A typical day at work for Dr Kadali Uma Nagendra Vishnu, the president of Telangana Junior Doctors Association (TJUDA), could range anywhere from 24 to 36 hours, with not many breaks in between, even to use the toilet. “Once we put on our personal protection equipment (PPE), we don’t take it off because that itself can become a source of contracting COVID-19. So, we go to the toilet, take food and water before we put on the PPE, and then don’t take it off for another 6-8 hours,” says the paediatrician who works in Niloufer Hospital in Hyderabad. “But because of the materials used in the PPE, we start sweating and get dehydrated within 1-2 hours of putting it on. But we can’t do anything.”
But when Dr Vishnu goes home, he heads straight for a separate bathroom that only he uses. He showers, and changes out of the shoes and clothes he has worn and soaks them for wash separately. Though his parents live in the same house, the fear of exposing them to the SARS-CoV-2 virus ensures that Dr Vishnu always stays separate from them, in his room.
“It’s harder for my colleagues who are married, or those who have young children. A female colleague of mine broke down one day, fearing that she may become the source of infection for her toddler. They can no longer hug their children,” Dr Vishnu says.
The battle against the COVID-19 pandemic would be lost if it were not for our frontline healthcare workers. However, these workers are rendering their services at a great personal and emotional costs. Working in healthcare is already stressful, but it is now compounded by the uncertainty of the future, fears of contracting and passing on the virus, and being compelled into isolation to keep loved ones safe.
Back in March, a video went viral. The moving clip showed a Saudi doctor in scrubs returning home. As he enters, his young child runs towards him with excitement, only to be stopped a few steps short from his father who urges the child to keep distance. The doctor then breaks down from the strain.
A Saudi doctor returns home from the hospital, tells his son to keep his distance, then breaks down from the strain. pic.twitter.com/0ER9rYktdT
— Mike (@Doranimated) March 26, 2020
This is the reality of many healthcare workers even today.
Dr RS Gopakumar, Health Officer of the Kozhikode Corporation in Kerala, was one of the people who helped conduct the burial of a four-month-old victim of the coronavirus in Kerala. He says that due to his work, he had to isolate himself from his family.
“I have a four-year-old child who literally sleeps on my hand. When I wasn’t allowing him to hug me and kiss me, he said I was a very cruel father,” he tells TNM. “I stayed at another location for around two weeks as well to protect my family. A lot of other healthcare workers are now staying in hotels and hostels, away from their families,” he adds.
While Dr Gopakumar is now back with his family after he underwent a COVID-19 test and self-isolated, the time he was away from them was hard. “This is a stressful job, and no one else can do it. We rely on support from our loved ones and family, but now, we are forced to forgo that and stay far from them as well,” he adds.
Dr Ankitha Dodiya, who works in the gynaecology department of Hyderabad’s Gandhi Hospital is in a similar position. Hailing from Karimnagar in Telangana, she now stays at a hostel at Gandhi. She went from living in a lively joint family with lots of cousins, to living alone. “I am proud of being able to serve my country at this time, but I miss home, I miss the safety of being with loved ones. Sometimes, I call up my father and tell him, ‘For how long should I do this? I just want to come home,’” she tells TNM.
Dr Divya Devulapally, consulting psychiatrist at Care Hospital in Banjara Hills, Hyderabad, observes most healthcare workers she has received distress calls from are largely worried about keeping their loved ones safe. “It’s not just those who are working in COVID hospitals who are worried about passing on the infection to their families, but people working in regular non-COVID-hospitals too. A couple of them have even sent their children and vulnerable family members away to a relative’s house to protect them,” she says.
“It’s not just forced isolation from families and friends, but also at work. Fewer colleagues are coming in and physical distancing is advised… so those friendly lunch-room sessions where we could vent and rejuvenate have also reduced, like the other support systems we relied on,” she adds.
The fact that healthcare workers have been working long hours for months now with no end in sight adds to their mental and emotional stress too.
Dr Ritesh*, who works at a fever clinic in Bengaluru, has been working seven hours a day for the last three months, without a break. “We are emotionally and mentally drained. A doctor not only has to treat patients, but also collect swabs, go for surveying an area where a person has tested coronavirus positive and so on. And since there is only one doctor in most public healthcare centres and this is a pandemic emergency, they can’t really go on leave,” he says. “There are no alternatives, even though you don’t need a person with medical expertise for all of these things.”
Apart from gruelling working hours in a high-pressure environment, being surrounded by the coronavirus discourse has also been overwhelming.
Dr Ankitha, for instance, wonders when she will be able to treat patients ‘normally’: “I wonder when I’ll be able interact with patients or touch them without PPE. We used to do 30-40 deliveries in a day… now I wish I could go back to doing that.”
“It’s like there is only coronavirus all around us,” she adds. “And sometimes, even after doing everything possible, we cannot save the patient. We cannot afford to get too emotional, but then, when patients are there for very long, we do develop some attachment. It’s especially difficult in the gynaecology department, because it feels like two lives are at stake if the woman is pregnant.”
Some healthcare workers TNM spoke to said that they are driven by a sense of duty at this point, but the exhaustion is creeping in. Dr Ashok HS, a retired professor of psychology at Bangalore University and visiting faculty at the Centre for Education and Social Studies, says that burnout is a very real possibility for healthcare workers. “Some of the symptoms are emotional exhaustion, feeling drained out, irritation and aggression. It could also lead to depersonalization – the inability to see patients as humans because they are seeing the same misery and pain day in and day out with no respite,” he cautions.
The latter is not necessarily a bad thing – doctors and nurses have to keep their emotions at bay to be able to treat patients practically. However, when it becomes an unhealthy coping mechanism, it can start to affect one’s work.
A major issue, Dr Divya and Dr Ashok say, is that uncertainty about when things will improve. “When there is an end in sight, a person can power through. But we don’t know when the pandemic will end. Being a healthcare worker has now become a thankless job. In many cases, loved ones or neighbours may be upset that a health worker is interacting with or treating COVID-19 patients instead of praising them. So the rewards are gone, and one can feel demotivated to work,” Dr Divya explains.
Working under such conditions, without adequate emotional and mental support can have long-term impact on one’s mental and emotional wellbeing.
Dr Divya says that there are some effects already – where she would earlier get 2-3 calls a month regarding stress from colleagues in healthcare earlier, in the last month, she has received around 15 calls. “Some of them are unable to relax and sleep in the free time that they do get, and have asked me what medication they can take for the same. They can write their own prescriptions because they are doctors, but need me to tell them which medication they should take, if needed,” she says.
“I’ve received several informal calls as well, where they won’t say that they are anxious or upset, but just want to talk… so it’s like a half an hour informal mini therapy session. But all these things are symptoms of stress and anxiety. A lot of it is related to the uncertainty,” Dr Divya adds.
Experts say that we could be looking at burnout and mental health issues among healthcare workers if things are allowed to go on this way long term. This includes exacerbation of existing conditions or symptoms if one has them. There will also be impact on workers’ personal relationships and daily routines, mental health practitioners add.
Dr Ashok says that we need to set up a system which allows for frontline workers to de-stress and vent. “The doctors’ commitment to their profession makes sure they carry on, but under the composed front, there are emotional components. If they are able to vent these – even if it is with each other – then some of the side-effects get mitigated. But there needs to be a system where time is set aside for that, and for lighter, recreational activities so keep the health workers motivated and mentally healthy.”
Others like Dr Vishnu and Dr Ritesh say that the authorities need to improve their working conditions – better quality PPE, humane work hours and assistants to do non-medical work. Healthcare workers like Dr Ankitha meanwhile, are thankful for technology that allows them to connect to their loved ones remotely.
“When we are giving cent percent, the authorities and government should also do as much to make conditions better for us,” she says.