Healthcare workers face stigma after Covid outbreak: ICMR study

The Indian Council of Medical Research (ICMR) conducted a study on healthcare workers (HCWs) from 11 cities in the country, including Noida, and discovered that the subjects reported major family issues and faced social stigma following the Covid-19 outbreak last year. The study’s findings were published in September.

“The study has been published in the Indian Journal of Medical Research and was carried out by conducting in-depth telephonic interviews with 967 HCWs involved in Covid-19 management across 11 cities- Bhubaneswar, Mumbai, Ahmedabad, Noida, South Delhi, Pathanamthitta and Kasaragod (Kerala), Chennai, Jabalpur, Kamrup and East Khasi Hills,” said Dr Shalini Singh, director of ICMR-National Institute of Cancer Prevention & Research (NICPR), Noida. Of the total subjects, 54% were females and 46% were males with most respondents falling in the 20-40 years age group.

The ICMR-NICPR and the department of psychiatry, Government Institute of Medical Sciences (GIMS), Greater Noida, carried out the study in Gautam Budh Nagar by randomly selecting subjects from government hospitals.

Some participants concealed information related to their duties to avoid distressing their family members. The study details the experiences of stigma and rejection that HCWs faced for caring for Covid patients. The study has found out that the neighbours, friends and relatives of the HCWs made them feel they were the spreaders of the infection and avoided them, made hurtful remarks and also showed reluctance to interact with them.

“Some HCWs reported that they also had to conceal their identities to prevent any social harassment… There were also some who reported stigma from their own families,” said the study. “This attitude was mainly because they were considered as vectors for transmission of the virus and not perceived as those whose primary service was to prevent infection and help those infected,” it said.

Dr NK Sharma, president of the Indian Medical Association (Noida) recalled such incidents that happened in Gautam Budh Nagar.

“There were instances of doctors facing rejection from society during the first few months of the Covid outbreak. A number of healthcare workers, who were living in rented accommodations in Noida, were asked to move out by their landlords. Some doctors approached the IMA for support and we protested against such behaviour. In some cases, doctors were ridiculed and subjected to bad behaviour. As representatives of doctors in the district, we had to get police protection at some hospitals in the city,” said Dr Sharma.

According to the study’s findings, HCWs reported major changes in the work-life environment. The issue most reported was the long duration of separation from families.

Dr Yatendra Singh, medical superintendent at the community health centre in Bhangel, Noida said, “It was a huge challenge to be separated from my family after the Covid outbreak. My son was just one-and-a-half-years old when Covid struck and I had to stay away from him for months as I was on Covid duty. While on one hand, I wanted to hug him, on the other hand, there was the fear of infecting him with the virus.” said Singh.

Along with the pressure of separation from families, researchers also found out that excessive workload, erratic working hours, challenges of working in a personal protective equipment (PPE) for hours, fear of infection, sleep deprivation, disruption in eating habits contributed to the mental trauma of the HCWs.

“Recent reports indicate that health personnel struggled with higher workloads and a swiftly changing workspace milieu that differed greatly from the familiar day-to-day reality while dealing with the social changes and emotional stressors of Covid-19. The longer working hours with erratic timings reported in the present study resulted in sleep deprivation as well as unhealthy eating patterns, which could have long-term consequences,” said the study.

In fact, the researchers have found out that female caregivers were more affected than male counterparts as along with their workload, they also had the responsibility of managing their homes.

As medical staff struggled to work in PPE kits at Greater Noida’s GIMS, Dr. Abhay Singh Tomar, a psychiatrist at the facility thought of a novel idea to cheer up workers.

“I could see HCWs getting suffocated under the PPE kits and this, in turn, affected their mental health. Moreover, in such a glum environment, it was difficult for the staff in PPE suits to exude positivity among their patients. As a result, we came up with the idea to scribble positive notes on the suits like ‘StayPositive!, ‘Faith in, Fear Out!’. This way, each medical staff was greeted with a smile as the patients read the positive notes,” said Dr Tomar.

HCWs are already suffering from burnout. The National Institute of Mental Health and Neurosciences (NIMHANS) conducted a survey among 3,083 HCWs across India. They published their findings in April this year in the Asian Journal of Psychiatry, which revealed that 26.6% and 23.8% of the respondents had anxiety and depression respectively.

Against this backdrop, ICMR conducted his study to find out the main reasons for the mental health crisis among the HCWs and make recommendations to the central government.

The study concludes that there is a need for psychological support for healthcare workers and their families to allay fears and prevent stigma associated with Covid-19 infection or transmission.

Dr Beena E Thomas from the department of social and behavioural research, National Institute for Research in Tuberculosis, Chennai, who is the main correspondent of the study, said there is a need to sensitise the public. “The stigmatisation adds to the mental health of the already exhausted and burned out HCWs. More focus should be laid on educating people,” she added.

The ICMR has suggested improving the working environment, allowing them breathing space and filling the staff crunch to ease the workload on HCWs.