The UK faces the biggest health crisis in a century and young doctors are rendered helpless, frustrated and exposed to the virus. 27-year-young Dr Meenal Viz who is six months pregnant with her first child, has protested outside Downing Street after being asked to continue working despite her concerns around coronavirus. This perhaps, is an accurate representation of the fears of hundreds of thousands of medics working at NHS frontlines without adequate protection and testing equipments.
Almost half of the country’s doctors say they are suffering from severe burnout, with some at the risk of developing psychological and mental health illnesses including anxiety, depression, and at worst Post Traumatic Stress Disorder (PTSD).
“I still don’t think that people understand the complexity of the disease. If I could, I would ask those venturing out for picnics enjoying the summer sunshine to come spend a day at our wards as we deal with increasing number of COVID-19 patients. It is like living a death a day.
“We tend to dance it out in our wards, for patients we know who may not make it. But I am afraid of going back home everyday at the end of my shift. I don’t want to infect my sister. I am scared about my parents, my dad has Type II diabetes and my mum has high blood pressure making them more susceptible to the virus. But I don’t want to temporarily move out either unlike my other colleagues, because I don’t know what the next day would bring for me,” said Dr. Rania Shah*, (name changed on request of anonymity) a junior doctor working at a NHS hospital in Harrow in a statement to Asian Voice.
British Medical Association (BMA) recently surveyed over 6,000 members between 14th and 16th April, where 44% of doctors said that they were currently suffering from depression, anxiety, stress, burnout or other mental health conditions. All related to or made worse by their work, especially due to the mounting evidence of the disturbing toll of the Covid-19 pandemic and the lack of PPE (Personal Protective Equipment).
More than half of doctors (51%) did not feel they were personally supported by the Government and confident that everything possible was being done to help them to keep patients safe, despite pledges that more PPE was being delivered to the front line. More than 4,500 doctors responded to the questions around mental health.
“This is a huge learning curve for all young doctors especially medical students who are transplanted from their dummy labs to these wards. They maybe very enthused at saving lives, but truth is there is that there is very little they can do even as the government calls on their support. On the contrary we are worried at the long-term impact that these daily deaths will have on their mental health,” said a consultant anaesthesiologist working at a NHS Trust hospital in West Midlands who asked to remain anonymous.
In testimonies provided to the BMA, one doctor, who did not want to be named said that “we are under immense and continuous stress”. While another doctor added, “What has been most distressing is seeing nurses break down uncontrollably in tears, knowing there is nothing you can do.”
This comes after the Health Secretary Matt Hancock failed to guarantee that hospitals would not run out of gowns this weekend and the publication of new Public Health guidance, which recommended the reuse of PPE for healthcare workers in the face of such shortages. It also recommended the use of alternative measures such as the wearing aprons instead of gowns to treat Covid-19 patients. All hands are on deck meaning young doctors
Chaand Nagpaul, BMA Council Chair, told Asian Voice, “This is a deeply disturbing finding and demonstrates the toll this pandemic is having on the wellbeing of frontline doctors.
“Doctors are working within exceptional challenges in fighting this virus, working long hours looking after unprecedented numbers of seriously sick patients and with relentless increases in deaths daily.
“Doctors deserve to be protected from becoming infected themselves in the course of their duty, yet many of our fears and warnings are turning into reality. It is unacceptable that many are being forced into a corner as they face acute shortages of vital personal protective equipment, particularly given the increasing numbers of healthcare workers themselves dying with the virus.
“As the Prime Minister has said, healthcare workers are the lifeblood of our NHS. But we need to face reality: they are facing a surge of critically ill people, knowing they do not have the right PPE in order to protect themselves and their patients. It is unthinkable that this would not take an emotional and mental toll, and we know that Covid will be around for many more months yet.”
How easy is it for the doctors to avoid these mental stress triggers?
Dr Sohom Das, a psychiatrist with a special focus on forensic psychiatry, told the newsweekly, “It is a deadly disease therefore, anxiety among doctors is normal. If you are a medic at the frontline, then there is no way you can avoid these stress triggers. They will see people dying everyday and they will be frustrated at the system being unable to cope with the increasing patients, they will be frustrated with the government for the shortage with the PPE. While they cannot avoid it completely, they can alleviate the stress levels by going to talking therapies and discuss their experiences.”
Speaking about the long term effects this pandemic may have on medics, he said, “There may be some long-term impacts of this pandemic for some who may find these experiences very harrowing. It depends upon the person but with the amount of deaths and suffering that they are seeing, it can cause anything from PTSD to anxiety and depression.
War veterans draft PTSD guidance for NHS
According to a recently published article in The Guardian, war veterans who served in Afghanistan and Iraq have drawn up support guidelines to help NHS workers cope with PTSD after treating patients on the frontline of the coronavirus crisis. The advice was drawn by the Help for Heroes charity, initially to support staff at the recently opened Nightingale emergency hospital but can be implemented at other such facilities across London.
Some military techniques that can help the NHS workers are based on clear and concise communication, establishing a camaraderie mentorship between experienced and inexperienced workers, and a proper rotation of responsibilities so certain carers are not overburdened. Particularly important is trauma risk management, where a team who often may have have completed a 12-hour shift come together and reflect on a difficult day’s events. Those suffering from PTSD can take years to recover from the stress of the pandemic in returning to a new normal post coronavirus and may have to undertake intensive counselling sessions.
“There are a range of counselling therapies that can be helpful depending on the type of psychological damage. If the psychological stress levels are not too high, then they will only need to go through de-briefing, which in layman's words is talking through the experience.
“For people suffering through a more severe depression- then ‘Cognitive Behavioural Therapy’ is the recommended solution. It is a more complex debrief where one focusses on not just their present feelings, but the underlying triggers, and stressors which lead to depression. It is about challenging the rough memories, and finding how to de-escalate their impact on your psychology.
“For people with a more complex mental illness like PTSD- a more in-depth trauma therapy module is recommended, where they identify each case, talk about every death in their memory and it is a longer process.”
Doctors across the UK already reported about losing their love for the profession as they report about wearing plastic bags as gloves. Perhaps, there repressed voices were best highlighted by a particular nurse in Northwick Park Hospital who in a recent interview with Harrow Times said,
“My love for the job has changed, I work because I need to work. But if I could change, I would stop and find another career.”
Emphasising that it is not in the nature of British doctors to abandon their duty, may however tough it gets, Dr Das added, “The attitude among British doctors as history serves is quite different in comparison to anywhere else in the world. Doctors have gone on protests in the past for PAYE contracts, reduced hours where they had stopped scheduling routine procedures. But they had never stopped consulting and treating in emergency cure cases.
“Once life returns to normal there will be a mixture of emotions: anger, frustration and helplessness. But there will be a sense of strength bonding everyone together, when they recollect the positives of saving lives, and going beyond their capacity in overcoming the pandemic. The answer to getting over this is to not bottle it up!”
