More than a year after the World Health Organization (WHO) declared the COVID-19 pandemic, There is talk of what is known as pandemic fatigue in the world population, in general, and in health personnel, in particular..
This report has been prepared in order to humanize this situation; Their interviews were compiled in writing, and their objective is to show, on the one hand, the testimony of a general doctor from Ecuador, Kathy Díaz, who tells her experience about what the pandemic was like in her country from last year until nowand on the other, give a panoramic view of the situation on a global scale.
Díaz talks, among other things, about how he found a way to adapt to the situation along what this path has been, with all its ups and downs, and how he tried to provide empathy, resilience, calm, training, agility and knowledge even when she herself was trying to fight a disease as unforeseen as it was unknown… a problem that both her patients and her co-workers have also fought against.
An experience that has had meaning for all those for whom the victims are not just numbers that add or subtract, but unforgettable faces, suffering and, above all, lives that could have been saved in other circumstances.
“A year ago we didn’t know what we were facing. We were a small group of doctors who worked in Emergency. We didn’t know how we were going to work, how we were going to provide care to so many patients infected by a virus that was new, and the worst thing was that, in many countries, this disease was undergoing experimental treatments.
Added to this was the isolation from our families, the protective equipment, the situations of helplessness and pain, the endless work. All this suffocated us, and I say suffocated because we all felt a pressure in our chest, a lump in our throat; The uncertainty was inexplicable.
At the beginning, we had the necessary protective equipment to take care of ourselves during the 24-hour shift, we didn’t care about getting dehydrated, getting a headache, that didn’t matter. The fear of getting infected, the fear of bringing the virus homemade us tolerate the unbearable heat that wearing them entailed.
Many patients died, my hospital became a sentinel just to deal with COVID. The health system was saturated to the point that we had nowhere to admit a patient; witnessing deaths at the hospital entrance, but being unable to do anything; relatives who arrived with their loved ones in their arms, but without vital signs, begging us to save their lives… It was a very painful situation. Caring for patients who kept coming because they needed oxygen, and no longer having that, is desperate; colleagues who were infected and whose presence we needed; Sharing my colleague’s pain at losing his father to COVID in our hospital, and seeing him continue working for patients, pushed us to move forward.”
Kathy Díaz is a Critical Care resident doctor at a hospital in Quito, Ecuador. This health center became a sentinel due to the COVID-19 pandemic. Even though she has been a doctor for eight years, she states that she never thought she would live in a similar situation, and in reality, most of the world’s inhabitants were not prepared for it.
He knows first-hand what this disease means from a physical and mental point of view, a disease that, at the time of writing this report in mid-June, has (according to the Johns Hopkins University monitoring center) of Medicine, of the United States) more than 178 million confirmed cases and more than 3 million 800 thousand deaths worldwide. This, despite the fact that more than 2.6 billion vaccines have been administered, a figure that, although encouraging, did not cover even half of the world’s population.
The United States, India and Brazil continue to top the list of countries with the most confirmed cases and deaths, although, according to the WHO, these have decreased in recent days.
Regarding Ecuador, there are more than 445 thousand confirmed cases and more than 21 thousand deaths, including doctors, nurses and other members of health centers.
Ecuador, by the way, was a country that became news at the beginning of the pandemic (this was declared as such by the WHO in mid-March 2020) due to the number of infections, the collapse of the public health system and the overflow of funeral services. The provinces of Guayas and Pichincha, whose capitals are Guayaquil and Quito, respectively, and which have the largest number of inhabitants in the entire South American country, have been most affected.
And this unforeseen disease put a resounding and prolonged test of the capacity, preparation, preventive culture and resistance of both health systems and health personnel around the world. Also the mental health of the population (including common prisoners, political prisoners, immigrants and refugees, people with disabilities, people with previous physical and mental health conditions, children, women and the elderly) , in general, and that of healthcare personnel, in particular.
For October 2020, Hans Henri P. Kluge, WHO regional director for Europe, noted in a press release that European countries were reporting, as expected, an increase in the degree of pandemic fatigue.
Thus, based on data from surveys carried out in countries in the region, it was calculated that said fatigue was, although it depended on each country, more than 60% in some cases.
Pandemic fatigue is the state of emotional exhaustion, due to the long time that the pandemic has meant, tension, worries, fear and the constant use of protective measures such as social distancing and confinements.
Pandemic fatigue, therefore, can affect the mood, behaviors and relationships of people, who could relax with respect to these measures, not seeking reliable information anymore. don’t give importance to coronavirusdespite warnings of the risk of outbreaks and the appearance of variants, on the one hand, and the increase in confirmed cases and deaths in some places, on the other.
Also, due to the fact that some people, having already been vaccinated against COVID-19, think that they are safe from any contagion, and underestimate these protective measures both for themselves and for others.
“Remember that getting vaccinated does not prevent,” Kluge warned in a tweet in mid-June, “getting sick or spreading the virus. However, vaccines decrease the chance of getting seriously ill or dying from COVID-19.”
To the consequences of pandemic fatigue We must add both the tiredness of hearing about the new coronavirus and the complaints of opacity or information manipulation in some countries.
The latter aggravates the situation of helplessness, anguish, anger, fear, stress, depression and anxiety that some people could be experiencing due to the confusion and lack of real figures; the mourning of individuals and families for having lost their relatives or friends, and for not having been able to say goodbye to them through religious ceremonies; the restlessness and drowning due to the economic crisis, unemployment, evictions, domestic violence, immigration, etc.
In this sense, Venezuelan health personnel, for example, are going through a dire situation due not only to COVID-19, but also due to official negligence and the humanitarian crisis, which has been hitting the population in recent years.
So, The staff of the public health system, which is no exception to the crisis, must battle day by day against precariousness and, with it, the lack of basic services, such as, for example, water, electricity, fuel; the lack of supplies and security equipment, low salaries, insecurity, threats or arrests if they report…
In this way, Médicos Unidos Venezuela indicated, according to the El Diario media outlet, that since June 16, 2020, 651 workers have died.
“One year after the first death of a health worker, we continue to demand the same things: protective equipment, supplies, medications, safety and vaccines is not too much to ask for,” they published in a tweet, also in mid-June.
Already in January of this year, the World Medical Association (WMA) published a statement in which specialists made a call for international cooperation to fight the coronavirus together, the collaboration of the world’s population to help stop infections and, especially, to get vaccinated, and the need to increase investment in health systems. The work of health personnel was also recognized, despite the risks they have run due to infections.
“Little by little we learned to deal with everything, we had to be strong. New health personnel arrived, whom we desperately wanted to be hired. We went from six doctors per guard to fifteen, and that was relieving. However, the number of infections increased. The work was such that many times we did not eat, ambulance after ambulance arrived and asked for oxygen for the patients who were in them, but we did not have any; all the tanks were occupied with patients sitting in chairs; the majority, decompensated, waiting for a bed, waiting for someone to die so that bed would be freed.
Not to mention the stories of all the patients we have treated: they have been so sad that just remembering them makes me cry again. Mothers, fathers, siblings, and even entire families admitted to the hospital; Some succeeded and won the battle against this lethal virus, and others lost it. Calling your family and having to tell them about the death of your loved one is very sad. The screams, the desperation of the person or persons receiving the news, is indescribable.
All of us doctors prepare to make the statement, we breathe deeply, we try to keep our voices from breaking, but it is impossible. Many times I have cried with the person who received my call. I regret from the bottom of my heart to break that news.
At the same time, when we thought that nothing could be worse, We began to run out of medications for sedation. You can imagine what that is like, how exasperating it is to hear the infusion pump indicating that the medicine is running out, rationing the medicines, and not to mention the personal protections, which are also beginning to be lacking, so we decided to buy with our money.
Between the month of September and October 2020 we felt a small respite, it seemed that the infections were decreasing and there was one or another free bed, but it didn’t last long when they increased again. Now they were younger patients, who, at the time, enjoyed excellent health, and once again we are experiencing the collapse of the health system, the lack of beds, the lack of psychotropic medications, and physical and mental fatigue.”
The Government of Ecuador published, for its part, the official CoronavirusEcuador.com page, where the population can see, among other aspects, information related to mental health in emergency cases.
He pointed out that the most common reactions in situations like this, which include pandemics, are:
In this way, the prolongation and intensification of a bad state of mind, physical or mental can lead to the appearance or worsening of work problems. Such is the case of stress, workplace harassment (also called mobbing) and burnout syndrome (professional burnout syndrome or burned out worker syndrome).
These situations can cause, among other damages, stress, anxiety, depression, post-traumatic stress, deterioration of self-esteem, insecurity, lack of concentration, lack of rest, fear and a greater risk of making mistakes… and healthcare personnel are not immune to this.
Elizth Pauker, general practitioner and surgeon, with a postgraduate degree in psycho-oncology, and coordinator and founder of the Community of Medical Women of Ecuador, pointed out that different problems that were already creeping in the health field of that country were evident through the pandemic and that this has an impact on the mood, physical and mental state of the workers in the sector.
“Difficult situations for health personnel emerged throughout the national territory, characterized by a series of limitations for their resolution, aggravating the emergency. In addition to this, the persistent situations of job insecurity as a chronic disease, which the National Health System has suffered for a long time, showed its consequences as a worsening of burnout and emotional suffering of professionals.
The pandemic has been an opportunity to expose the aforementioned conditions, a product of the negligence of the authorities or managers, in ignorance of the requirements or demands of the health services to face the health emergency. This time Corruption and inexperience in the administration of health care and human talent in health have won.the result of which is the number of deaths, an important lesson in the search to improve the SNS,” said Pauker.
To this he added that both Guayaquil and Quito were the most affected provinces not only due to the number of confirmed cases and deaths, but also due to the conditions in which the pandemic had to be faced. In this sense, young people, as part of the health personnel, have stood out among those affected.
“Guayaquil and Quito have been the most affected cities not only due to the number of citizens infected or deceased by SARS-CoV-2, but also due to the improvised conditions in which the care was carried out.
The lack of leadership, reduced access to adequate information, few referral centers and means, the situation of hospitals, the absence of personal protective equipment (PPE), among others, are the circumstances in which we have been exposed to develop attention.
To this we add the lack of emotional resources to manage emotions in periods of crisis on the part of health professionals, which has fallen on the youngest, who, by force, faced situations for which they were not prepared.
In the case of Quito, incivilities generated frustration and increased distress among health professionals. These acts of irresponsibility of the population confronted the efforts to save the greatest number of lives through healthcare.”, he assured.
“Each of the patients we have cared for has left a deep mark. Many times with a feeling of helplessness, anguish, pain, that we keep it and that it is a time bomb.
How many times have we witnessed a colleague crying and we have not been able to give a comforting hug; How many times have we witnessed a patient crying because he misses his loved ones. They haven’t heard from them for days, lost in time, and the only thing we can offer them in those moments is a video call to their family member, and many times that is the last call; It is beautiful and sad at the same time, our emotions are running high because of all the things we hear his family member say to the patient and vice versa.
Some patients say goodbye as if that call were the only thing they were waiting for to leave this earthly world; others gain strength and fight against this disease. Although they have had everything against them, their progress has been impressive.
But not everything has been bad, because we learned to be more supportive, more empatheticwe are more colleagues, great friends, a great work team, professionals with more experience and many specialties united for patient care.
On the other hand, I have been a doctor for eight years and I never thought I would go through all this. At first, I thought that the pandemic would last a few months, about six months to be exact, but, as the days passed, that option seemed far away.
I started working with all the love, patience and effort that is needed; However, everything I have experienced has made me lose hope in people: grandparents who arrive at the hospital without having any idea why they were infected, drowning, begging that we not let them die, because their old man would be left alone (referring to your spouse). Some are forgotten by their family, it seemed that they wanted to get rid of them; others, very necessary for their family, are attentive to them all the time.
I have had so many experiences… I have seen many people die; I will never forget most of the faces. I remember the case of a family that came to the hospital; This was made up of mother, father and son. All serious, all were intubated. The parents died. All of us who worked in that area felt sadness.
The young man improved and we managed to remove the tube from his mouth, but, within a few hours, the first thing he asked was about his parents. My partner and I looked at each other; I had a lump in my throat, a pressure in my chest. We told him: ‘Rest, you have to recover.’
How could he tell him that his parents had died, if before the intubation, he had said that he had been responsible for infecting them. What great pain he was going to feel!
On the other hand, I learned to operate a mechanical ventilator, something that, for me, as a general practitioner, only intensivists, anesthesiologists and emergency physicians did, but the pandemic changed my opinion. I learned to manage critically ill patients and that was what I liked the most about my profession, but, at the same time, it was what saddened me the most. because the majority of seriously ill patients do not win the battle.
Being able to take a patient off the ventilator and see that they can breathe on their own is the greatest emotion!”
Néstor Rubiano, mental health representative for Doctors Without Borders (MSF), in Mexico, noted that pandemic fatigue at this time, in the particular case of global health personnel, will depend on the working conditions in which each one finds themselves and depending on each area in which you are located.
“The situation depends a lot on each country or each region. For example, the same is not true in North America, where resources and vaccination rates are greater, than in other places where uncertainty, fear and pain abound. In Mexico, especially, which is where I work, I think there is fatigue among health personnel even though morbidity and mortality have decreased, at least compared to the previous year. I think it is a situation that is related, for example, to working conditions, salaries, the shifts they must do, among other things,” he said.
He noted – with respect to what he recommends for health personnel to protect themselves physically and mentally and, thus, their family and friends – that It is important that they are treated with dignity; recognize their efforts through decent contracts; psychosocial support, decent work spaces, supplies, investment in human resources, training, medical programs and diagnostic aids, etc.
On the other hand, Indira Ullauri, clinical psychologist and general manager of Superar Centro Integral de Psicología, in Quito, Ecuador, added that she feels admiration for the fortitude, drive, discipline and tenacity of Kathy Díaz, who came to her psychological guidance. in search of relief, relief and recovery, and who, being a member of the Ecuadorian health personnel, knows first-hand how important it is to take care of oneself physically and mentally.
“I have not been able to stop being moved by Kathy’s fatigue, grief, fear, pain and helplessness. How vulnerable we are, but, at the same time, how potential we are. (…) I admire every Tuesday when Kathy arrives after her shift, without having slept, saving some and broken by others who left. “I admire the strength they found as a team, the support they provide each other, the smile when they tell that they extubated one of their patients, and I am also moved by their tears when they tell the end of many stories,” she stated.
“At the beginning of the pandemic I didn’t see patients coming off the ventilator; However, new scientific studies continue to guide the entire hospital team to try another treatment.
I have cried so many times, I have had panic attacks, I had depression, anxiety, all of this because of the great emotional burden that is experienced in a Critical Care area.. Having seconds to intubate someone, do CPR, and while I’m doing it, I’m praying that patient comes back to life. Some do; others don’t. Many times I am happy that my intubated patient is responding appropriately, and then I firmly believe that he is going to come off the ventilator, but to my surprise, upon returning to my shift, I find out that he has died, that he had multiple respiratory failures. other organs and that did not resist.
Today, a year and two months after being face to face with COVID, I continue working with love and patience, but physically and emotionally tired. Thank God, I no longer have depression, but anxiety and stress occur sometimes. However, with the help of my psychologist and my co-workers, this becomes more bearable and, most of the time, I know that all members of the work team are like this. Talking for a few minutes and expressing how we felt relieves us a lot.”
Author: Adriana Ramírez, from the Superar psychology center.
