Covid-19: Frontline health workers, individuals and their families affected

With the advent of the novel coronavirus and its subsequent spread across the globe, people are at risk of adverse physiological as well as psychological problems. Bangladesh, too, has witnessed the gravity of the problem with an increased number of deaths and Covid-19 infected individuals every day. 

SAJIDA Foundation in collaboration with British Asian Trust is working in the mental health space to provide support to frontline healthcare workers (FLHWs) and their family members. As part of the collaboration, SAJIDA Foundation has conducted a need assessment to gain insight into the mental health status of FLHWs, individuals infected with Covid-19, and their family members and identify modalities of action-based interventions. The need assessment was carried out using a semi-structured qualitative interview guide. Some of the key findings are as follows:

Psychological and physiological   

Fear of infection, feelings of anxiousness, frustration, low mood, anger or irritability, problems with memory and concentration were found to be significant psychological health concerns across categories.  A feeling of being tired or fatigued, weakness, sleep disturbances, headache, and loss of appetite were the most notable physiological complaints.

Behavioural change 

Talking slowly and preferring being alone, showing irritable behaviour, reluctance to talk to others, news consumption, overprotection, spending time with colleagues, increased benevolent activities, recalling old memories were some of the notable behavioural changes mentioned by the frontline workers.  

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Increased independence and access to mobile phones, disrupted sleep cycles, hyperactivity, unwillingness to stay at home, reluctance to study, fighting with siblings, disobeying parents, staying up late at night, and playing games were frequently reported to be problematic behaviour in children.

Family relationship 

Increased interpersonal communication and care among family members were reported. However, poor communication, conflict, misunderstanding and physical distance from the family members were the most prominent concerns. FLHWs often hide work details from family members to keep them stress free.

Social attitude and behaviour 

Lack of socialization and inadequate awareness, and social harassment were some of the prominent features in social attitude and behaviours.  FLHWs were found to hide their current professional identity to avoid social stigma and discrimination.  Deliberate avoidance, negligence, torture, blaming, bullying, and threatening were the most notably reported social discrimination. However, support from neighbours and colleagues and other significant sources have also been emphasized.

Workplace

Extended duty hours and workload especially for FLHWs, wearing PPE and masks for a considerable time period, lack of safety, unsupportive and unempathetic management both surfaced in the report as work-related issues. Heavy workload with extended duty hours and a change in the usual environment were reported as work-related concerns.   

Parenting  

Difficulty managing children, worry over children’s education, and not being able to take proper care of children due to workload have been reported.  

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Coping mechanism 

Listening to music was the most common coping activity for self-management of FLHWs while praying, sharing, and communicating with family and friends were mostly indicated by the Covid-19 infected individuals. Performing daily prayers was also seen to be common among the family members of Covid-19 infected individuals and FLHWs.

Family was the most commonly found coping resource for FLHWs and for the Covid-19 infected individuals. Participants from all categories reported social support and personal attributes also being highly effective during this crisis.   

Majority of the FLHWs and Covid-19 infected individuals reported the need of having job security as a means of better coping. They had strong recommendations for introducing counselling support in the workplace. 

New normal

Most of the participants were found to be slowly accepting the new normal. A lot of changes in daily routines have been found in their lifestyle, for example, maintaining hygiene routine, balanced diet and taking care of psychological well being. A few of them were also found to be making financial adjustments accordingly such as moving to villages or switching career paths. Some of these aspects were experienced as positive impacts by the participants. Both the FLHWs and Covid-19 infected individuals reported that increased public awareness was the most significant positive impact left by this pandemic.

Recommendations

A set of recommendations have been made depending on the findings. Some key points among them are as follows:

• ● Occasional training targeting the skills for burnout management can be of paramount help in this regard. Other professional support such as online and face-to-face psychological counselling can help manage burnout.  
• ● Skills based training programs can equip FLHWs with better coping skills. For example, anger, stress, anxiety, and crisis management skills, relaxation, effective communication skills, problem solving, parenting, increasing concentration, grief management, and selfcare etc. can be useful.
• ● Online videos, webinar, booklet, and other self-help materials containing the effective skills can be provided. 
• ● Trainings on managing primary mental health problems can benefit FLHWs in identifying appropriate mode of treatment for individuals. Furthermore, an insight into the mental health problems will reduce the stigma which often acts as a barrier in seeking mental health care.  
• ● Ensuring a safe working environment with adequate safety measures (PPE and masks, for example) and creating an empathetic working environment can reduce the anxieties associated with the nature of the work. Besides, proper rest, compartmentalizing the duties with less duration, acknowledgement, and incentives (including financial) can help sustain motivation. On-site psychological counselling and professional guidance can be offered.   

This article is part of a paid partnership between SAJIDA Foundation and Dhaka Tribune