What the piling bodies and helplessness are doing to our overworked health workers

Hyder Sherif, a junior health inspector in Kerala, was a tranquil, silent, diligent and workaholic person. According to his colleagues, he was a family man too, with very limited socialisation. He never took a holiday since April 2020, when the Covid-19 lockdown was announced in India. He took his laptop home even on Sundays, worked round the clock like many other health workers. He never went to a cinema, dinner or took a holiday with his family for a year.

Early this year, amid his relentless battle, Sherif tested positive. He took leave and quarantined himself at home for 14 days. But after that, he did not return to work. When colleagues tried to persuade him, he told them he had a serious mental block.

“I was told that he used to take the lunch packed by his wife and go out as he used to do in the past (as if towards hospital), but he never reached. It was late by the time we came to know about it,” Raju, health inspector at the Family Health Centre at Vadakkekkadu in Thrissur district, and a colleague of Sherif, told The Federal.

On February 18, Sherif hanged himself at his home.

“After he survived Covid, he almost stopped going out and confined himself at home. His colleagues with a sense of guilt realise that they should have understood the alarming signs of stress and depression that he expressed. All of us are burnt out. Who is getting time to think about colleagues or even about ourselves?” asks Raju, who is yet to come out of the shock.

This might be a one-off incident but is a pointer to the mental battle Covid warriors fight in our country and across the world.

“We have given special focus on the mental health of workers since the beginning” says Dr Kiran, nodal officer for mental health in Kerala.

A team of professionals were deployed to provide psychosocial support to frontline warriors on Covid duty from March 2020.

“Initially we called each person on duty—from the doctor to the ASHAs on field—and reached out to them and to keep a track of their mental health,” says Dr Kiran, adding that the health workers were too busy to attend such calls.

“We have often received furious responses from them saying that they had little time to engage with ‘such calls as they were tightly packed with Covid duty,” says Dr Kiran.

Even then, mental health workers handled an exponential number of stress calls from Covid frontline warriors on duty. 128 stress management trainings were conducted since April 2020 in which 1,531 doctors, 1,169 nurses and 1,357 health inspectors participated. Around one lakh calls were made by the mental health team as a follow up of the stress and emotional turbulence experienced by health workers on Covid duty.

“People adopt different mechanisms to cope with stress. In my case, focusing only on work round the clock was the option,” says Dr Shemeer, the nodal officer on Covid duty in Government Medical College, Kozhikode, who had also treated Chief Minister Pinarayi Vijayan when he was Covid positive.

His Facebook note on his experience of being the doctor of the Chief Minister has gone viral.

Dr Shemeer was assigned a lead role since the beginning of the pandemic in 2020, counting on his experience in handling the deadly Nipah virus in 2018.

“I was completely engaged in the Covid ward and hardly got time to sit back and think. I have trained myself to maintain my composure level, but our team still found it hard to handle the deaths. No matter how senior you are, every death will shatter you—both as a doctor and as an individual,” says Dr Shemeer.

After a long battle in the Covid ward, Dr Shemeer tested positive last week. “I am determined that I will not let myself down. I am only worried about the additional burden that my colleagues have to bear,” says Dr Shemeer.

Dr Samin, psychiatrist at Government Hospital, Ernakulam, regularly receives calls and texts from healthcare workers on Covid duty, sharing the trauma and stress that they go through.

He shares a text message from a doctor at a Covid hospital in Madhya Pradesh: “What I see around is death and only death. I am falling into depression. I lost compassion. I have become a machine. I feel that life has no value any more.”

“I tried to talk to him but he does not get time even to talk to me. These frontline warriors hardly get time to take care of themselves,” says Dr Samin.

According to psychiatrists, the pandemic has had a severe impact on medical professionals in general and on those having problems of stress or clinical depression in particular. The burden of work, restrictions on mobility, exposure to a contagious disease and isolation have worsened such conditions.

A recent study by The Lancet journal published in February 2021 says that the healthcare workers all over the world are exposed to tremendous levels of risk for anxiety, depression, burnout, insomnia, moral distress and post-traumatic stress disorder.

There are multiple factors for these—heavy workload, inadequate training and infection control practices and guilt for being unable to save lives.

The study also points out that some healthcare workers were burdened with emotionally and ethically fraught decisions about resource rationing and withholding infrastructure facilities as they have to prioritise.

“Many are badly hit with the fear of getting infected and being a carrier. In the first wave of Covid 19, the health workers were unable to go home. The emotional turbulence created by the isolation from the dear and near ones for weeks and months also triggered depression among health workers,” says Dr Joseph Chacko of Government Medical College, Thiruvananthapuram.

“I can give you examples of at least three residents from a premiere institute of the country who committed suicide last year, and some of them were suffering from mental illnesses like bipolar disease and schizophrenia,” says Dr Mohemmad Arshad, a junior resident at the department of psychiatry in NIMHANS.

The pandemic has been a trigger to those who have already been suffering from clinical depression or bipolar diseases. According to him, there is a tangible rise in the number of healthcare workers seeking professional help for mental health.

“Healthcare workers are already vulnerable to developing mental health problems considering the stress and burden they are facing due to the poorly managed healthcare system in the country. Even before the lockdown, we used to come across many undergraduate medical students and residents in the outpatient department with depressive and anxious presentations,” says Dr Arshad. “Many of the HWs are not seeking help due to various reasons, and one among the strong reasons would be the burden on them,” he adds.

The chilling story of Shiny Varghese, a Malayali nurse working in the Covid ward in Manipal hospital, epitomises the unbeatable commitment, devotion and courage of every frontline worker in the battle against the pandemic.

Since the beginning of the pandemic, Shiny has been on Covid duty. Four persons in her family got infected, including herself, her daughter, husband and father-in-law.

Shiny’s husband and father-in-law succumbed to Covid last year. The deaths did not pull her back from her duty as a nurse.

“I am seeing people every day who are in need of me. I can’t turn my back on them. This is my duty and responsibility,” Shiny tells The Federal.

How did Shiny fight the trauma? As Dr Shemeer of Calicut Medical College said different people adopt different mechanisms. “Prayer,” says Shiny. “I am a believer; I pray and gain strength from God.”

Most health professionals that we talked to unanimously expressed a concern. Uncertainty is a major cause of anxiety.

“Working overtime is not a problem if we have an idea of the period of time that we have to do it. Here in the case of Covid, we have absolutely no idea when it would end and when the world would go back to normal,” says Dr Joseph of Thiruvananthapuram Medical College, adding that this is one reason for emotional fatigue.

However, Shiny is clear about how to deal with it. “Live in the present. Live the moment and accomplish your responsibility. The rest is not in our hands, hence stop worrying about it”

She says institutional support is a key factor in keeping health workers sane.

“I received tremendous support from my authorities and my colleagues. Unfortunately, many health workers do not get such institutional support.”

She says that healthcare workers should not shy away from seeking professional help if required. “They must know it better than anyone else.”