By James Ochieng
Health-care workers have continued to provide care for patients despite exhaustion, personal risk of infection, and fear of transmission to family members, illness or death of friends and colleagues, and the loss of many patients a new research by World Health Organization (WHO) shows.
Sadly, health-care workers have additionally faced many unavoidable sources of stress and anxiety, and long shifts combined with unprecedented population restrictions, including personal isolation which has affected individuals’ ability to cope.
The research adds that as the pandemic unfolded, many health-care workers travelled to new places of work to provide patient care in overwhelmed facilities; those who volunteered in unfamiliar clinical areas were often launched into the pandemic ICU setting with insufficient skills and training. The burden of training and supervising these volunteers fell on already stressed clinicians.
Further, hospital-based health professionals worked long hours wearing cumbersome and uncomfortable personal protective equipment (PPE), after initial shortages of PPE had been addressed. They strived to keep up with emerging knowledge, institutional and regional procedures, and changing PPE recommendations, while trying to distinguish accurate information from misinformation. Health-care workers had to adopt new technologies to fulfil patient care and educational responsibilities, including the provision of telemedicine.
Insufficient resources and the absence of specific treatments for COVID-19 added to the challenges of managing severely ill patients. Health-care workers had to care for colleagues who were ill, offer comfort to dying patients who were isolated from their loved ones, and inform and console patients’ family members remotely, the report notes.
Some health-care workers were burdened with emotionally and ethically fraught decisions about resource rationing and withholding resuscitation or ICU admission. They shared the pain of patients without COVID-19 who had their surgery or other essential treatments cancelled or postponed.
The fear of transmitting COVID-19 led many health professionals to isolate from their families for months. Working remotely and being shunned by community members further contributed to loneliness.
Many health-care workers experienced lost earnings because of cancellations in outpatient visits and elective procedures. The training of health-care workers such as medical students, residents, and allied health learners was also interrupted, leading to loss of tuition fees, missed learning opportunities, missed exams, and potentially delayed certification.
Home health-care workers experienced additional challenges that exacerbated the inequities they face as a marginalized workforce, including limited or no PPE, varying levels of employer support, and the difficult choice of working with its attendant risk or losing wages and benefits.
According to the report, the burden of COVID-19 on health systems and health-care workers was substantial in low-income and middle-income countries (LMICs), where difficult daily triage decisions had to be made in the context of grave shortages of basic equipment and consumables.
LMICs saw an internal drain on human resources as health-care workers were pulled from clinical practice to join COVID-19 committees and task forces. In the already stretched areas of anesthesia and intensive care, a high clinician burnout rate might have contributed to worse outcomes for patients with COVID-19.
Further, an increase in non-COVID-related health problems and deaths those caused by disruptions to vaccination or screening programs for other infectious diseases, including personal health challenges for health-care workers such worsening of diabetes control, further strained poorly resourced health systems.
“LMICs experienced high rates of health care-associated COVID-19, due in part to a shortage of PPE, increased workload, inadequate training and infection control practices, and pandemic fatigue. Guilt and stigma associated with COVID-19 were common,” said Doctor Apestianyi Yawa in a virtual briefing.
Cases of health-care workers abandoning their posts or refusing to attend to patients suspected of having COVID-19 were not uncommon. Health-care workers have been subjected to denigration from various sources during the pandemic, including political leaders and hospital administrators.
In some LMICs, such as Uganda, health professionals were targeted by the public because of their roles on scientific advisory committees, and their policy decisions were met with mistrust and hostility.
Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant thus cause a health risk themselves, their patients and others.
“Recently preliminary analysis finds the majority of health workers are not benefitting from optimal protection leaving them dangerously exposed to COVID 19 infection and well-being of that of the patient they look after,” said doctor Moeti.
The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy, the report notes.
Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects.
The notion that it is a doctor’s responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific.
“Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing,” said Michael Ekuma Nnachi.
Dr. Moeti noted that despite vaccination being Africa’s best defense, we are still lagging behind as compared to other continents.
“We know that vaccination is our best defense but while many high income countries report more than 60 percent vaccine coverage just over 7 percent of Africa’s population is fully vaccinated in spite of a rise in shipment of doses to the continent,” she said.
However there were calls to support health care workers in delivering their services for a better health system.
According to Dr. Mihigor, to effectively support health-care workers the greatest assets of our health-care systems we must understand their challenges and needs. Burnout and other forms of work-related psychological distress are unavoidable occupational health issues.
By acknowledging the commonality of psychological distress related to caring for patients with COVID-19, we can destigmatise work-related mental health issues and appropriately attend to the mental health needs of all health-care workers affected by the pandemic, he said.
He added that there is hope that the COVID-19 pandemic will prompt a redefinition of essential support workers, with recognition of the contribution of all health-care workers and appropriate education, protection, and compensation.