The other day, the CNN showed the intensive care unit of the University Hospital Medical Centre in New York. The ICU is at capacity, patient beds line the hallways of the emergency department, and the morgue is overflowing. Dr Arabia Mollette, an emergency room physician attending to the Covid-19 patients, said the Brooklyn-based hospital was now “a war zone”. “A medical war zone.” She said “Every day I come, what I see on a daily basis is pain, despair, suffering and healthcare disparities.” This is the true picture of many hospitals across the world where healthcare professionals attend to patients suffering from the coronavirus. The gloomy statistics run from the United States to the United Kingdom, to Italy, to Spain and slowly creeping alarmingly to every part of the world.
Healthcare workers want people to understand that the situation is dire for them who attend to these patients, and they continually ask their governments to supply them with resources especially personal protective equipment to help to continue to fight the virus. “The hope that we have is that if people be more socially responsible and stay at home and do what they can do to flatten this curve, it will help alleviate the pressure off the emergency department,” Mollette said.
“I can say that every corner, every part of the hallway, every room, every space has been filled up to capacity with our patients,” Mollette added.
Inside the ER, a staccato of coughing fills the room as a nurse goes from one bed to another while attending to patients.
“It’s not easy coming here when you know what you’re getting ready to face.” Healthcare workers feel like “lambs to the slaughterhouse.”
Lab technician, Andrei Legoun, works dozens of COVID-19 tests in the hospital. Legoun said he is not nervous about working on such samples – the samples are first deactivated by placing them in a water bath. And he adds, “I have a mask.”
Yet, Legoun said he had been away from his family for more than two months and had avoided face-to-face meeting with anyone including his family. “In case I’m a carrier for some reason, I don’t want to pass it along to them,” he said.
For months too, Mollette hasn’t seen her family. And so for many such healthcare workers.
“I’m going to be honest with you: I don’t really sleep that well at night,” Mollette said. “I’m worried about my family, I worry about my safety. I’m worried about my colleagues. I worry about if a family member is going to come and be patient as well.”
So, healthcare workers not only think about themselves but also about their families. Doctors staying in the garage, rental apartments or hotels instead of going back home so they don’t accidentally infect a family member. Healthcare workers avoiding small children when they come home until they can shower and change out of their work clothes. A nurse who had recently given birth decided to quarantine out of concern she might infect her newborn. She pumped breast milk and kept it outside her door for her husband to feed their baby.
Now, there are reports describing the significant psychological distress healthcare workers are experiencing. Post-Traumatic Stress Disorder (PTSD) is well-known. But less appreciated is the moral injury, something described as “a trauma wrapped up in guilt”. It is said that moral injury occurs when “a person commits, fails to prevent or witnesses an act that is anathema to their moral beliefs.” It’s further described as psychological trauma involving “extreme and unprecedented life experience”, that can lead to “haunting states of inner conflict and turmoil.” This can happen to healthcare workers confronted with the COVID-19 outbreak.
A doctor told the BBC the stress was intense. “Seeing people die is not the issue. We’re trained to deal with death… The issue is giving up on people we wouldn’t normally give up on.” There is the long shifts with little break and sleep before returning to the job. When all this is over and life is now normal for the rest of society, that’s when healthcare workers will sit down to ask: “What happened?” That’s also when some medical personnel go into depression and may take their lives because of moral injury, having been “crushed by decisions they had to make, swamped by unrelenting grief, consumed by fury and humiliation at the authorities who failed them.” If healthcare workers in countries with advanced healthcare system are experiencing this, imagine then what Nigerian healthcare workers in a decrepit healthcare system are then going through.
With COVID-19, surgical masks, gloves and other personal protective equipment became scarce even in public hospitals in Nigeria. And where available, the price skyrocketed. Still many healthcare workers have to get masks for themselves somehow. Even with the lockdown, Nigerians have continued to move about, putting healthcare workers and they themselves at risk.
Outpatient departments in most public hospitals in Nigeria remained open and few if any observing social distancing. Now, the term “frontline” is being erroneously used in Nigeria to refer to healthcare workers in the isolation centres. But get it clear: frontline healthcare workers include those who work in the ER and even outpatient departments confronting potential coronavirus patients.
Paradoxically, the isolation centres are now relatively safer! They are provided with full personal protective equipment. But for some of us who chose to remain in the ER, it is not so. We are not as protected as those in the isolation centres. The more dangerous patient is the asymptomatic one. Who then infects others who may end up having severe symptoms.
People must get this clear too. Nigerian healthcare workers are not scared of coronavirus or any other pathogen for that matter. All we want is to be given the things to protect ourselves so we don’t become sitting ducks. It’s infuriating to see politicians wearing respirators when healthcare workers who directly confront the virus beg for surgical masks. Yes, doctors and nurses took oaths. But our families did not take these oaths. And perhaps they, like the person in charge of our health ministry, are not aware that our hazard allowance is N5,000!
Just a few days ago, a suspected coronavirus patient died at our hospital. Initial test carried out on the patient came out negative. And we all cheered. But a few days after, another information came out to say a second test was now positive. Meanwhile, the ER had been disinfected. Work had continued almost immediately in the ER. And it’s been business as usual in the outpatient departments since then.
My colleagues who worked that shift are being tested. It’s a long wait. Even for us who took over from them!
Dr Odoemena, a medical practitioner, writes from Lagos