How Russia’s doctors are dealing with the psychological strain of COVID-19
For several months, Russian medics have been living with the constant stress of coronavirus. The Ministry of Health is talking about providing psychological help, but most doctors aren’t ready to talk to specialists.
This article was originally published by MediaZona. We translate it with permission here.
Since the start of quarantine in April, a constant stream of phone calls has been hitting the Clear Morning hotline, which provides psychological assistance to cancer patients in Russia. People have complained about chemotherapy appointments being postponed or cancelled and the tactless behaviour by some oncologists, director Olga Goldman tells me.
“They’ve sent patients out of the room, yelled at them or refused to speak to them,” Goldman says. “Patients have also asked doctors a question and got the answer: ‘Why did you come to see me? You’ll be dead soon.’ Then we realised that medical staff also needed help and started taking calls from doctors from all areas of treatment. Doctors need to be healthy and ready, otherwise they won’t be able to help anyone.”
Most of the 82 medics who have contacted psychologists at the “Doctors Need Care” initiative complain of emotional burnout, apathy, fatigue and depression, says founder Lyudmila Golubkova.
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Many of them need emergency help: “We help them cope with their anxiety and problems relating to their colleagues and families, as well as psychosomatic issues like sleeplessness and loss of appetite. We’re often asked to teach self-help courses, and we’re planning to record some short audio guides on scientifically proven calming techniques, so that doctors can return to a normal state of mind by themselves.”
People often phone in a state of panic “or when someone is already sitting and thinking about taking their own life”, Olga Goldman from the Clear Morning hotline says.
“In normal circumstances, doctors - therapists, ophthalmologists and neurologists - don’t often have to deal with patients dying very often,” Goldman says. “But now they have had to enter the “Red Zone’, and some of them have even reassigned – from gynaecologists to experts in resuscitation, to put it bluntly. At the same time, any patient’s death is a recognition of the doctor’s own inadequacy: their main task is, after all, to heal. They have feelings of guilt, hopelessness, unfairness. Everyone is working at their limit, they’re run off their feet – and people are still dying. This is an enormous factor in professional and psychological burn-out.”
Ill humour, psychosis and anxiety
In early May Antonina Sedova, a nurse from St Petersburg, wrote a letter to Vladimir Putin about the lack of resources for personal protective equipment in the Djanelidze medical emergency research institute, where two nurses had already died of confirmed coronavirus. On the following day, the Institute’s director called Sedova into his office.
“He told me that I had gone against the collective,” Sedova recalls. “What do you mean, ‘against the collective’? I was doing it for the collective. I was sorry for my colleagues: they were going on sick leave one after another. It’s my opinion that if the director hired us, he should protect us. On the next day I had a positive Covid-19 test, and on the day after that I was taken to hospital.”
The nurse spent over a month in hospital, and sent goodbye messages to her family several times: “I was so anxious, I would awake in the night, my heart beating as though I had done a cross-country run. I buried my husband two years ago and I have a six-year-old daughter and elderly parents. And I realised that this could be the end. I was afraid I wouldn’t pull through.”
Anastasia Litovchenko, a first aid paramedic from the Karelian town of Kostomuksha, has had to perform breathing exercises to be able to fall asleep. She is regularly called out at night to patients with suspected Covid-19.
“At the start of the pandemic, I was talking to colleagues from other regions and thinking that a massive infection was on its way,” Litovchenko recalls. “I was particularly worried about the virus spreading in such a chaotic fashion with no resources for containing it, and there would inevitably be a large number of deaths. All this worry almost led to psychosis on my part: I bought a PPE set and ordered a respirator online. I wasn’t afraid for myself, but for my family, and kept thinking about where I could isolate myself from them and whether I was well enough protected at work.”
At the end of April, a St Petersburg cardiologist Marianna Zamyatina resigned from her job at a war veteran’s hospital in protest - they didn’t have enough masks, respirators or PPE sets. “I was so stressed that I couldn’t concentrate, couldn’t read,” she tells me. “I started posting stuff on women’s online forums. I laugh at myself now, but when you’re stressed, scared and angry, it can unexpectedly help.”
The JAMA Network, the journal of the American Medical Association, has published research showing 1,257 medics in 34 hospitals in China showing symptoms of depression, anxiety and sleeplessness, and notes that the risk of clinical errors among depressed doctors has risen to 62%. The US National Institute of Health is warning that frequent patient deaths increase the risk of stress reactions in medics many-fold. Scientists at Oxford University are, meanwhile, predicting an increase in suicides and in Russia, according to the Federal Medico-Biological Agency, 10% of medical staff have depression and a further 40% “have problems coping with stress”.
Alcohol, aggression, tears
In May, Russia’s Ministry of Health recommended that hospital directors maintain a “satisfactory psychological status” for their staff and bring in psychologists to work with them. Olga Goldman, however, believes that this is a useless initiative: medical workers usually try to avoid sharing their issues with psychologists at their workplaces.
“Psychology is a very confidential thing: not a word from a client should be passed on to their employer,” says Goldman. “But some psychologists can’t stand up to bosses or observe this confidentiality. Then you get a conflict of interests.”
In April, clinical psychologist Veronika Salimgareyeva, a resident of Perm, had a confirmed case of COVID-19: she was infected in the “red zone” of the city’s hospital No.7, where she treated patients and medical staff.
“Some medics had communication issues,” Salimgareyeva says. “Some couldn’t talk to patients who showed aggression – they would avoid them and threaten them with the police. Nurses would be passive aggressive to one another: they would taunt each other or boycott each other. There was an ‘us and them’ situation, as though they were in a war zone: those who would engage with Covid patients and ‘deserters’. Everyone cried all day, but that’s a normal reaction to stress being lifted.”
“People will never shout at a doctor, but they will yell at a nurse"
“Nurses need psychological support more than doctors,” says Ekaterinburg cardiologist Viktor Yamshchikov. Junior medical staff have both a lower social status and lower pay.
“People will never shout at a doctor,” Yamshchikov explains, “but they will yell at a nurse. I would suggest that senior hospital personnel compensate them partially, at least with anonymous psychotherapy sessions, even if only to improve their productivity. But it shouldn’t be a management directive, but a suggestion: here’s the phone number, use it if you want.”
Russian medics, however, are not generally going to look for psychological counselling, says Dmitry Ptashnikov, a neurosurgeon at the Vreden Institute of Traumatology and Orthopaedics.
“I think psychological counselling isn’t the Russian way of doing things”, the surgeon says. “For us to go to a psychologist instead of opening a bottle? We get together with friends or family and sit round the table. Most doctors work flat out, and we still need to find the time in this constant flow of events.”
Dependence on alcohol is a result of post-traumatic conditions, says Olga Goldman. “Losing your job, family problems, a nutritional disorder, alcohol – they’re all there. It’s like soldiers after battle. The extreme situation is over – and everything catches up with you.”
It’s dangerous to ignore alarm signals, says Yakov Kochetkov, head of the Russia’s Association of Cognitive-Behavioural Therapists. Around 50 medical workers have requested free consultations during the pandemic: “Thousands know about us, but only dozens come to us,” he says.
Cardiologist Yamshchikov advises his colleagues to draw on psychotherapy, using the example of birds who fly immensely long distances:
“During a long flight, birds will fold their wings and drop for a few seconds. That gives them time to relax their muscles, and they then catch up with their flock. Psychologists need to teach medics how to quickly suppress their workplace stress. If you constantly hold your wings out, you can end up falling into a swamp.”
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