Mental health issues another challenge overworked healthcare workers face in India

Gauri Gupta has been working for 14 hours daily at the emergency ward of a hospital in Dehradun as the surge in Covid-19 cases continues to increase the workload of doctors like her across the country. Apart from her struggles of being constantly in personal protection equipment kit (PPE), Gupta has helplessly seen patients dying that left her traumatised.

"...a few weeks ago, a 22-year-old man was admitted as an emergency case. His oxygen levels were drastically dropping...as doctors, we always need to feel hopeful and give hope to the patient's family. Deep down, I knew that he could not be saved but we never gave up. We provided him with all the essentials, yet could not save him," said Gupta. "When I had to break the news, I was shaking and had to mentally prepare myself to talk to his mother, who was very hopeful. I broke down as I told his mother and locked myself up in my chamber..." Gupta said she felt helpless over her failure.

PPEs have added to the woes of health care workers as the mercury continues to rise over the 40-degree C mark at many places in the country. "The PPE kit is extremely warm due to which I have had breakouts around my nose and mouth. ...the first time I had my period in a PPE kit...I could feel blood seeping through my PPE kit, as we usually have one kit assigned for one doctor a day..."

Gupta said she felt extremely distracted, conscious, and uneasy. "I could smell the stinky blood and could feel it sticking against my legs because of the sweat. After my 14-hour long shift, I ran home, feeling miserable..."

Damini Grover, a counseling psychologist, said consequences of such traumatic experiences are real. She added they can lead to long term issues like hyperactivity, post-traumatic stress disorder, depression, emotional imbalance, frequent panic attacks or depression. Grover said most doctors might always work with the feeling of guilt and doubt as the second wave of the pandemic has gone out of hand. She added considering doctors as humans is extremely important as they are witnessing so many deaths everyday. "The prolonged impact of the trauma the doctors are facing right now will deeply impact their personality and their personal lives," said Grover.

Subin Varghese, ICU supervisor at Delhi’s Max hospital. (Sourced)

Subin Varghese, the Intensive Care Unit (ICU) supervisor at New Delhi's Max Smart Super Speciality Hospital, said at the beginning of this year, the control in the rise of the infections made people careless. "I saw people not wearing masks or wearing them incorrectly, and similarly both the central and the state government did not plan..."

Varghese said it is distressing to see patients die due to the lack of oxygen cylinders or ICU beds. "There are times you know that if I had an oxygen cylinder or a bed, I would have been able to save the patient, and that makes me feel hopeless... When you have six patients and one of them suddenly shows extreme symptoms, you put in all the resources available to save that life, but when that patient dies, what do you do?" Varghese said as healthcare workers, they do not have the time to mourn a patient's death. "It is because you have five more patients to look after. I focus all my energy to save those five. My workplace has been very supportive by giving extra compensation for each shift to every worker but the misery of deaths and suffering I have been seeing for over a year now has made me numb..."

Varghese said there are days when he is unable to sleep thinking about the people who could not be saved.

Nikita Dhawan, who started her internship in April 2020 and has since been working in Covid wards in Dehradun, said seeing people die helplessly was very difficult to cope with. She has often suffered anxiety and even thought of giving up.

Dr Nikita Dhawan. (Photo: Sourced)

"...there were days when we had to lock the hospital gates from inside as there was no capacity left to accommodate people. I could see people outside the gate, holding onto the hope that their loved one could be saved, and at that point, I used to feel hollow. I felt guilty for not being able to help," said Dhawan. "But when you are on duty, you need to be numb. I have felt the loss of every patient, particularly a 15-year-old boy...I was in shock and felt a void. I could not stop crying while preparing his death certificate the next day. It was traumatising."

Shishupal Singh, the nursing in charge at Gurugram's Fortis Memorial Research Institute, said they have to be positive and continuously motivate the patients. "There are times when the patients get emotional and miss their families [and we arrange] video calls... It is definitely tough to see the patients go through so much pain. But when I brief my team in the morning, I always make it a point to mention how the soldiers of our country are protecting us from the outer threat. Similarly, we have to protect our country from this virus."

Singh said there are times when his staff feels demotivated or anxious. "During such times, we stand as a team. We video call others, try to crack jokes, and play online games like Ludo to keep ourselves relaxed and positive."