At risk: Nurses outside a Covid-19 ward at Tembisa hospital. Global studies find healthcare workers are experiencing an increase in mental-health issues since the advent of the pandemic. (Marco Longari/AFP)
(Photos by MARCO LONGARI / AFP)
Exhausted healthcare workers have an estimated two months of precious respite to build resilience to burnout, read up on mental health injury symptoms and discover where to get help before the third Covid-19 wave hits.
This while they continue to suffer twice the Covid-19 infection rate of the communities they care for, according to experts who spoke to the Mail & Guardian. A full 6.8% of all public healthcare workers contracted Covid-19, and they lost 340 of their colleagues between March and November last year.
‘Dog-tired’, scared healthcare workers
Over that time, there were 35 145 confirmed Covid-19 cases among public-sector healthcare workers.
To offset this formidable loss, the government employed another 2 926 doctors and 14 232 nurses, while boosting education, training, and social and psychological support.
The experts who spoke to the M&G are using the current decline in Covid-19 cases and decreased pressure on healthcare facilities to accelerate their bid to equip these workers with better coping and survival skills.
One dog-tired specialist, who is managing vaccinations at a provincial tertiary hospital, said some healthcare workers were abusive during the risk-priority verification process.
“Also, I’ve not had a single supportive call from the national department of health or the EVDS [electronic vaccine data system] people asking how it’s going,” he said. “It’s no wonder none of my colleagues wanted to take this job! It feels like I’m being hung out to dry.”
Dr Nokwazi Mtshengu, a psychiatry registrar at the Dora Nginza provincial hospital in Zwide in Gqeberha, said that when she got Covid-19, she was hospitalised for several days, before isolating and recovering at home for two weeks. Her fiancé, a doctor who also works with Covid patients, contracted the virus as well, but has since recovered.
“Both work and our infections were incredibly stressful, especially waiting for the vaccine shots. The first wave caught us totally off guard — the hardest is losing your colleagues. We’ve lost more than a dozen here, and several of my extended family died,” Mtshengu said. “Adjusting your patients for Covid, many of whose psychological conditions have them unable to adhere to hygiene protocols, was also stressful.
“We started a group counselling system for healthcare workers, teaching self-care and how to ease anxiety … in small, socially distanced sessions of 10 at a time. It was totally oversubscribed, but made a big impact and created strong bonds.”
Two psychiatrists who counsel healthcare workers stressed the vital importance of self-care, seeking professional help and for managers to lead with compassion.
They said hundreds of global studies of healthcare workers have found that, since the pandemic started, the prevalence of anxiety has shot up, from 24.1% to 67%, as has depression, from 12% to 55%. Although there’s a paucity of data about South African healthcare workers, the figures may well be worse, given the country’s quadruple disease burden (communicable and noncommunicable diseases, maternal and child mortality, and injury and trauma).
Professor Renata Schoeman, director of the Psychiatric Management Group, says a study published in December shows an alarming number of teenagers with depression.
“A full 38% of 1 200 children surveyed in their late teens had depressive symptoms, such as life not being worth living and suicidal ideation. Now, if you think of the stresses and moral injury to healthcare workers at a Covid-19 peak, you can only imagine,” she said.
Depression setting in
A South African Depression and Anxiety Group study conducted early last year shows that, of more than 1 000 workers or managers, 74% reported one or more symptoms of depression, including trouble concentrating, forgetfulness and indecisiveness. All this affected their ability to work. On average, they took 18 sick days off work annually. According to a 2014 research paper, nearly one in three South Africans will suffer from a mental disorder in their lifetime.
All this impacted their normal ability to work. On average, they took 18 days off work annually. According to a 2014 research paper in conjunction with the University of Oxford, nearly one in three South Africans will suffer from a mental disorder in their lifetime, a higher prevalence than many low- and middle-income countries.
Psychiatrist and clinical psychologist Dr Frans Korb said that depression affects cognitive functioning such as decision-making, concentration, memory and problem-solving abilities. “If an employee has depression but is at work, they are five times less productive,” he added.
Schoeman said that the fear of infection, illness, colleagues’ death, social isolation and a high workload all affect the mental health of healthcare workers. “The new one on the block is vaccination anxiety. In other words: When will we be vaccinated?”
She said research showed factors that increase the risk to mental health include working directly with Covid patients, the availability of personal protective equipment, and socio-demographic factors, like being younger, a woman, having an underlying illness or working in a rural area with fewer resources.
But Professor Ian Sanne, Sisonke Johnson & Johnson vaccine roll-out, appealed to healthcare workers not to stress or panic. He said there was a limited vaccine supply in the first two weeks of March, with a resultant focus on higher-risk healthcare workers, such as those working in a Covid-19 ward, emergency and casualty wards, or doing triage duties.
The help that healthcare workers need
Protective factors for healthcare workers included more experience in their field and training in dealing with the pandemic, with resilience bolstered by being in a committed relationship and knowing your loved ones were health.
Schoeman listed six self-care practices that healthcare workers need to attend to: sufficient sleep, regular exercise, ongoing education, a healthy diet, socialising more and spirituality.
Schoeman said the World Health Organisation considered burnout an occupational phenomenon, not a condition. Still, pandemic fatigue is real, particularly when the lines between home and work are blurred.
“One of my patients said he was so tired of having his boss in the bedroom and the kids in the boardroom [a reference to attending virtual meetings from home],” she chuckled.
Psychiatrist Dr Antoinette Miric said the Healthcare Worker Care Network, which she co-founded last year, had received calls from just 245 healthcare workers in Gauteng.
“As the pandemic peaked, so the calls increased. We expect the same to happen for the third wave,” she added.
Miric said, of those who called in, 64% had an hour’s free therapy session provided by a network of 14 psychologists and psychiatrists. However, only 10% of the healthcare workers continued therapy.
“There’s a huge need out there, and the response by our profession has been quite amazing,” Miric said.
Who to call to access help
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