistics draw a dismal picture of the mental state of medical professionals.

A UK survey found that 68% of respondents had depression; a Canadian study that 80% of doctors were suffering from burnout, and in New Zealand mental health problems are nearly three times as prevalent among GPs and surgeons than in the general population.

In similar studies across the globe the findings were the same.   

Of all occupations, the medical profession is consistently number one with regard to being at risk of depression and anxiety, leading to the fact that the mortality risk caused by these illnesses are also higher.

Research has constantly shown - according to one source now for more than 150 years already - that physicians have an increased risk to die of suicide.

This is in contrast to global statistics that show doctors have a lower risk to die from cancer or heart disease, but a "significantly higher risk" of dying from suicide.

The reason for the former is that they presumably have more knowledge of self-care and early diagnoses.

For the latter it seems their "better knowledge" about mental ill-health does not save them from suicide, described as "the end stage of an eminently treatable disease process".

And, as Professor Beth Brodsky, associate clinical professor of medical psychology in psychiatry at Columbia University, said: People do not "commit"suicide. They die by suicide. Also: "Suicide is an illness and not a crime."

The question is: How can we break the silence and the stigma in the medical fraternity?

Tragically, as indicated, it starts at an early stage: It also is the most common cause of death among medical students. Studies also show burnout cases among medical students are between 45% and 71%. 

An expert in burnout, or occupational dysphoria, especially among health workers, Christoffel Grobler, head of the Clinical Unit at the Elizabeth Donkin Hospital in Port Elizabeth and associate professor at Walter Sisulu University, says the Covid-19 pandemic might result in what he calls "moral injury" to health workers.

According to him, despite government doing an excellent job to flatten the curve and South Africa being a resource poor country, it has to be accepted that "our resources may at some point run out because of high demand".

This may lead to health workers having not only to say to relatives "We did all we could", but "we did our best with the staff and resources available, but it wasn't enough".  

Grobler says health workers also need to "mitigate the negative moral effects of the current situation" regarding the "moral dilemmas we are going to face".

According to him "properly preparing staff for the job and the associated challenges reduces the risk of moral injury and mental health problems".

This includes healthcare workers not to be "given false reassurance, but a full and frank assessment of what they will face, delivered without euphemisms and in plain English".

To do anything else, Grobler says, "may add to feelings of anger when reality eventually sets in".  

Grobler participated in developing a seven-day "Mental Health Lockdown" moodle course for the Foundation for Professional Development.

It is not only meant for students; the public can also access the free online course.

It is an excellent tool to help reduce stress and there are even resources for parents and children.

Sadag, the South African Depression and Anxiety Group, has experienced a doubling of phone calls on their help lines since lockdown.

It seems that currently more than half of South Africans - 55% - have feelings of anxiety and panic, while almost half - 46% - experience financial stress.

Specifically for healthcare workers Sadag, with other partners such as the South African Medical Association and the Psychological Society of South Africa, will be launching a Covid Response Fund, specifically to assist with the needs of healthcare workers.  

CS4D Day was started in Australia by cardiologist Geoffrey Toogood who lived with both depression and anxiety. One day, while wearing an odd pair of socks, he overheard remarks behind his back of how he is "falling apart again".

His socks, however, were not to be blamed.

He had a new puppy, and the socks were merely the last two not destroyed by his new housemate.

Because of stigma, however, instead of asking whether he was okay, his colleagues simply could not address the situation. This was the moment when Toogood decided to do something to break the silence and the stigma.

The result was CS4D, a funky and funny campaign to help his profession and our society as a whole to understand and support mental ill-health in the healthcare environment. 

In South Africa CS4D is organised by the Ithemba Foundation, a non-profit with two public benefit goals, namely to raise awareness around depression and related diseases such as anxiety as clinical, biological, and therefore treatable illnesses, and to support research.

Ithemba means hope in isiXhosa - the message that if depression is the illness of despair we need to hang on to hope.

In the words of Ithemba director and general practitioner Marita van Schalkwyk: "As healthcare workers we must undertake to serve the sick and needy, but we must also look out for one another, help one another, inspire one another and seek help when we ourselves cannot keep up the demanding pace. There is always hope - the meaning of ithemba."

It is clear: We as the public must show we #Care4OurCarers and that between us and a deadly virus they are the ones fighting in the frontlines and putting their lives at risk.

As a grateful public we should show how much we value our health workers and show we are right behind them.  

And, fortunately, all of us have a number of despondent socks in our drawers who will be just too happy to find a mate on 29 May to highlight the importance of the 2020 #CS4D Day.

Even if you sit behind your desk in home office style, you can don your socks and post your sock selfie on www.facebook.com/IthembaFoundation1 to show you care.

Let’s use #CS4D to show we #Care4OurCarers and to say a BIG thank you to all our healthcare workers. 

- Lizette Rabe is professor at Stellenbosch University and founder of the Ithemba Foundation (www.ithembafoundation.org.za). Ithemba’s registration number is 2012/171250/08 and its SARS PBO Number 930/048/019. 

If you need help, please do not hesitate to call these numbers: Lifeline 24-hour helpline: 0861 322 322  CIPLA 24-hour mental health helpline: 0800 456 789 or WhatsApp 076 882 2775.

Article link: https://www.news24.com/news24/columnists/guestcolumn/opinion-showing-support-for-our-frontline-healthcare-workers-more-crucial-than-ever-20200522