What more could be done to save lives? A question that agonises health workers

Long working hours, critical patients and the overcrowded hospital have become part of his routine as an intensive care specialist in the pandemic days. Still, what Dr. Abdullah Asef Akhond could not be used to and dreads most is having to declare his patients dead.

Weeks ago, when infections and deaths peaked in the second wave of the pandemic in Bangladesh, he saw seven to eight patients die every day.

"It never gets easy, despite my six years' experience in intensive care services," said Dr. Akhond, ICU register at Impulse Hospital in the capital.

He is not alone. Most frontline health workers are saddled with a Herculean task – saving lives with limited resources and manpower, and it has a psychological toll on them, which only intensifies when they realise that the pandemic is not going to go away soon. 

A recent peer-reviewed study report titled "Mental health of physicians during Covid-19 outbreak in Bangladesh: A web-based cross-sectional survey" sheds light on the gravity of the problem. Published in February, it says the prevalence rates of anxiety and depression among the 114 physicians surveyed were 32.5% and 34.2%, which is high if compared to the fallout of other global pandemics. 

The study also points out, citing previous researches, that it takes one to three years for psychological impacts, such as depression and anxiety, to taper off following a pandemic of this magnitude.

Even though doctors are trained professionals, who tend to be more resilient to mental trauma, "we need to understand that they are human beings who are in the thick of this pandemic," said Kamal Uddin Ahmed Chowdhury, associate professor and clinical psychologist, of Dhaka University.

"There were days when we had 25 to 30 patients waiting for an ICU bed. It was profoundly sad that we could not accommodate them. We simply did not have space," said Assistant Surgeon Mizanur Rahman of Mugda Hospital. 

A question – "what more could we have done" keeps tormenting him every time a patient dies, he said. 

The agony that healthcare providers have been enduring remains unspoken and unseen behind desperate moves to save lives. But when health workers see one of them die for contracting infection in the line of duty, they feel shaken up. As many as 145 physicians have died of the disease in Bangladesh. 

Amid mounting stress and anguish over months turning into a year, several doctors in parts of the world died by suicide. 

The latest was on 2 May when, according to NDTV, a resident doctor at a private hospital in Delhi ended his life out of distress. 

Such deaths could be prevented if the deceased had been given psychological support. But there is no such measure both at government and private hospitals. 

Md Enayet Husain Sheikh, director of Anwar Khan Modern Medical College Hospital, said the thought of providing counseling to doctors and nurses was absent.

But he acknowledged that Covid warrants mental health management services for health workers. 

"Not just during the Covid crisis, I believe doctors and nurses should be provided with mental health support at all times. The psychological impact of this [healthcare] job is a lot. We have mental health professionals accompanying the national cricket team when they go abroad to play tournaments, then why are healthcare professionals not getting the support, who, in many cases, continue doing their job staying away from family?" said Enayet Husain. 

Those who stay with family worry over carrying the virus home from hospitals. 

In partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh, the Department of Clinical Psychology, Dhaka University conducted a workshop on stress management last year. "We found that a recurring concern of frontline healthcare professionals was infecting their family members," said Prof Kamal Uddin. 

Dr Akhond had rented a separate apartment and lived there since June, particularly thinking of his elderly father, a cancer patient, and his newborn child. Last year's Eids were spent doing hospital duties and he anticipated that this year would be no different. 

"I doubt if I will be able to spend time with my first child this Eid," he sighed.

Dr Akhond's seven-member ICU team looks after the 56-bed ICU wing at Impulse Hospital. Five members of the team contracted the air-borne virus on the job at different times since the first wave. When tested positive, they went home just to put back on their hospital scrubs and serve patients immediately after recovering. 

At the end of 2020, a colleague of Akhond fell severely ill and was hospitalised with 40% of his lungs affected by the virus. 

"My workload doubled at that time," recalled Akhond. "I opted to stay in the hospital to save commute time. I would find a quiet room, lock the door and sleep for a few hours before getting back to work." 

The study on mental health of physicians found that long work hours along with job location and marital status contributed to anxiety. Married physicians were likely to experience less anxiety, possibly due to the emotional support they got from their partners, the study report says.  

"We also need to take into account the length of the pandemic. It has been over 14 months that our frontline healthcare professionals are relentlessly working," said clinical psychologist Kamal Uddin. 

Regrettably, doctors and healthcare professionals feel that their efforts are unrecognised, be it by the government or society, he added. 

There were instances last year when personal protective equipment was made available to non-medical civilians before healthcare professionals, a glaring example of why frontline doctors and nurses feel demoralised and unsupported, Kamal Uddin said. 

Moving forward, counselling support is absolutely necessary to address the mental health problems of health professionals. 

Additionally, measures need to be taken to end the stigma associated with mental health services, Kamal Uddin said. 

"The negative connotation that going to a mental health counselor means 'you must have lost your marbles' needs to be addressed through outreach and awareness campaigns," he added.