Caring for caregivers – Asian Scientist Magazine

Asian Scientific Journal (April 6, 2023)

By Jill Arul and Denise Gonsalves

One morning just after sunrise in August 2021, Wong walked back to his rental apartment after working all night. The moment Wong entered her house, she burst into tears. Wong, who prefers not to reveal his last name to protect his identity, took some time to recover before preparing a meal and getting some rest. Her next shift at 7 pm that night was watching her. Wong is a nurse at one of the largest hospitals in Singapore. She, like many healthcare workers, was forced to attend to an influx of patients at the start of the COVID-19 pandemic, which overwhelmed hospitals across the country.

Since then, Wong, who is twenty years old, has been working odd shifts and long nights away from his family abroad.

She was due to graduate from her nursing school in Singapore in May 2020. But a month before that, as COVID-19 infections began to rise, her entire cohort was called in to fill staffing shortages facing hospitals.

Suddenly thrown into a new high-pressure environment, Wong did his best to stay afloat. Often, the hospital would ask staff to take shifts in the COVID-19 wards without discussing it. Within a year she began to feel exhausted and unhappy. It took him two years to finally seek help in 2022.
Wong’s experience is shared by many health workers in Asia and the rest of the world. Studies show that healthcare workers tend to face high levels of stress and burnout that intensify in times of crisis.

Throughout the COVID-19 pandemic, as communities expressed gratitude for healthcare workers through art, applause, and awards, these workers continued to struggle with massive workloads, emotional stress, and healthcare resources. mentally exhausted. Over time, these struggles surfaced with protests in the Philippines and Japan, and online activism in Singapore following the suicide of a nurse in 2021.

Such action alerted governments, hospitals and the scientific community to the crises, which had been brewing even before the pandemic began. Finally, the unique mental health challenge facing healthcare workers is being addressed.

Social discrimination

According to a review published in Brain, Behavior, and Immunity in 2020, at least one in five health professionals in countries affected by COVID-19 experienced symptoms of depression and anxiety in the first months of the pandemic. Rates were highest among female health workers.

In addition to heavier workloads, the workers faced societal discrimination for fear of carrying the virus. In the Philippines, reports of health workers losing their apartments and denied access to public transportation flooded the news.

“Once people found out we worked in a hospital, they avoided us, even when we didn’t see patients directly,” said Lyra Advincula, an administrative officer at a small hospital in the Philippines. Asian scientific journal.

To assess the post-traumatic impact of COVID-19 among allied health professionals at The Medical City, one of the largest private hospitals in the Philippines, the researchers conducted psychometric tests and interviews with health care workers who returned to work shortly after recover from COVID-19. 19 The research revealed that the pandemic had instilled heightened feelings of uncertainty, anguish, fatigue, and dissociation among study participants, who also questioned whether staying in their jobs was still worth it.

According to Mark Carascal, a research specialist who led the study, social discrimination was one of the biggest stressors.

“We didn’t want people to associate us as the harbinger of death in our local communities,” Carascal said. Asian scientific journal.

Similarly, a study from Japan published in Public Health Ethics found that stigma and shaming of health care workers isolated them from the public.

Such experiences forced some healthcare workers to take furloughs or quit their jobs, even as their hospitals faced spikes in COVID-19 infection. According to a report in the Japan Times, at a Tokyo hospital, more than 20 staff members resigned when a COVID-19 outbreak was suspected.

common humanity

In general, workers, including those in the healthcare industry, tend to find solace in the company of their colleagues after work hours, whether it be over dinner, drinks or a cup of tea.

“Rating a little bit with my friends in the living room takes some of the punch away. It helps a little that they know what I’m going through,” Wong shared. “But they can’t relate to everything, they don’t understand how alone I feel being away from my family.”

Turning to colleagues who understand your situation can be especially important in Asian countries, where it is as much a coping mechanism as a form of self-care, explained Professor Yasuhiro Kotera of the University of Nottingham, UK, whose work is to study the mental health of health workers in Japan.

“Self-care and self-compassion are about showing understanding for yourself and your shortcomings and knowing that the difficulties you experience are also experienced by others,” Kotera told Asian Scientist Magazine. “When you know you’re not the only one, you don’t feel so isolated.”

The researchers refer to this act of reaching out to others who are likely to understand their condition as ‘common humanity’. Among the different pillars of self-care, including kindness and mindfulness, common humanity is most significant in collectivist societies like those in Asia.

Not being able to access ordinary humanity could affect people’s mental health, a problem Kotera found in her interviews with health workers in Japan. Rather than engaging in informal conversations in hospitals, workers rely heavily on after-work socialization to cope with daily stressors as part of a cultural practice called nomikai. When the lockdowns began, many overwhelmed healthcare workers found themselves alone in their fights. Ordinary humanity was suddenly unavailable to them at a time when they needed it most, Kotera said.

deeper problems

Emerging research shows that crises like pandemics often expose or exacerbate existing challenges facing healthcare workers.

For example, in 2019, the Philippine Department of Health estimated a shortage of around 290,000 Filipino healthcare workers, the majority of whom were Filipino nurses. Data from the Philippine Overseas Employment Administration also reveals that almost 19,000 Filipino nurses have left the country in search of better financial opportunities abroad since 2014.

“In the past, I have had patients who were healthcare professionals. They felt shame or guilt for wanting to leave the country, but during the pandemic, these feelings were downplayed because they felt mistreated,” said Rowalt Alibudbud, a nurse-turned-psychiatrist who works at a counseling health center in Makati City.

Alibudbud added that paying healthcare workers a decent wage is important because if a person is constantly struggling to make ends meet, it will affect how they behave. Alibudbud’s sentiment is backed up by an in-depth study by the World Health Organization, which found that people from low socioeconomic backgrounds tend to face a higher risk of mental health disorders. Realizing the problem, the Philippine government has announced that it plans to increase the salaries of nurses. Singapore has already started to do so.

moving the needle

Health institutions have also begun to initiate changes. For example, The Medical City in the Philippines has introduced weekly check-in sessions with a licensed psychologist for its healthcare workers. According to Shirley Maclipay, the hospital’s director of human resources, ward leaders have also been trained to spot early warning signs among their staff members.

However, the country’s smaller hospitals cannot provide such resources. Advincula, who works at one such hospital, said that while his hospital offers counseling services through the Human Resources department, employees have to seek help elsewhere if their mental health problem worsens.

Meanwhile, the Singapore government has introduced policies such as mandatory access to counseling services and peer support schemes to reduce burnout among public health workers. Technology-supported initiatives such as self-assessment tools and artificial intelligence (AI) chatbots have also been added to the country’s growing pool of healthcare solutions, as well as systems for staff to raise concerns about their mental well-being and that of their colleagues. colleagues.

It is worth noting that such internal systems may not work for everyone. For example, Ella Wong did not feel comfortable accessing the peer support system where she would have to share her concerns with senior staff members. She did not want her colleagues to know the details of her anxieties, and she could not be sure they would be kept confidential. So she approached a nonprofit organization to find a counselor.

Since speaking regularly with the counselor, Wong has found that he is better able to control his emotions and provide better care for his patients.

Back in Manila, Carascal said people need to understand that health workers are not superhuman and experience distress like everyone else. “When our needs are heard and prioritized by local governments and institutions, we can continue to provide the best healthcare for everyone.”

This article was first published in the print version of Asian Scientist Magazine, January 2023.
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Copyright: Asian Scientific Journal. Illustration: Shelly Liew