· Mental health support must be a priority, say experts
As COVID-19 continues to ravage the globe, killing many and crippling economies, female frontline health workers say they suffer mental health challenges as they struggle to juggle the triple roles of wives, mothers, and caregivers to people infected by the virus, TESSY IGOMU reports
As the magnitude and dynamics of the COVID-19 pandemic continues to unfold, its risk, especially to female frontline healthcare workers, becomes more glaring.
Faced with the daily struggle to effectively balance their roles as mothers, wives and caregivers to COVID-19 patients, PUNCH HealthWise learnt that the overall mental health of these heroines on the frontline comes under immense strain.
While speaking with our correspondent, most admitted to suffering from mental health disorders due to the peculiar challenges thrown up by the pandemic.
With no end in sight yet for the pandemic, some fear that it’s just a matter of time before their overstretched mental health snaps.
Experts say female HCWs could have panic attacks and anxiety disorder from feeling vulnerable to infection due to working in environments where they feel under-protected; could become depressed from continuously seeing children and the elderly suffer and die from COVID-19; and be stressed from being overburdened with heavy workload during extended shifts.
They also say the chances of having them voice out their emotions are slim, due to fear of possible backlash from colleagues and health authorities.
Mental health disorders
According to the World Health Organisation (WHO), mental health disorders refer to a wide range of mental health conditions that affect the mood, thinking and behaviour of people.
It notes that there are many mental disorders with different presentations, adding that they are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviours and relationships with others.
The WHO states that these include depression, bipolar disorder, schizophrenia, psychoses, dementia and developmental disorders.
The global health body, however, notes that there are effective treatments for mental health disorders and ways to alleviate the suffering caused by them.
It maintains that access to health care and social services capable of providing treatment and social support remains key.
‘I now manage anxiety disorder’
Ajoke Ogunrinde is a nurse in one of the isolation centres in Lagos. The mother of three told PUNCH Healthwise that she’s had a fair share of the devastating experience of COVID-19.
Ogunrinde (pseudonym) said she was diagnosed with anxiety disorder by an expert and claimed to have developed the condition days after resuming in one of the isolation centres in Lagos.
She told our correspondent that she struggles to pull through each day, and that the mental health consequences of providing care for COVID-19 patients quite outweigh the physical.
“While at work, my mind becomes unusually unsettled and becomes quite uneasy,” she confesses.
She added, “I get scared that my colleagues may come down with the virus and unknowingly infect me.
“Some of them have underlying health conditions like high blood pressure and diabetes, which are serious predisposing risk factors.
“Being on duty is like walking on eggshells”
Ogunrinde has undergone three COVID-19 tests that came out negative, but several of her colleagues, she reveals, have not been that lucky and have variously been admitted to the isolation centre in Agidingbi, which was built specifically for health workers.
“I fear for my health and that of my three children. Though I am housed in a facility with others to prevent such from occurring, I don’t want to go through the experience that most patients undergo.
“It’s quite scary. I look forward to having my peace of mind back,” the nurse says.
On therapy from depression
Just like Ogunrinde, Adeola Adegoriola, a doctor, is currently suffering from depression.
She is among some aggrieved volunteer HCWs, who were disengaged from the Gbagada isolation centre.
The medical practitioner alleged that she was paid a pittance after being owed several months allowances.
Adegoriola revealed that she tested positive for COVID-19 in June and was admitted for treatment at the Agidingbi isolation centre.
Recounting her experience to our correspondent, the doctor said she gradually slid into depression in April, after seeing a high number of patients die from COVID-19 complications.
Attending to critically-ill patients, especially children between the ages of six months and four, she said broke her spirit.
The doctor said she had concluded plans for her wedding, which was slated for August.
Tearfully, Adegoriola said it was cancelled by her fiancé, who was scared of getting infected by her.
She stated, “He called off our wedding and accused me of not consulting him before accepting to work at the isolation centre. He said he wasn’t ready to die and the experience made me recoil into my shell.”
Adegoriola is presently undergoing treatment and therapy for depression at the Psychiatry Department of the Lagos State University Teaching Hospital (LASUTH) and is optimistic that she will pull through eventually.
I became frigid from seeing so many COVID-19 deaths –Nurse
For Labake Ogunnaike (pseudonym), her elation of being among the HCWs posted to the Infectious Disease Hospital (IDH), Yaba, over time, turned into sadness.
The nurse said initially, she had no underlying fears about getting infected with COVID-19, but after two of her colleagues tested positive, she became very apprehensive and started experiencing panic attacks at work.
According to the mother of two, she couldn’t stay in the hotel provided for them, because her children are quite young.
So, she was left with the option of returning home daily with underlying fears of possibly exposing her loved ones to the virus.
Ogunnaike revealed that with her condition came frigidity, as she became unable to fulfil her conjugal responsibility.
She explained, “Going home became a sad chore. It was not easy because when it was time to leave the facility, I usually became paranoid.
“I lived with the fear of infecting my children and husband.
“Despite disinfecting before leaving the isolation centre, and leaving my clothing in a designated place at home, I still couldn’t bring myself to embrace my husband and children. I avoided them.
“I made excuses with the virus each time my husband wanted intimacy.
“The few times we had sex, I must have spent quite some time in the bathroom scrubbing and would put on a face mask afterwards. I was usually unresponsive.
“My mind was always filled with images of children and adults on ventilators, and of those that eventually died. It was living a nightmare.”
Ogunaike said it took her redeployment to another department to restore her sanity and save her marriage from collapse.
“It takes great guts and the grace of God to survive mentally in any of the isolation centres. I almost lost my mind,” she confessed.
Rollercoaster of emotion treating COVID-19 patients
Margaret Agbo has worked as an infection prevention control expert for over a decade.
Despite working as an infection prevention control (IPC) expert with the African Union and the Nigeria Centre for Disease Control, she said the dynamics thrown up by COVID-19 made her adopt prayer as a form of daily protection.
Her 12-hour shift, she noted, was carried out with trepidation and admitted to experiencing mental exhaustion from treating COVID-19 patients.
She told our correspondent that sometimes, she stayed for weeks without seeing her husband and children, adding that it had been quite unsettling.
She stated, “My only daughter longs for me. I know there is a gap or void that needs to be filled at home, but the risk of infection for my family members is very high.
“It is better this way to keep the distance and avoid infecting them.
“The magnitude of COVID-19 doesn’t really hit me until I walk into the hospital and see the number of critically ill patients that depend on us for survival.
“You are put more at risk by the aerosol generative procedure, and have to be well kitted and safety conscious.”
The infectious disease nurse recalled facing the lowest moment in her career after learning that some of her colleagues had tested positive for the virus.
“I had to get tested and the result was negative. It has been a rollercoaster of emotions treating critically ill COVID-19 patients.
“Sometime, I get overwhelmed by emotion and become withdrawn,” she noted.
For Ayorinde, all female HCWs need to get mental support from the society and at work because of their multi-tasking nature and high demands of working in the health sector.
‘I miss my baby and the warm embrace of my husband’
Adetola Adeife, a doctor at the IDH, confessed to missing her now two-year-old daughter, who was relocated to her mother’s house in Ibadan, Oyo State, before the nationwide lockdown commenced in March.
She said it was the toughest decision taken to protect the toddler, who at the time was a year and two months old, from COVID-19.
Balancing work life with family responsibility, she admitted, had been quite challenging.
Adeife said her husband fears for her life, but he takes utmost precaution to avoid being exposed.
She explained, “When I get home, he tells me to go straight to the bathroom. No hugging or touching. I miss my husband’s warm embrace.
“I am pained that I have not been able to cook for him since March, due to the nature of my work that entails me to be on call always. But he loves me and understands.”
Adetola said her mental health was tested at the peak of the pandemic, adding that when the country’s COVID-19 index case, a 44-year-old Italian man, was recorded in February, she was overtaken by anxiety.
“Those were scary moments. As the number of cases continued to climb and people were dying in large numbers, I became overwhelmed and worried about what I could do differently to reduce the number of deaths being recorded,” she recalled.
“Each death was like a big stab to my heart and made me quite sad. This was aside worrying about the health of my immediate family.
“At a point, I had a COVID-19 scare and took a test that was negative and another that was inconclusive. I knew I had the virus but managed to pull through.”
The doctor acknowledged that so much had been done by the state for the HCWs at the frontline, but still believes more needs to be done, especially for the females.
Women at the frontline should look at the brighter side and be positive
Speaking exclusively with PUNCH HealthWise, Vetty Agala, President, Medical Women in Rivers State, acknowledged that the pandemic had been quite challenging for everyone, especially frontline female HCWs.
She said depression couldn’t be ruled out, noting that it had not been easy working longer hours and having to adhere to universal safety precautions that include the use of uncomfortable Personal Protective Equipment.
“For female HCWs, the fear of infecting those at home is constant. When that is combined with running the home, especially now that schools are in session, it can be quite challenging.
“However, women at the frontline should look at the brighter side and be positive. Female HCWs should learn to live within the new normal. There should be mental, physical and economic adjustment.
“Mental health is something we are currently becoming aware of in the country,” she said.
Agala said there were limited numbers of mental health experts in the country, adding that HCWs lack access to them.
“I know there are mental health specialists at isolation centres to offer psychosocial support, but how many HCWs actually have access to such services?
“My advice to any female HCWs going through any mental disorder is to speak up and get support.
“We are aligning with the new normal and we as women have loads of challenges to adjust to.
“Women need to know that they need care. There is so much pressure, but we must keep a positive attitude and live knowing that tomorrow will be better.
“We must follow infection, prevention and control measures in all the facilities and in the public.
“However, what should be done for us is better welfare, provision of PPEs and other basic needs,” she said.
COVID-19 challenges female frontline workers’ mental health
According to a report published in the International Journal of Emergency Medicine, vulnerability to psychological distress is a challenge faced by female HCWs battling COVID-19 globally.
It revealed that female nurses, especially, disproportionately face more mental health consequences as they work in close contact with patients for longer working hours, which might result in fatigue, stress and anxiety.
It stated that they experience high levels of depression, stress, anxiety, distress, anger, fear, insomnia, and post-traumatic stress disorder.
Risk factors for mental health in these women, the report noted, include overwhelming situations, social disruption of daily life, feeling vulnerable to infection, and fear of transmitting the disease to families and loved ones.
It warned that if timely measures were not taken, although COVID-19 would subside eventually, a new surge of patients suffering from psychological morbidity would emerge.
The report stated, “Pandemics exert significant psychological impacts on female HCWs, highlighting the need for appropriate psychological support, interventions, and staff support measures.
“COVID-19-specific psychological interventions for the HCWs should include psychological intervention support teams, psychological counselling, availability of helpline, establishment of shift systems in hospitals, online platforms for medical assistance, incentives, providing adequate breaks and time offs, and providing a place to rest and sleep.
“Protecting the well-being of HCWs through appropriate measures is a crucial tool in national emergency public health response to fighting the outbreaks.”
Similarly, another report published in the peer-reviewed BMJ, a neurology, neurosurgery and psychiatry journal, revealed that the outbreak of COVID-19 posed an unprecedented threat and a great challenge to female frontline HCWs.
It revealed that based on the 2019 Chinese Health Statistics Yearbook, the number of female frontline workers accounted for 71.8 per cent of the HCWs, far exceeding that of men.
It noted that female frontline workers became the major force to tackle the COVID-19 epidemic, mostly due to entrenched traditional social roles that placed them at a considerable dilemma of how to balance work and family care.
“Previous studies have also suggested that women were vulnerable to mental health problems.
“The mental health problems of women HCWs may affect their attention and decision-making ability and could have a lasting effect on their overall well-being.
“Hence, the psychological impact of COVID-19 on women HCWs at the frontline should be pronounced,” the report advised.
The report further noted that a cross-sectional survey showed that female frontline workers had a high proportion of stress, depression and anxiety symptoms during the early stage of COVID-19.
It stated, “Those women HWs might face more occupational exhaustion, family responsibilities and inequality in domestic labour.
“Moreover, the crisis of COVID-19 has placed them at a considerable dilemma, which existed between working and family care, and between family care and avoidance of contact with family members.”
Keeping mute due to stigma and fear
Dr. Ayodeji Nathaniel, a clinical psychologist in Lagos, said the case of female frontline HCWs was peculiar because they deal daily with traumatic situations.
He noted that anything traumatic had a way of becoming embedded in the mind and could cause mental disability.
The psychologist, who is also the public relations officer, Nigerian Psychological Association, Lagos State Chapter, advised that they should always debrief themselves as a way of diffusing tension, noting that this was procedural.
He, however, said they might be reluctant to seek help when they suffer from symptoms of mental disorder due to the belief that they were not susceptible to illness; a culture encouraging self reliance and coping mechanism; guilt over the possibility of being away from work; stigma and the fear of the regulating authorities getting involved.
Appropriate evidence-based support or care must be provided
A nephrology report published in Nature, a peer-reviewed journal titled: ‘Mental health of health-care workers in the COVID-19 era’, stated that the pandemic had seen many HCWs working extremely long hours in high-pressure environments.
It noted that additionally, they might have been exposed to trauma or faced moral dilemmas relating to challenges in the delivery of high-quality care, possibly due to a lack of experience or equipment.
It stated, “These unprecedented circumstances are likely to increase the risk of mental health disorders such as post-traumatic stress disorder (PTSD) or depression, anxiety disorders, substance misuse and suicide.
“HCWs caring for patients with COVID-19 are also at increased risk of infection, and by extension, have to contend with the risk of infecting their families.
“It is imperative that managers of HCWs take measures to protect the mental health of staff as well as identify those who do experience psychological injuries to ensure they are provided with appropriate evidence-based support or care.”
Frontline female HCWs should be encouraged
The Director of Research and Head, Microbiology Department, Nigeria Institute of Medical Research, Dr. Rosemary Audu, agreed that HCWs generally should get all the necessary encouragement and support they require to combat the pandemic.
She said usually, what could likely bring about mental disorders among those at the frontline was the fear of getting infected, and that efforts should be made to ensure that they were well kitted with PPEs.
Audu added, “They are prone to infection because by nature, the virus is very transmittable.
“Getting them well trained in bio-safety will also go a long way to boost their morale.
“The PPE is quite expensive, but there is no substitute for it.
“Frontline female HCWs should be encouraged to know that they can do it. For those undergoing mental health issues, encouragement is all they need to forge ahead.”
This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project.
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