We are going through the most challenging crisis since World War II and one of the worst periods in healthcare in more than half a century. The coronavirus (COVID-19) pandemic has led to a perilous time and is practically holding much of the world firmly in its grip. On the other hand, by highlighting the influence of healthcare workers, the pandemic has also produced a model of heroism that reflects the best of humanity.
“Whoever saves one life, saves all of humanity,” reads a verse from the Quran and in the present devastating scenario, these words serve as fuel for an impossible mission – a mission of care and compassion undertaken by healthcare professionals in every corner of the world in these morbidly tense times.
They return day after day to the scene of some of the worst medical room emergencies. These are ordinary people whose work takes them to the extremes of human experience. Each day brings them new traumas, and still they rush in to help.
The influence of the healthcare workers is felt in the movement they are leading, the examples they are setting and the barriers they are breaking.
As the situation worsens, healthcare workers risk their lives on the front lines. In the war against the aggressive virus that is the novel coronavirus, our healthcare workers are our brave soldiers.
In an age where countries emptied their coffers to spend on weapon acquisition and increase military spending, it is the healthcare workers who have come to personify the heroism and tragedy of the coronavirus pandemic.
In an anonymous letter written by an intensive care anaesthetic doctor and published by The Guardian, the doctor explains they are dealing with a “different cohort of patients – ones who are sicker for longer and who might not survive.”
Take a moment to look at the situation from a healthcare worker’s perspective.
They are dealing with a strain of virus that is still pretty much a stranger – an invisible enemy. Day in and day out they are caring for patients whose struggle to breath because of alarmingly low oxygen levels are visible in their panic-ridden eyes. Because a lot of these patients are all alone and don’t have their families close by, they rely on the doctors and nurses to not only make their medical decisions but also provide emotional support. This can be a lot of burden for medical professionals.
But even if they are stretched, they are going the extra mile to make the patients under their care feel human. When the patients are dying, they hold their hands to make the ordeal bearable.
In the past few days, we have also heard of multiple instances where the doctors or nurses on shift are using their own mobile phones and iPads to help the relatives of patients see their loved ones a final time.
Needless to say, the care they provide goes beyond just the cocktail of drugs and the paraphernalia of equipment.
As a senior subeditor in the photos team of a global news organization, I sift through hundreds of images depicting the ongoing COVID-19 situation around the world on a regular basis. No one image is similar. Every photo has a story to tell and an emotion it evokes in me as a viewer and as an image curator.
It was hope that I felt when I saw photos of children playing on the streets of Spain after they were allowed to go outside for one hour each day. Images of a group of Americans protesting the stringent stay-at-home measures angered me. A profound sadness filled within me when I saw photos of a single worshipper in a mosque at the start of Ramadan or mass being held without any devotees in churches around the world during the Holy Week.
However, the photo that left me utterly heartbroken was a close-up shot of a medical professional at the end of a 13-hour shift. She had just taken off her face shield and mask. She was drenched in sweat. Her eyes looked dead with fatigue. Her face was bruised and her nose bridge raw because of the personal protective goggles she had been wearing.
The rawness of the subject combined with the green hospital background sent a chill down my spine.
Since then, of course, several nurses and doctors have taken to social media to share selfies sans their personal protective equipment after long and gruelling shifts.
As I came across more of these images, one after the other, there was this nagging thought that I just could not dismiss. These medical professionals at least have protective equipment to prevent possible contraction. What about those health workers who have to make do with basic masks and single-use plastic raincoats or trash bags as protective gowns?
On March 31, Reuters reported that the shortage of protective gear in India has forced at least some doctors to use motorbike helmets and raincoats.
A report by the Times of India, dated April 23, highlighted the rise of a kind of pecking order in the distribution of protective gear and allotment of residence facilities. “Doctors are accommodated in hotels so that they don’t have to worry about infecting their families when they return home. However, nurses and technicians are made to stay in hostels and guesthouses and are transported to and from their place of residence in packed buses, defeating the whole concept of social distancing,” the report read.
Our understanding of healthcare workers is often limited to just doctors and nurses. It is important to note that the network of professionals working hard to safeguard us also includes technicians, healthcare assistants, clinical staff, hospital domestic cleaners, administrators, radiographers, hospital porters, food service workers, pharmacists, biomedical scientists, security guards, military forces deployed to set up hospitals and deliver aid, and more.
The Indian Express reported on April 1 about growing complaints of discrimination faced by cleaners. As per the reports, while nurses and doctors were being given N-95 masks and proper protection gear, cleaners were forced to adjust with “inferior quality knee-length gown and 2-ply or 3-ply mask.”
As per the Organisation for Economic Co-operation and Development (OECD), India’s total health spending (out-of-pocket and public) at 3.6 percent of GDP fares much below several other countries. According to the OECD Health Statistics 2019, updated in November 2019, the global average of spending on health as a share of GDP by OECD countries remained at around 8.8 percent in 2018. Developed nations like US and Germany have spent 16.9 percent and 11.2 percent, respectively. Even among the economic bloc of countries that form BRICS, India is the least spender. In 2019-20, India’s public health spending was a mere 1.29 percent of the GDP.
At the time of writing this piece, a total of 1,147 had succumbed to the novel coronavirus in India alone. The global death toll stood at 2,33,388. People are suffering and dying needlessly. The current scenario that we have found ourselves in is an affirmation that we were not taking the time and investing the resources needed to protect ourselves, our loved ones and our communities from all possible contingencies.
This is a crucial step that needed to have been taken.
Why? Because we haven’t been hit by a truly devastating pandemic in a long time. For most of us, this doesn’t follow a precedent. This is as novel as it gets. As individuals, we let our guard down and kept mum when leaders defunded the services needed to protect us. And now those that bear the brunt of this callousness include people like you, me and healthcare professionals.
The risk to humanity of continued foot dragging is huge.
Inadequate preparedness programmes combined with insufficient investments required to fund and sustain them mean we as a country have become woefully susceptible to a major healthcare crisis.
Some naysayers might debate that this is what the health workers signed up for when they joined this profession. Technically, yes, but that’s not wholly true. They didn’t sign up for a situation where they did not have the right supplies.
A global shortage of supplies and equipment is not something they anticipated. The efficiency of the supply chains and the availability of essential medical kits should have been vetted and vetted repeatedly when the news of coronavirus first came out of China. Full four months into the catastrophe, it is fully evident not one leader or one government had the foresight to anticipate and predict the incoming load on healthcare systems around the world.
This leads to the question: Who will help the helpers?
Medical staff requires a steady supply of personal protective equipment kits, gloves and N95 respirator masks in order to carry out their responsibilities without fearing for their lives. However, PPE is in short supply in many countries.
In Germany, medical workers are highlighting the dearth of protective equipment and extreme working conditions by posting photos of themselves in a naked state, partially covered by medical equipment, paperwork and other props. The idea is that without the required protective gear they are as vulnerable to the virus as they would be if they were naked.
"We are your GPs. To be able to treat you safely, we need protective gear. When we run out of the little we have, we look like this," reads the statement on their website "Blanke Bedenken."
Hospitals in India are faced with a similar kind of acute shortage and have been issued directives to ensure judicious use of personal protection equipment kits. Oftentimes, the judiciousness employed in using these essential protective layers means that more health workers end up not getting access to it.
In the month of March, on a specific Sunday at 5 p.m., there was a whole spectacle of clapping and plate-banging and bell-ringing in honour of the healthcare workers in our country. We will not go into the ultimate grotesqueness of the theatrics, but we do need to question the efficacy of that step. If, after that entire circus, some of us have not learned to treat healthcare workers with respect, then of what use was that tamasha? There have been numerous reports of doctors and nurses being ostracized from their residential complexes because they have come in contact with COVID-19 patients. It is insulting and upsetting when people are visibly scared of healthcare workers because of the nature of their work.
Perhaps the most horrifying incident was that of people violently hindering the burial of a doctor who died of COVID-19. Dr Simon Hercules was ultimately buried close to midnight by a fellow doctor. Whither went the dignity and respect offered to medical workers during the theatrics of plate-banging, one wonders.
It is crucial to understand that the challenges that healthcare workers face do not cease to exist once they are out of their workplace. On top of the same pandemic-related issues we all are experiencing, health workers have added challenges such as the worry that they may have contracted the illness and passed it unknowingly to their family, unusually high work pressure (oftentimes caused as their colleagues fall sick or are quarantined), changing protocol, guidelines and health advisories from higher authorities, deduction of salary if they do not report to work, no extra pay for extra hours put in, acute shortage of lifesaving medical equipment such as ventilators and hospital beds, and the moral dilemma of deciding which patient gets the lifesaving care and who does not.
In spite of these and several other challenges and the fears they may harbour, medical staff continue to demonstrate a brave front and care for their patients with compassion.
And all of this takes a toll on their mental well-being. Personal protection equipment can control the chances of getting infected by the virus, but they are not enough for protection against emotional and mental devastation caused by the pandemic. As a country we haven’t been vocal about mental health in general and now it could be those in the health sector that bear the brunt of our complacency.
There are already reports of medical professionals experiencing severe psychological distress.
In New York, a top emergency room doctor, who had been treating COVID-19 patients, suicided on April 27. Her father later told media she witnessed “devastating scenes of the toll the coronavirus took on patients.” “She tried to do her job, and it killed her,” he said.
The severe blow our collective mental health is taking during this lockdown time is a pandemic in itself – one whose intensity will continue to play up in the coming years. It is even more difficult for medical professionals who are witnessing the battle between life and death on a daily basis. A psychiatry investigation, published in the medical journal Jama Network in March, found that among a cross-section of 1,257 health professionals who had come in contact with COVID-19 patients in China, 71.5 percent were experiencing signs of distress, 50.4 percent signs of depression, 44.6 percent signs of anxiety and 34 percent signs of insomnia.
As the lockdown periods continue to be extended in several parts of the world and with no end in sight, these feelings of despair will only seem to get darker.
From consultants to cleaners, each health worker is putting themselves in harm’s way often without the necessary equipment to protect themselves and treat many of their patients. The least we can do right now is acknowledge their unswerving commitment even in treacherous working conditions.
When will all this end is still a difficult question to answer. But what we can definitely gather from the lessons thus far is that when the country (and the world) crawls back to its feet, it will be in most part due to the selfless service of our healthcare professionals. When the history of 2020 is written, it is they that will stand out. But once all this is over, how will we honour the sacrifices and courage of frontline healthcare workers?
We can begin by honouring them with respectable wages and humane working conditions. This is what they deserve and by doing so we are communicating to them that they are heroes not just during a pandemic but also when we have lived through the worst crisis in modern history. Remember, we owe them our thanks and our lives.(Published on 04th May 2020, Volume XXXII, Issue 19)