The devastating second wave of COVID-19 has severely overstrained and pushed India’s public health system to the limit, breaking horrifying world records in terms of daily cases, with the country accounting now for nearly half of the total reported cases worldwide. The death toll is immense, and media show heart-rending visuals of people crying over oxygen cylinders, hospital beds, essential drugs like remdesivir, over-capacitated crematoriums and burial sites, dead bodies piling up in mortuaries, and being cremated in make-shift parks, road-side pavements, and recently also dead bodies floating on the banks of the rivers Ganga and Yamuna.
Amidst this catastrophe, we see our frontline health workers, including doctors, nurses, community health workers, allied and paramedical staff, sanitation workers, graveyard workers, … all working overtime, risking their and their families’ safety, to serve the public. By putting them on the frontlines, we take it for far too granted that they will overcome every potential challenge, big or small, to save lives, for that is their sole duty. What we often turn a blind eye to, is that these workers are human beings too, like us. The pandemic has unleashed havoc in all of our lives, but even more so in the lives of these health workers, given the amounts of pain, agony, frustration, illness, and deaths they are witnessing on a daily basis.
In the words of a young mental health professional: “In such a crisis situation, where everyone is trying to merely survive, they are expected to work overtime, even double or triple their capacity with little to no support from the system. We have seen several healthcare staff members with co-morbidities, being posted in COVID-wards, now how responsible is that?” (Sharon Ann Sabu, Research Associate, Centre of Mental Health Law and Policy)
Recently, 14 doctors in charge of rural hospitals in Unnao, Uttar Pradesh resigned from their posts claiming that ‘despite the fact that their teams are making endless efforts in responding to the population needs from village to district level, they are being made scapegoats for the rise in COVID infections and made to attend endless review meetings, to provide a proof of their work’. Similarly, in a few districts of Punjab, nearly 9000 contractual health workers under the National Health Mission (NHM) went on a strike to press for regularization of their jobs. They reported being overburdened with work, while being on COVID duties and immersed in vaccination drives. Many of them contracted the virus, but they did not receive much support from the government. Reflecting on the severely crunched and overworked healthcare staff, a family member reports that in these desperate times “nurses have become doctors, ward boys have become nurses, and the families have become ward staff”.
Our frontline health workers, who somehow managed to brace themselves during COVID’s first wave, are finding themselves on the verge of breakdown for the sheer magnitude of the devastation they are witnessing in the second wave, most of which is beyond their control. While we heard and discussed the urgent need for building a resilient and responsive health system to prepare for the next emergency of this nature, during thousands of webinars held over the past year, it is disappointing to see things not even improving a bit on the ground. The inefficient response of the Indian Government to the exponential surge in COVID cases during the second wave has left our healthcare workers and health care system ill-prepared for dealing with the (expected) second wave, but also vulnerable to abuse and violence from the country’s population. Being the first point of contact with the citizens, these health workers end up bearing the brunt of government’s policy failures. When one checks the website of the Ministry of Health & Family Welfare, the last reference to mental health guidelines or any relevant resource dates from November 2020, conveying the sheer ignorance of the growing and urgent mental health needs of its people.
Some more quotes from friends and colleagues show the dire situation in terms of mental health:
“To see people dying under your supervision, due to lack of oxygen, or non-availability of a hospital bed, is absolutely traumatizing. While talking to several health care staff members, I sense a feeling of helplessness and numbness” – Sharon Ann Sabu
The gruelling burden this pandemic has posed on the health workers is insurmountable. “Fear of infection makes many workers stay away from families for months, while others had to go back home to care for family members with symptoms, going through the exhausting infection control, while some of them have to leave to care for their parents in ICU in another state. And then there are the streams of phone calls and whatsapp messages begging them to somehow help a friend or relative to get a bed with oxygen” – Kaaren Mathias, Director, Burans community mental health project, Emmanuel Hospital Association.
“Psychological health of the caregiver is often on the back burner, since the needs and priorities of the ones they care for, are prioritized. Apart from health workers who work in hospitals and manage COVID patients, there are many other kinds of care workers, including care workers who care for elderly, disabled and others who live with chronic conditions.” – Shubha Nagesh, Director-Research, Latika Roy Foundation.
“The quality of life of these healthcare workers is questionable to the point where several of them lack sleep for several days due to personal or professional distress. Work-life balance has gone out of the picture now. And this overwhelming experience is not soothed by any means if they want to access mental healthcare from within the system.” – Helen Martin, Clinical Social Worker and PhD candidate (psychiatry), McGill university.
“They are exhausted and going through compassion fatigue, they had to bottle up a lot of emotions, they are used to it perhaps, but not to this scale. So, it is very important for healthcare professionals and other frontline workers wanting to talk about it and seeking help, in early stages before it aggravates to depression, self-harm and suicide like situations.” – Sudeep Das, Clinical Psychologist.
Numerous helplines exist for the general population, but very few for the healthcare workers. Furthermore, the question is what kind of support do these helplines provide, and how many of these are actually effective – well acknowledging that they are initiated with good intentions ? At what stage should one reach out to these helplines, given health workers’ immensely tiring 12-18 hours daily shifts or even longer, do they have the bandwidth to talk about their issues, and what are the key questions to ask? These helplines work as an external intervention, while they need a more integrated approach in their work culture that allows them to unwind and openly share their feelings and anxieties without being judged.
Mental health, still considered a forbidden or tabooed subject in many spaces, is silently yet rapidly turning into yet another pandemic we are ill-prepared to deal with. The language, the conversations, and policy priorities need to systematically integrate mental health into our public healthcare system. And we need to act swiftly on this emergency as well, if we are to save our health workers from experiencing mental agony and distress, or worse.
Acknowledgements: The author would like to acknowledge insights and reflections shared by Azaj Sheikh, Helen Martin, Kaaren Mathias, Poorva Patil, Shubha Nagesh, Sharon Ann Sabu, Stuti Chakraborty and Sudeep Das.