For the past 11 years of practising medicine, Dr Olugunoye Ajibola has never seen anything close to the COVID-19 pandemic, and this is not surprising. For many health workers across the globe, pandemics were only a subject they read in books and studied while in school – until the COVID-19 pandemic came.
The COVID-19 is caused by a new strain of the coronavirus called Severe Acute Respiratory Syndrome Coronavirus 2, or simply SARS-CoV-2. According to the World Health Organisation, the first case of the novel coronavirus was recorded in December 2019 in Wuhan, Hubei Province of China. The disease has infected millions globally and killed thousands worldwide.
In Nigeria – after an Italian index case was recorded on February 27, 2020 – the disease has infected over 9,000 people and killed 261, statistics by the Nigeria Centre for Disease Control showed. Over 2,697 patients have, however, recovered.
Ajibola, a public health physician and epidemiologist who works at an isolation centre in Osogbo, Osun State, described working as a frontline health worker treating COVID-19 patients as being on a battlefield.
“I started my medical career 11 years ago, and the COVID-19 pandemic is entirely different from anything I have seen so far because the disease is novel. There is no vaccine for it yet and years of research will have to be put in to discover a cure,” he said.
When it comes to treating COVID-19 patients, Ajibola said, “You learn on the job.” He stated that the job had been tough ranging from encounter with the patients, inability to be with family and friends, fears of contracting the virus while on the frontline including the emotional stress attached to the job, among other things.
On what it was like treating COVID-19 patients, Ajibola said at first when he started working on the frontline, he experienced some emotional stress, which he had been able to manage afterwards.
He said, “Any human being wants freedom, and this is the case for the patients. When they are admitted to the isolation centre, we have to first lecture them on why they are there. We have to explain to them that the disease is new and that we are keeping them there because we don’t want them to infect others. We tell them that they may not die, but if they infect others, others may die.
“We do this because some patients would just tell you that they want to go home on the second day they are admitted, especially when they are not showing symptoms. Some of them would tell us, ‘It is a lie; there is nothing like coronavirus,’ because they are asymptomatic; they give us issues and don’t want to take any drug.
“They would tell us we can’t just keep them in a place when they are not sick. Usually, when we have a patient like that, we do some psychotherapy for them by inviting a psychiatrist who tries to speak with them and make them feel at ease.”
But for symptomatic patients, Ajibola said the experience was different.
He said, “They are usually calmer and don’t need much persuasion before taking their drugs and eating their food; they don’t give us any issues. “But when we want to administer drugs to them, they would ask, ‘Do you think these drugs will cure my ailment?’ We reply them that we are hopeful because they are trial drugs.’’
At first, when he started treating COVID-19 patients, Ajibola said he had emotional stress but he said it had now become a lifestyle. “Though, I notice some of my team members are sometimes psychologically down and weak. The stress is normal but what makes me happy is when a patient is discharged and reunited with their family. I forget all the emotional stress once a patient tests negative. It gets to you when patients are down,” he said.
Asked if he always nursed fears of getting infected with the coronavirus while treating COVID-19 patients, the doctor answered in the affirmative, adding that it was the reason health workers like him needed to be more cautious.
“It’s natural to be afraid of getting infected, so we have to be cautious. Thankfully, at the isolation centre where I am, we have enough PPE (Personal Protective Equipment) and I think it has helped us to be bolder to fight this disease. We also do tests on ourselves after a week or two to know if we have got infected,” he said. But being on the frontline has had a toll on his family.
“Once I leave the isolation centre, I go to the hotel where health workers are lodged; we don’t go to see our family unlike before the COVID-19 came. It’s a challenge not seeing one’s family, though once in a while, I can go after isolating for 14 days and I test negative for the disease,” he said.
Asked if he had ever witnessed a patient who died of COVID-19 and what their last words usually were, Ajibola said in an emotion-laden voice, “Yes, I have witnessed a patient who died. A few hours before she died, she asked for a Bible and someone went to get it for her. She said she wanted to live but she couldn’t make it.”
Another health worker, Emmanuel Egorp, a nurse at one of the isolation centres in Abuja, said joining in the fight against COVID-19 had made him to dearly miss his four-month-old son. The indigene of Calabar State lamented that he might not be able to see his son anytime soon if the number of COVID-19 cases kept rising in the country.
By implication, as the number of cases keep increasing, so would Egorp’s inability to see his nurse wife and son anytime soon.
He said, “I’m on the front line and I’ve been unable to see my family for some time. I have a four-month-old son and I don’t get to see him. I won’t see him and my wife as long as the cases keep rising because of negligence on the part of some people who believe falsehood.
“I’m amazed at the disbelief and misinformation going round. Some people don’t believe COVID-19 is real. Some are alleging that the NCDC is paying us health workers to report false cases. Someone in the United Kingdom even sent me a video where it was alleged that if a health worker could inject someone with the coronavirus, they (the health worker) would be paid N150, 000.
“Funnily enough, many people believe all these misinformation. For us health workers, any misinformation or falsehood can put more pressure on us because more people will not take precautions and they will be getting infected and still be in denial.”
Be that as it may, Egorp said his wife understood his new assignment and he always looked forward to speaking with her after his daily 12-hour shift.
“Being a nurse too, my wife understands what’s going on. She’s on maternity leave and we speak every day via chats and video calls whenever I return to the hotel where we are lodged,” he added. Surprisingly, stigmatisaton is one of the challenges Egorp has faced in his supporting the fight against COVID-19.
He cited a recent experience when he had a long break and met with a female family member to pick up some items for his wife.
He stated, “Her children were with her and they were approaching to greet me. She asked where I had been all this while, and I told her I had been working at a COVID-19 isolation centre. She practically held her kids backwards and did not allow them to approach me. I laughed initially but later I felt bad and I know that it will continue until this period is over.”
Although the nurse said the government was trying its best to cater for their needs by providing PPE, good food and accommodation, Egorp said they (health workers) usually nursed fears of getting infected with the coronavirus because many health workers had been infected.
“We get tested every now and then and we wait for our results with apprehension,” he said. Despite the challenges, Egorp said he had the best of experience as a nurse working at an isolation centre, especially in terms of inter-professional interaction.
He said, “Nigeria is having a consistent inter-professional rivalry. But one thing I have noticed during this pandemic is that every medical professional looks out for the other person. The doctor looks out for the nurse, the nurse looks out for the hygienist, the hygienist looks out for the medical laboratory scientist and the pharmacist and so on. We work closely and can even take up the roles of other professionals occasionally just to get the job done.
“If we continue this way even at the end of this pandemic, more attention will be on the patient and the health sector will be better for it. No one will feel belittled and unmotivated. This inter-professional relationship will improve the quality of our health care afterwards. COVID-19 pandemic has taught me a big lesson.”
For another frontline health worker, Mr Hassan Ankuma, a pharmacist who has practised for 19 years and works at an isolation centre in Abuja, treating COVID-19 patients has altered his normal way of life.
He shared with our correspondent a conversation he had with his seven-year-old son before he resumed at the isolation centre.
He said, “Before I resumed work at the isolation centre, my seven-year-old son came to me and asked, ‘Daddy, I heard that you would be away for some time. Is it true?’ I said yes. He said, ‘No, no, I won’t let you go.’ But I told him my country needed me and I needed to go. He had to agree. As a health worker, I think I was prepared psychologically to handle the situation before I volunteered to be on the front line.
“Of course, being on the front line means I don’t get to see my family for now; we talk on the phone. It has also affected my normal lifestyle. We are restricted and basically what I do every day now is to go to the isolation centre and return to the hotel where they lodged us. When I return to the hotel, I go through the back door, where I take off my shoes and clothes before entering the room due to the risk of contaminating the room.”
‘I usually have dreams of getting infected’
Another health worker, a hygienist at one of the isolation centres in Ogun State, simply identified as Bose, said assisting in the fight against COVID-19 had a toll on her psychological health.
“Sometimes I dream that I am infected with coronavirus and admitted to an isolation centre but I quickly wake up to rebuke such dreams. Working at an isolation centre is a whole different thing from my usual job. I have to take extreme caution and anytime I remember my dreams of getting infected, I take the precautions more seriously,” she said.
Similarly, a medical laboratory scientist at one of the isolation centres in Rivers State, Mrs Favour Amadi, said she sometimes feared she might get infected with coronavirus even though she always took all the necessary precautions.
She said, “The COVID-19 crisis came unexpected and from the rising number of cases, it is expected that we will nurse some fears. The issue is that the coronavirus knows no one, whether one is rich or poor, whether one is a health worker or not.
“Being on the frontline of the COVID-19 is like being on the battlefield. As a soldier can be shot by the enemy on the battlefield, so can a health worker be infected with the virus. PPE and other safety measures are there but there are still chances of being infected. It’s a fear that some of us nurse every day.”
Some colleagues contemplated writing their wills –Kano NMA chair
A consultant physician and nephrologist and Chairman, Kano State chapter of the Nigerian Medical Association, Dr Sanusi Bala, also shared some of the challenges he and his colleagues faced in the course of treating COVID-19 patients.
Unfortunately, he said 64 doctors had been infected with the virus so far. “We lost one doctor, a number of nurses and laboratory scientists. Many others recovered,” he said. Speaking on the traumatic experience he faced battling the virus, Bala noted that at a point many of the health workers couldn’t return to their homes to see their loved ones out of the fear of infecting them.
He said, “It was traumatic. We were obsessed with rubbing methylated spirit wiping and re-wiping our instruments. The COVID-19 patients in critical conditions required our full attention. “There were periods of insomniac nights, nightmares and paranoia. To be candid, some were contemplating writing their wills. It’s a situation one wouldn’t like to see in their life again.
“At the peak period of the pandemic in Kano State, we used to close late; even when one finished early, one always avoided going home early because of fears of infecting one’s family. We kept away from our parents.
“This was because we made an assumption that we (health workers) were all positive so we tried to avoid one another and our family members. The logic was that if one of us eventually got infected, the risk of transmitting the disease to colleagues and family members before developing the symptoms and getting tested would be significantly reduced. I think it worked and gave us the confidence to be safe.”
Speaking further, Bala said the COVID-19 pandemic challenged the state’s health care system. “But we, the government and other stakeholders took up the challenge and also learnt more on the job and we are better now. We thank the Almighty and pray it will never happen again,” he said.
Health workers fighting COVID-19 are like soldiers –UN
With the coronavirus pandemic, the United Nations said the world had somewhat been reminded of the key importance of the health workers, who have been on the front line since the disease broke out in late December 2019.
The UN described the health workers as soldiers protecting the people from a common enemy: the coronavirus.
As the battle against COVID-19 pandemic rages on, the plight of health workers has been on the front burner as they are being daily exposed to the virus. According to the Minister of Health, Dr Osagie Ehanire, around 113 frontline health workers were infected with the coronavirus as of April 30, 2020.
Ehanire stated this while responding to questions at the daily Presidential Task Force on COVID-19 briefing. Because they were vulnerable to the disease, the minister advised health workers to take extra precautions in handling suspected cases.
But out of the infected cases among health workers, some have died. However, this is a global situation. As of May 25, The Guardian UK reported that the number of health care workers who had died of COVID-19 had reached 200, out of over 90,000 health workers who had been infected.
In the United States, more than 60,000 health workers were infected, and close to 300 died from COVID-19, according to data from the Centres for Disease Control and Prevention. It’s the same story among health workers in other countries across the world, a situation that has caused emotional stress and depression for many, including those uninfected.
How health workers combating COVID-19 can handle emotional stress – Psychologist, WHO
In a recent interview with our correspondent, the President, National Association of Nigeria Nurses and Midwives, Mr Abdrauf Adeniji, stated that frontline health workers might face emotional stress or trauma, a situation the country must prepare to manage.
“Nigeria must prepare to manage PTSD (Post-Traumatic Stress Disorder) among health workers because those on the front line are at a risk of facing stress and emotional trauma,” he said.
With regards to this, a psychology expert at the University of Lagos, Prof Oni Fagboungbe, said frontline health workers needed to be provided with psychological support so they would not break down due to emotional stress or depression.
He said, “The situation in which our health workers are is a precarious one and what comes into play now is the personality of each individual to cope with the crisis. This situation can provoke fear and emotional imbalance, and extra-sensory perception. A frontline health worker might be imagining themselves falling sick. It can be traumatic.
“What can be done to minimise these psychological effects for frontline health workers is to create an atmosphere that will reduce fear, frustration and emotional imbalance. The government should try as much as possible to make sure that where they (health workers) are lodged during this period is comfortable to the extent that they wouldn’t feel as if they are being caged or under bondage.
“The government should also compensate them handsomely for their work because incentives can create a sort of emotional balance and make them cope well. We should create a better sense of hope for them.”
Commenting on how the family members of the health workers could also cope during this period, Fagboungbe said there was something in psychology called classical conditioning.
“When a person finds themselves in a situation and it appears there is no alternative, the best thing is to condition themselves to cope with the situation. There are methods for doing this. For instance, family members of frontline health workers can communicate with their loved ones via all the various technological platforms,” the don said.
Also, in its guidelines on the strategies for health workers to protect their mental health during the COVID-19 pandemic, the WHO said feeling under pressure was a likely experience for many health workers.
Noting that stress and the feelings associated with it were by no means a reflection that an affected health worker could not do their job, the organisation said managing their mental health and psychosocial well-being during this time was as important as managing their physical health.
The WHO advised, “Take care of yourself at this time. Try and use helpful coping strategies such as ensuring sufficient rest and respite during work or between shifts, eat sufficient and healthy food, engage in physical activity, and stay in contact with family and friends.
“Avoid using unhelpful coping strategies such as the use of tobacco, alcohol or other drugs. In the long term, these can worsen your mental and physical well-being. The COVID-19 outbreak is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses.”
The WHO added that some health workers might, unfortunately, experience avoidance by their family or community owing to stigma or fear.
We’ll provide psychological support for frontline health workers –Govt
The Director of Hospital Services, Federal Ministry of Health, Dr Adebimpe Adebiyi, said the Federal Government had partnered the Psychological Association of Nigeria on providing psychological support for frontline health workers.
“We are working on that. We have partnered the Psychological Association of Nigeria; we have integrated them into the stakeholders’ forum,” she said during a telephone interview with NAN.
On when the project would take effect, Adebiyi asked our correspondent to contact the health minister. But enquiries sent to the minister through an email address indicated on the ministry’s website had yet to be responded to as of press time.
Also, a message sent to the WhatsApp line on the ministry’s website had not been responded to as of the time of filing this report.
Similarly, when contacted on the phone, Mr Emeka Oguanuo, the media aide to the NCDC Director-General, Dr Chikwe Ihekweazu, asked our correspondent to send him a text message via his mobile. But he had yet to respond to them as of press time.