A 35-year-old resident doctor at a private hospital in Delhi died by suicide recently, allegedly due to severe stress amid the pandemic. Dr Vivek Rai had been dealing with COVID patients, at least seven to eight of them critical, every day.
In another heartbreaking video last month, a doctor from Mumbai, Dr Trupti Gilada, broke down over the covid situation and appealed to people to remain safe. "I have never felt this helpless in my whole life", she said.
It's expected that the healthcare workers (HCWs) would have had an exposure to various life and death situations. But the burden of the COVID pandemic has been particularly hard on the HCWs, not just physical, but on their mental health as well. The social media has been flooded with SOS messages and stories of doctors at breaking point amid the devastating second wave.
Has the second wave of the pandemic been harder for HCWs than the first time around? Are we better equipped to deal with this mental-health epidemic among HCWs?
Doctor’s Notes on Fear
"There is an enormous difference in my mental health. While the sense of fear regarding donning the PPE kits has come down, there is a fear of not finding beds this time. Looking at the statistics on the mortality of the HCWs, especially in India, where it is high, there is always some insecurity," said Dr Girish CS, who works in the Department of General Surgery at a government hospital in Karnataka.
“We don’t get to wear PPE kits in the OPD. Across sections, there are at least 30 percent of undiagnosed COVID patients in the OPD and we are constantly in touch with them.”Dr Girish CS, Department of General Surgery, McGann Hospital, Karnataka
270 doctors across the country have succumbed to the COVID infection in the second wave so far, the Indian Medical Association (IMA) said. Over 50 doctors lost their lives to the virus in just one day, on 16 May. 748 doctors died due to the disease in the first wave.
What's more, the biggest fear plaguing the HCWs is regarding their families. "When you come back home, there is no provision of quarantine. No arrangement for any HCWs in the second wave. We are constantly worrying about the safety of our families," Dr Girish said.
The enormity of the patient load during the second wave of the pandemic and the lack of availability of resources has been huge and has hit the HCWs quite hard, said Dr Harish T, Professor in Psychiatry at NIMHANS in Bengaluru.
“For the HCWs, their own kith and kin are getting affected in many ways and as a result, it has been very hard on them.”
Understaffed, Overworked and Overwhelmed
To hear, Dr Niranjan, a junior doctor at a private hospital in Karnataka, the worry is justified. The patients admitted are more serious this time, all of them needing oxygen and continuous monitoring. However, there aren’t enough specialists to handle them.
“The government is threatening private hospitals to increase the number of ventilator beds...Number of doctors is not improving, number of trained staff to manage sick patients is not improving, only the beds are increasing,” he said.
In the initial few months of the pandemic last year, doctors did COVID duty for a week and there was a week of quarantine. However, now, the doctors work continuously.
“Even if we’re symptomatic, if we can continue working, we should…We can’t take any break because we’re understaffed. Everyone is stretched out,” Dr Niranjan said.
Dr Sameer Parikh, a Psychiatrist at Fortis Hospitals in Delhi, thinks the pressure is tremendous, primarily because this situation is one we are unprepared for.
“Here, it’s not merely about overwork. It’s the fact that you are dealing with life and death situation virtually 24X7 and you are seeing a lot more of helplessness in one way or the other around you consistently which puts you under the pressure.”Dr Sameer Parikh, Psychiatrist at Fortis Hospitals, Delhi
Besides the doctors, Dr Parikh thinks, we need to look at other frontline HCWs, especially the nursing staff. The impact on young nurses and duty doctors could be significant as they might not have the same skills or exposure as an interventionist who's been doing the ICU work for several years.
‘Gratitude, Empathy’: What Healthcare Workers Need
By all accounts, healthcare workers have gone out of their way to respond to the multitude of needs of the society. While we've seen doctors breaking down, the pandemic has also largely been about how doctors have really stood up and gone beyond the call of duty and worked really hard, Dr Parikh said.
So, what has been done to alleviate the mental health related issues of the HCWs?
During the first wave itself, the mental health resources were created and have been updated, Dr Harish said, adding that the professional bodies are reasonably well-equipped to handle the mental health aspects of the pandemic.
Meanwhile, Dr Parikh said we’re still very much in middle of the pandemic. “If you were to see the pandemic like a war, then your frontline workers, the doctors, are your soldiers.”
"So, when you look at what impact happens on them, essentially the impact that would happen, may happen, all of these things would be not necessarily right now."
Just like in a war, where it is absurd to ask a soldier take a five-minute break or spend time with family, doctors can't be asked to take time off, he said.
“The first thing the society needs to do is have gratitude and empathy...the environment has a role to play because the doctor lives in that environment.”Dr Sameer Parikh, Psychiatrist at Fortis Hospitals, Delhi
Dr Harish also said that the message that needs to go out in the community is that the HCWs are trying to do their best with whatever limitations they have.
"The HCWs try to provide the best possible care and in return expect patience and acceptance of the systemic limitations in providing care. It is important for patients and caregivers to heed to the professional advice and not get carried away by promotion of unscientific remedies."
The other aspect is for the healthcare providers worldwide, to start looking at mental health components for healthcare workers.
Dr Parikh said each micro-system of workplace needs to start looking at mental health outcomes along with all other measurements of success, or failure. Eventually that's where we should go.
But the pandemic has also moved beyond the big cities to small towns and rural areas. How can mental health-related support be extended to doctors in places where access to even basic healthcare is scarce?
Dr Harish said the professional bodies have a significant role to play. "Almost all doctors are members of the IMA, nurses have their own associations. These bodies need to tie-up with the local mental health professionals in each districts," he said.
Dr Parikh thinks the future of healthcare lies in digital health because outreach will happen in tier-2 cities.
Further, once the impact of the pandemic starts diluting, long term measures need to be looked at, to prevent the aftermath, he said.
The doctor community itself has not been the best self caretakers in any case. Life skills in medical college, importance of basic things like grief management, self care are important in the long run. This needs to be a learning experience, not just for healthcare, but for all working microsystems.
"Right now, we need gratitude, acceptance, validation, listening. That's the best we can do. Everything else is just bizarre", Dr Parikh said.