‘EMOTIONALLY, we are not coping. Seeing death at this rate every day is not normal,’ was the view of hospital nurse Mosima Doreen Mabeba – working in the intensive care unit (ICU) of a provincial hospital in Limpopo.
She is one of the many health professionals – both in South Africa and in many other heavily-affected countries – who are battling to cope emotionally with the surge in Covid-19 cases.
Some feel they are not getting adequate mental health support. And the International Council of Nurses has found that governments have failed to provide this support.
The second wave of the Covid-19 pandemic has hit the hospital hard, she says. ‘Of five patients on ventilators she had cared for recently in the hospital, only one survived,’ she says.
‘There was a lady who was intubated and then she got off the machine, now she’s fine, she’s at home. But unfortunately, we lost the other patients, mostly because of their age and co-morbidities,’ she says.
Mabeba leaves home in her uniform, only to take it off when she arrives at the hospital. Walking into the change room dressed in her uniform – and walking out armed in personal protective equipment (PPE) – is a constant reminder that things are not normal.
‘We don’t wear our uniform when we go into the Covid ward and ICU. We wear the scrubs provided by the hospital and then we wear the PPE over it,’ she says.
While her working hours have remained officially unchanged – 12 hour shifts, 40 hours per week – Mabeba says staff shortages have affected her workload and forced her to be flexible with her shifts.
Health professionals were already under pressure before the Covid-19 pandemic, says Dr Nokukhanya Khanyile, who works in the paediatric unit at a Johannesburg hospital.
‘I don’t think we were even coping before Covid, but we had to make do. Even though we’re quite efficient because we’ve had to work in hectic circumstances, it does become very strenuous when there are staff shortages.
‘The existing staff has to cover the gaps and work extra calls to share the load. But,’ she says, ‘health professionals have had no choice but to keep working, because there are patients to care for.
‘You have this push and pull within yourself. It’s like: “I’m exhausted, I can’t do another call: but if I don’t do the call, who is going to do the call?”’
To overcome the physical exhaustion and emotional fatigue Mabeba says she has relied heavily on prayer. And, she uses the shower as a safe place to let go and cry.
‘You need to help somebody with a clear mind even though you know this is not a normal situation. You know that somebody needs you emotionally, psychologically and physically, and you have to be there for them,’ she says.
The suspension of visiting hours has meant that staff have to support patients who are isolated from their families and to deal with the families who are not allowed to view the body of a loved one who died.
‘It is really painful,’ she emphasises. ‘People in the last moments of their life.’
‘People are really struggling right now because we’re seeing a higher rate of death,’ adds Dr Precious Dohnodzo Chikura, who is completing her community service at the obstetrics and gynaecology unit at a district hospital in Mpumalanga.
‘We are under a lot of pressure, and we are at the coalface of seeing people in the last moments of their life,’ says Chikura.
Healthcare professionals need a channel to express their fatigue and to debrief, says Chikura – who has founded Frontline Refuge, an online platform where mental health professionals offer therapy sessions free of charge to colleagues. She says there is increased demand for mental health services for health professionals.
The International Council of Nurses’ (ICN) most recent report found that governments have failed health professionals by not ensuring that they have adequate mental health support.
‘There is a huge hidden mental health risk to our nursing workforce submerged below the surface of the pandemic.
‘ICN research indicates the real scale of the mental health legacy of Covid-19 will undoubtedly mean that sickness, absenteeism, burnout and nurses leaving the profession because of ill health will increase, making shortages even more severe and resulting in an unquantifiable loss of experience,’ said Howard Catton, ICN chief executive officer, in a statement.
While Chikura appreciates the sentiment behind encouragements like ‘healthcare workers are heroes’, she says it creates a false impression that they do not buckle under the pressure or need support.
‘There’s a danger in that hero label,’ she says, adding that it puts health workers in a position where they have to over-perform all the time. ‘Looking at healthcare workers as heroes neglects the government’s responsibility to provide danger pay, and time off after experiencing trauma,’ she warns.
- In a few days, thousands of health-care workers in the country will be part of phase one of the government’s ambitious Covid-19 vaccination drive. But there’s just one problem – many of them don’t know much about it.
Democratic Nursing Organisation of South Africa spokesperson Sibongiseni Delihlazo said nurses had expressed their concerns about the government’s lack of communication long before the rollout programme.
‘Nurses have been asking questions without (getting) any answers from the government,’ Delihlazo said. ‘Many of our members still don’t know the pros and cons of these vaccines, and that has led to many saying they won’t be getting the vaccine.
‘We are also concerned about the second phase, when members of the public are expected to be vaccinated. If we, nurses … don’t have any knowledge about the vaccine, how are we going to convince the public to take it? We are appealing to government to be clear with their communication.’
A Western Cape Health Department poll found only 54% of health workers wanted to be vaccinated. Another 26% were unsure, and 19% said they would decline.
In his weekly letter, titled: ‘From the Desk of the President,’ on Monday, South Africa’s President Cyril Ramaphosa said the government was ‘aware of concerns that the government had not been sufficiently transparent about its efforts.
‘For its part,’ he continued, ‘the government will work to improve all its channels of communication, to keep the public regularly informed on the development of the vaccination programme, to provide information that is accurate and factual, and to continue to engage with and listen to the broad range of voices in our society.
‘All of us need to be part of this national effort and not allow the spread of rumours, fear and mistrust. False information and fake news can and does put lives at risk.
‘We all need to work together to build confidence in the vaccine, to demonstrate its effectiveness and its safety – and to emphasise its vital importance in overcoming this deadly disease,’ said Ramaphosa.
The South African Medical Association (Sama), which represents public and private sector medical practitioners, said it was working closely with the the national Department of Health to get doctors registered on an online app for the Covid-19 vaccine.
Sama chairperson Dr Angelique Coetzee said: ‘We have started, in collaboration with other doctor groupings, a vaccine for health workers initiative whereby we ask the different surgeries to please register the personnel that works with them.
‘In phase one,’ she said, ‘we will get the database of general practitioners in South Africa including their personnel.
‘In phase two, also we will ask GPs if they are willing to be part of the vaccination centre when the rest of population will be vaccinated,’ she said. ‘All this data will go to the national Department of Health.’
The Department of Health has yet to respond to queries regarding these issues with the vaccination programme.