Two days ago, a third doctor fell victim to Covid-19 infection, adding to the list of medical staff and nurses, mostly young, who have already left their loved ones prematurely by succumbing to the disease too. They fell in the line of duty, bravely fighting to save the lives of the patients they were caring for, inadvertently getting infected in their own turn and not being able to save themselves or be saved by their colleagues.
The death toll we are witnessing in this current wave is a tragedy on a scale hitherto unseen in recent times, for which the health services were taken unawares. But aside from the deaths of their colleagues, shortages in staffing have also been caused by others falling ill and needing to self-isolate, or doing so after posting in the Covid wards, as well as having to take time to recuperate in the normal course of duties. In other cases, nursing and auxiliary staff have had to bear episodes of anger from distressed and anguished families seeking information about their loved ones. They are not responsible for protocolar or communication deficiencies, nor for ambulance or hotline ones. Overall, therefore the nurses and doctors who are the ones in closest contact with the patients they are treating have been under pressure from overwork – but they are also humans like all of us, with families and children to care for. They naturally have the same fears and apprehensions as regards the safety of the latter, and this is bound to impact on their work.
Seeing patients and colleagues die affects them emotionally, psychologically and mentally, because of the helplessness they have felt as they saw their efforts failing.
On the other hand, there are not enough nurses to man the Covid wards and ICU as per norms, and this too impacts the quality of care. The accounts of those who have had to be admitted for treatment and who have been fortunate enough to get over the disease confirm this fact. Besides, staff have described the discomfort felt in the prolonged use of face masks and the PPE, which is cumbersome at the very least.
The authorities have announced that personnel from abroad will be recruited, but they are yet to be seen. This paper has made suggestions about the recourse to local resources, such as the deployment of final year nursing students to relieve the pressure on the limited staff in the wards, the resort to doctors nearing completion of their pre-registration training to help in monitoring in the ICUs or even Covid wards. They would need to be given a strong enough incentive – this could take the form of compensating them by giving them upfront marks in their exit exams. Relatives also could be roped in to dispense personal care according to a protocol which they will surely willingly follow.
Another idea is the use of telemedicine, which would mean having about 40-50 doctors available 24/7 to give advice to any caller – and there are enough of them around. All these measures can be implemented more rapidly than recruiting foreigners, but even if the latter scheme materializes, using local resources in the manner outlined is still a valid option that can be continued with as long as the pandemic requires. Further, the fact that the number of admissions is diminishing does not alter the reality that bedside care, both general and nursing, and monitoring are intensive tasks that primarily require manpower.
Unlike other countries, we have not done a survey to find out the problems of frontline health workers, as has been done in Australia, for example. This has been described in an article by Sara Holton, Senior Research Fellow et al of Deakin University, published on December 7, 2021 – ‘6 ways to prevent a mass exodus of health workers’.
They write about frontline health workers who are bracing for a potential summer surge in Covid cases and hospitalizations, and are concerned about the potential impact of the new variant, besides apprehending the summer surge would put even more pressure on health workers who, as their research shows, are already experiencing high levels of distress. As they assert, ‘Health workers often experience high levels of stress as a result of working long hours or shift work, providing emotional support to patients and their families, and patient deaths. The pandemic has increased this stress.’
‘We surveyed almost 3,700 health workers including nurses, midwives, doctors and allied health staff such as social workers, physiotherapists and occupational therapists in Australia and Denmark. We found Covid negatively affected health workers’ psychological well-being and personal lives, despite the relatively lower numbers of cases and deaths in Australia compared with other countries. About a quarter of those we surveyed reported symptoms of psychological distress, including depression, anxiety and stress. Their main concerns were contracting the virus, putting family members at risk and caring for infected patients.’
Undoubtedly, all that they have said holds true for all countries who are battling with Covid. At least elsewhere, the health staff who decide to quit can have other opportunities. These do not exist in our small island – which is all the more reason for the authorities to act decisively and promptly to support the frontline health workers. Otherwise, the tragedy will only swell further. On the contrary, instead of giving them encouragement, they are being further stressed by deducting their periods of mandatory isolation from their sick and vacation leaves, and there is no insurance coverage to provide for their families in case they succumb to Covid. The times ask for a more humane approach to their plight. Their appeal should be heard.
Supporting the frontline health workers does not necessarily imply monetary compensation but public recognition from highest levels of their immense contribution during this prolonged pandemic, can go a long way to ease the pressure while means are found to increase their availability and improve their work conditions. As we go to press, we understand this is precisely what the PM has acknowledged in his Thursday evening address. The address also included a renewed appeal for vaccination and to adhere strictly with all sanitary precautions during the coming shopping season, a welcome caution that we are not out of the woods yet. This is no time to let down our guards with such a mutating invisible threat.
* Published in print edition on 10 December 2021
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