Radha Adhikari, Research Fellow, School of Social and Political Science, University of Edinburgh.
…After receiving those patients on the ward, witnessing them deteriorating so fast; their needing Oxygen therapy, then ventilation, so many drugs, anti-coagulants and fluid replacement, with many suffering multi-organ failure, and many people dying, all of this coupled with realising the coronavirus is so contagious, I have been just very scared of the virus and traumatised by the situation at work. After each shift, I have a full scrub before leaving the hospital. And after arriving at home, I would have another extra hot bath, soaking myself in the tub for at least an hour before going near anybody in the house. Too much hand washing, frequent showers and extra hot baths have damaged my skin. I just do not want to bring Covid-19 back home and give it to my family.
In recent days, we [the frontline care staff] have been so stressed. After I have a few days off from work, with just the thought of going back to work, to look after Covid-19 patients, I am not able to sleep or rest for days. Everything still feels like being in a horror movie or a nightmare. I have been so traumatised, indeed we all have been. I was so distracted that one day I hit a parked car while trying to park in the hospital car park. Lack of sleep and constant stress, and the fear of bringing Coronavirus home has dominated my life. Witnessing so many deaths, with so many dying so fast, and not being able to save those lives has been very stressful. It has been the most traumatic experience in my life…
These are the words of a frontline practitioner, originally from Nepal, working on a Covid-19 ward in a busy London Hospital.
Having worked as a nurse on the frontline, in a pre-Covid-19 context, in Nepal and in the UK, I am sensitive to the many ways in which Covid-19 threatens our existing societies and our future. I felt that there was a need to hear more about the current situation and learn from the experiences, and fears, of those frontline practitioners working in the UK and also globally. I had the opportunity to speak with my former colleague and we shared several conversations about the frontline Covid-19 care situation in London.
My colleague’s stories are a reminder of the devastating effects of the Covid-19 virus. It has attacked and killed. It has emotionally scarred care-givers, survivors and their loved ones. The pandemic has also exposed how the British Government’s health policies have failed to save vulnerable lives. For this nurse, Public Health England acted incompetently. Guidelines to treat Covid-19 cases were inconsistent and confusing at the beginning of the pandemic, which added to the strain of those working on the frontline in London hospitals. The UK media has continually highlighted the grave situation of the social care sector: undeniably the hardest hit, for it was completely neglected in the early stages of the Covid-19 response plan. Fear and frustration was everywhere.
Chaos in a Covid-19 ward in London
The World Health Organisation declared Covid-19 a ‘Public Health Emergency of International Concern’ on January 30, 2020. In early March, the virus began sweeping across Europe and it was then declared a pandemic. The virus began to affect Britain in early March. While the government tried to reassure the public and frontline workers they were providing them with adequate Personal Protective Equipment (PPE), my colleague found that there was a lack of PPE at her workplace. On some days staff working in the Critical Care Unit, looking after Covid-19 patients had to wear the same set of PPE for the whole shift, although she says that the situation has improved gradually in recent weeks.
When people with Covid-19 began to be admitted to the hospital, my colleague witnessed and experienced a wave of panic, not only amongst frontline workers but also healthcare managers. Special beds and wards were designated for Covid-19 cases, and these areas were termed ‘red’ or ‘hot’ zones. Staff from various hospital departments were redeployed to work in the Covid-19 wards.
Those receiving in-patient treatment at the time were quickly discharged. Some patients went home. If they were not ready to go home, they were discharged to nursing homes. Patients were discharged without testing, and were later found to have been the source of Covid-19 outbreaks in nursing homes.
When Covid-19 cases started coming to hospital for treatment and for critical care, there was no clear treatment protocol. Being a new virus, and in the absence of treatment protocols, practitioners had to try anything they could think of to save their patients. Initial guidelines provided by Public Health England changed abruptly. Health care professionals were confused and had to follow new protocols: the situation had become chaotic. It became clear that the system was ill-prepared to look after Covid-19 patients. It failed to save many of those admitted to hospital in the early stages of the pandemic.
Eventually, those frontline professionals who provided care in the Critical Care Unit learned through trial and error. Now the hospital protocol is much clearer. Staff know what they are supposed to do, what is effective and what is not. Additionally, the hospital admission and the death rates have started to come down. However, what we could have learned from the experiences of other countries remains a recurring question.
My colleague, who shared her story of being on the frontline, has had to live through the failures of policy. ‘Those Nightingale hospitals, with their very smart-looking cubicles, and plenty of oxygen supplies and ventilators in place have not been in use’ she told me. ‘They look good on television but that’s all the good they have achieved: a cosmetic exercise and a waste of National Health Service funds. Those beds and ventilators have not been used, as the Nightingale hospitals had no experienced Critical Care Teams, who were sufficiently skilled to look after Covid-19 cases. I wonder why there was no sharing of any experience and information from China.’
But it is not only workplace stress that healthcare practitioners experience; they also have their own lives, loved ones and families. Those working in bigger teaching hospitals, and also in the nursing home sector, have been scared of bringing the virus home from hospitals and nursing homes.
As we have been witnessing, Covid-19 has disproportionately claimed the lives of what is commonly referred to as the Black Asian and Minority Ethnic (BAME) population in the UK and in Black and racial minority groups in the USA. In the health care workforce, and more widely, these groups have been found to be at a higher risk of Coronavirus infection than white populations. Early UK study findings suggest that the members of the BAME health and social care workforce have been assigned to frontline care more often than their white counterparts, and with inadequate access to PPE. Other essential workers, such as those in transport and delivery services, have also been exposed to higher risks of Covid-19 virus infection. Knowledge of this disparity is an additional stress for racialised healthcare workers and the essential service workforce.
Bringing Covid-19 home
Significant numbers of frontline workers have been infected with Covid-19 and the virus has proved to be a major occupational health risk worldwide. It is an increased threat for some of us. A Nepali nurse who works in a Covid-19 ward in a New York hospital, and who took part in a webinar on ‘How migrant Nepali healthcare professionals have been experiencing Covid-19 frontline care’, shared her fears:
…I was very scared, I thought about quitting my job. I was very worried about my children and husband. I thought about quitting my job seriously for a week or so, I discussed my fears with my husband. I knew I would get exposed to Covid-19 at work. News of Covid-19 virus affecting Wuhan, Italy and Spain was horrific; for watching the news from China and Europe we realised Coronavirus was coming our way and imminently. Further, lack of information made everybody very scary. However, I decided not to quit my job, and am currently working on a Covid-19 ward.
I feel a little settled at work now. However, after finishing my shift at my hospital, I have a full body scrub before leaving the place. Then after arriving at home, I would get changed in my garage, and leave all my clothes there before entering the house, and have a full bath again. I live with my family but I am frightened of going near them…
As we have gained more experience and knowledge, Nepali healthcare professionals feel they have developed greater emotional strength. They are able to share their personal experiences with their colleagues working across the world and also those who are still in Nepal.
Nepali healthcare professionals helping themselves and helping others
Nepali nurses’ groups across the UK, and the Nepalese Nurses Association UK (NNA UK) in particular, have established support networks in London and other cities in the UK. Similarly, Nepali healthcare professionals working in the USA have developed their own information sharing and support mechanisms. These diaspora networks have been in conversation with each other, and also with wider diaspora communities, reflecting on and sharing their personal experiences, anxieties, fears, coping strategies and lessons learnt. They have found that this has helped all those traumatised by the Covid-19 frontline experience.
They have also run on-line meditation and yoga sessions, discussion sessions on post Covid-19 mental health support needs for themselves, their families and friends, which they feel are helpful in relieving stress. The NNA UK group, for example, has facilitated various web-based discussion sessions with their colleagues in Nepal. Recently, they also ran online infection control information sessions, which is particularly crucial at this time. The America Nepal Medical Foundation recently ran an online question and answer and information sharing session about Covid-19.
The Covid-19 crisis has highlighted the fragility of human society and underlying prejudices, but has also been an opportunity for solidarity that invites us to address social inequalities, and put things right.
Edinburgh. London. Nepal.
Radha Adhikari is a nurse and health system researcher, currently working on international labour migration from Nepal. She has worked with migrant healthcare professionals in the UK and is the author of ‘Migrant Health Professionals and the Global Labour Market: the dreams and traps of Nepali nurses’, 2019, Routledge. She can be reached at: firstname.lastname@example.org; Twitter: @radhaadhikari4.