Resilience at the frontline

By Aditi Roy

New Delhi, April 11  The global pandemic of COVID-19 has exposed us to unprecedented times. With copious amounts of news about fresh cases, deaths, impending social and economic effects flowing through every channel of media, it has been weighing heavily on common citizens worldwide.

It is natural for healthcare workers like doctors, nurses, paramedics, and other medical staff who are at the frontline to feel insecure and anxious at such times. This is because coronavirus can be contracted by anyone easily which makes their work quite a dangerous place.

This is why when they are out there, they may be constantly thinking of their health and safety; seeing other people with the illness can affect their mental health, say experts.

At this hour of crisis, for professionals in the frontline, the horrors will continue to mount, and the effects of their exposure to the dire circumstances cannot be ignored.

“As a doctor, nurse or medical administrator there is a certain inkling to treat or to “fix” things. This is the hardest part of these altruistic individuals is that they simply cannot ”fix it”. There are no appropriate testing guidelines or methods and for them, medications and immunizations seem to be too far off in the distance,” says Dr Ranjan Ghosh, Psychiatrist, Good Karma.

Prime stressors affecting the healthcare workers

The rapid spread of COVID-19 and the severity of symptoms it can cause will acutely tax the limits of healthcare systems and it already has in certain areas of the world. While the physicians, nurses, paramedics are providing their expertise on the field, at these circumstances the community’s response, validation, and support play critical roles in mitigating traumatic responses.

Shortage of ventilators and intensive care unit (ICU) beds necessary to care for the surge of critically ill patients and the high communicability without PPE (Protective Personal Equipment) are some of the aggregators to the issue, including the recent spates of violence against doctors in Indore, Madhya Pradesh and more recently at Safdarjung Hospital, New Delhi.

“Other factors contributing are unknowingly bringing the virus home as carriers so they can stalk your family. Recently on top of these, numerous stressors that have emerged are like neighbors being aggressive and doctors being suspended for not working without PPE. These are all making the care providers more susceptible to mental health issues,” opines Dr Ghosh.

Secondary Traumatic Stress

Secondary Traumatic Stress or Acute Stress Disorder, which includes anxiety and panic disorder are distinct possibilities at this time, say experts. Some of the symptoms are:

a. Bodily sensations and physical effects such as rapid heart rate, headaches, nausea, inability to relax when off duty, trouble falling asleep or staying asleep

b. Strong negative feelings

c. Difficulty thinking clearly this could worsen to Numbing, detachment, reduction of emotional responsiveness, memory loss, and dissociation.

d. Problematic or risky behaviors

e. Social conflicts

A fight or flight mode

Being around patients that are dying and that is sick can have a traumatic effect on one’s psychology, because one can easily get into fight or flight mode. One may think that he/she is resilient and immune to such fear but mostly it sticks inside our head somewhere and brings you down. This is why it is very important to keep oneself resilient and also talk to therapists as they can help you unload the trauma that you are going through, says Prakriti Poddar, an expert in Mental Health, Director, Poddar Wellness.

Resilience at the cost of camaraderie

A lot of frontline workers are witnessing their colleagues lose their lives while being on the field on duty. It”s almost like what the armed forces go through when they are at war. It”s a very difficult situation to see their family or colleagues go through this kind of illness. Moreover, when you see life and death closely it makes you aware of your own mortality and can make you think about it a lot more than usual, Poddar adds.

The way forward

Healthcare workers should focus on their nutrition and their sleep as well so that they are more resilient in the day and are able to deal with this pandemic and treat people who need them because adequate rest is required to do it day in and day out. Both mental and physical energies together can only create a sense of wellbeing which helps in treating infected people which is why healthcare workers at the frontline must focus on their nutrition, rest and positive mindset, says Poddar.

Acknowledge that secondary traumatic stress can impact anyone helping families after a traumatic event, rounds up Dr Ghosh. After identifying the stress, some of the steps one can follow to reduce it are:

a. Practice stress management techniques- diaphragmatic breathing, meditation etc.

b. Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt) as well as those listed above.

c. Allow time for you and your family to recover from responding to the pandemic and involve them in preparation and planning activities.

d. Develop a self-care plan to be done following shifts including Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.

e. Take a break from media coverage of COVID-19.

f. Ask for help if you feel overwhelmed or concerned

(Aditi Roy can be contacted at aditi.r@ians.in)