“I cry every day. I feel lonely and sad. With the increasing pressures of work comes anxiety and insomnia. I even considered suicide when I suspected I had contracted the virus.”
This is how nurse Salma (alias) tells her story of suffering as a result of her work in the coronavirus unit of a hospital. Salma, who preferred to use an alias so as to not worry her family and friends, has tested negative for the virus. Despite this, her mental health continues to deteriorate.
Salma has stopped seeing her parents. They are of old age, and she fears she could transmit the virus to them. Friends and colleagues alike have taken their distance from her once they found out she decided to work in the wing dedicated to treating COVID-19 patients.
“When I was given the choice between working in the coronavirus unit and another in the hospital, I chose the first to gain God’s approval,” she said.
Salma’s mental state is typical for medical workers inside hospitals and health centers welcoming those infected with the novel coronavirus. A recent study in Wuhan, China revealed that around 50 percent of medical and health workers at the forefront suffer from depression, 44 percent struggle with anxiety, and 34 percent are battling insomnia.
Another study, with a sample population of 1257 people (almost 40 percent of which are doctors and 60 percent of which are nurses) revealed that over 70 percent are leading personal battles with their mental health. While these numbers cannot be applied to the medical and health sector in Lebanon, they do reflect a harsh reality where the vast majority of workers in the health sector are battling mental health issues due to the COVID-19 outbreak.
Hiba (also an alias), another nurse working in the coronavirus unit at the Rafik Hariri University Hospital (RHUH), could not hold back her tears during the phone call with Beirut Today.
She finds herself overthinking and worrying during the day, and during the night, she battles insomnia. Her sleep schedule has come to suffer, the culprit being her deteriorating mental health. In her opinion, all those working in the coronavirus unit are in need of psychological support.
“We are under immense pressure, and so is the hospital administration,” she said.
“No one is capable of taking care of anyone,” added Hiba, who also mentioned a sense of comradeship between her and others in the unit she works in, where they support each other to “lighten the load a little.”
Nurses are not the only ones struggling, with doctors sharing similar sentiments.
“Nighttime is the harshest time. My coworkers and I are haunted by nightmares related to the virus,” said Dr. Souha Fakhreddine.
According to Fakhreddine, the mental health of medical workers is partially strained because of the psychological state that their COVID-19 patients are in. “They need a lot of support,” she said.
Complaining is practically forbidden inside hospital wings, and all medical and health workers in the coronavirus units work in silence. Most do not see their parents or children at all in fear of asymptomatically carrying the virus and transmitting it to them. These are the same healthcare workers who earn low wages and work long hours, trying their best to stay strong and push past these challenging times.
They hope to gain some of the rights that public and private hospitals alike have taken from them. Perhaps now people will recognize their importance and the difficulty of their tasks.
The “working in a hospital” badge
In light of the recent situation, the idea of a metaphorical badge has become attached to hospital workers, especially those who work in hospitals that receive coronavirus patients.
When Aziza tries to take public transportation to work, she is refused by taxi drivers as soon as she states her destination is the Beirut General Hospital. She told us her workaround has been to request a drop-off a little bit further from the hospital and walk the rest of the way.
In another hospital outside of Beirut, nurse Mahmoud was quarantined for over a week after one of his patients tested positive for the coronavirus.
“I was really anxious and started shaking once I found out,” said Mahmoud. “The self-isolation period felt like a prison. I couldn’t sleep, and once I was allowed to go back home, I was bullied by neighbors and relatives because I now carried the badge of working in a hospital.”
Medical workers and hospitals: Fear and Monitoring
In statements to Beirut Today, nurses working in hospitals where coronavirus is not being treated have also expressed fears of contracting the virus from patients who come in for other checkups but unknowingly are carriers of COVID-19.
The medical staff has expressed anxiety and concern related to the possibility of their hospitals beginning to treat the coronavirus as the number of those infected with it rises.
In such a case, medical workers become divided into three groups:
One group would love to join the teams that work in coronavirus units, the second rejects the task and refuses to join the team, and the third would prefer not to join the coronavirus taskforce but is forced to do so. The shortage of specialised experts in intensive care is driving some medical workers to resent their hospital duties.
At Wuhan University, 180 medical workers who were at the forefront of the outbreak between December and February 2020 were taken in for a study. The results indicate that when social care was offered to the medical staff, the levels of stress and anxiety in the staff were significantly lower. This helped them perform better at their jobs, and in battling insomnia.
The First Aid Initiative
To fill in for government shortcomings related to mental health support, concerned students in the psychology department of the Lebanese University have teamed up to implement their own initiative.
Najwa Daja, an expert in clinical psychology and supervisor on the team, has stated that the work aims to provide “psychological first aid” to those in need. The team currently consists of 30 volunteers who are in private contact with individuals in need of psychological aid. They have been in contact with 600 people so far.
Daja adds that, following a lengthy correspondence with the concerned ministries, the government has decided to support this initiative by dedicating a specialized hotline between the students and those seeking help.
When asked whether the team also deals with medical workers, Daja indicated that this sector is in urgent and dire need of support and they are working on dedicating a special team for this purpose. This has already been set in motion following Beirut Today’s Interview with Daja, as the struggles and hardships of this sector have been conveyed.
This initiative has massively grown and is now part of a bigger circuit that joins doctors under the guidance of Dr. Hasan Salameh, who recognizes the grave importance of medical workers today. “Clapping [on balconies] is wonderful, but alone, it is not enough,” said Salameh.
Salameh gave the example of the volunteer circle in the health sciences department of the Lebanese University, who are risking their lives for the cause without expecting any returns. “They don’t even have life insurance,” he said.
The World Health Organization’s (WHO) Messages
On March 18, 2020, WHO released a number of messages in support of those struggling with mental health issues in the medical sector. The most important are:
- Taking enough breaks during work hours
- Eating good and healthy portions
- Staying in touch with family or friends through phone calls or texts
- Avoid harmful coping mechanisms such as the consumption of nicotine, alcohol or drugs
- Referring to colleagues, managers or trusted personnel for mental and social support
The organization also addressed administrative personnel with a few tips, some of which are:
- Periodically alternating working hours for medical and health staff between high-pressure environments and low-pressure environments, as necessary
- Offering lenient working hours for exhausted or stressed employees
- Providing medical staff with the necessary time needed to express psychological support for one another
- Focusing on the ability to resume work remotely because the pandemic is not expected to disappear quickly
*This article was originally published in Arabic on Beirut Today.