Healthcare practitioners within the milieu of the COVID-19 pandemic : a holistic response to enable wellness

Abstract

The COVID-19 pandemic crippled healthcare systems globally, whilst exposing and exacerbating the weaknesses within the South African healthcare system. The virus overwhelmed the local healthcare system, reflecting that Africa has one of the weakest health systems globally. Within this milieu there was limited scholarly evidence at the onset of the pandemic related to how prepared South Africa was, for the onslaught of the virus. Undoubtedly the spread of the novel corona virus and the associated morbidity and mortality placed healthcare workers at increased risk because of their exposure to COVID-19 patients. There were several under recognized and unaddressed areas were the mental health sequelae linked to clinical and non-clinical stressors, such as the shortage of personal protective gear, deep fears of infecting loved ones, losing colleagues to the disease, personal struggles with COVID-19 infection and limited resources to address their recovery and wellness developed. This provided the impetus for the current study which sought to understand how the COVID 19 pandemic affected healthcare workers at a physical, psychological, social, and spiritual level and to develop recommendations that would enable their well-being. Guided by a qualitative case study research design, data was gathered from five samples. The first four samples included doctors, professional nurses, enrolled nurses and paramedics who all worked at the forefront of the pandemic. In total these four samples were made up of sixty five healthcare professionals, who were recruited from the uMgungundlovu health district in KwaZulu-Natal, South Africa. The latter reflected the boundaries of the case of this study. All four samples were recruited using purposive non-probability sampling strategies, from a variety of healthcare settings within the district, namely a tertiary hospital, a district hospital, a field hospital, two ambulance bases, and tracer teams. Data was collected using semi structured interviews for all four samples. The fifth sample was a group of wellness experts, who participated in a focus group discussion and contributed to the design of a wellness program. The latter was linked to a set of strategies that emerged to support the psycho social wellness of the health care practitioners. iv The data collected from the first four samples revealed huge deficiencies in the preparedness of healthcare institutions to manage the rapid onslaught of COVID-19. The study found significant shortages in essential resources, including hospital beds, adequately trained personnel, and adequate supplies of personal protective equipment (PPE). Moreover, the healthcare workers interviewed were found to have had little preparation to cope with a pandemic of this magnitude which contributed to increased psychological distress. Post-acute sequelae of COVID-19 commonly referred to as long COVID-19, were reported amongst the participants, together with mental health complications such as anxiety, depression and post-traumatic stress disorder. In addition, healthcare workers were found to be at increased risk of being long COVID-19 haulers, leading to deep levels of exhaustion amongst this cohort. The sheer volume of suffering and death witnessed by healthcare workers during the pandemic accentuated their psychological distress with many navigating personal and professional grief which emerged from the loss of loved ones, colleagues and their patients who rapidly succumbed to COVID-19. Of significance is several participants grappled with the virus themselves and spent time within the intensive care units in hospitals. Collectively these experiences underscored the complex toll of the pandemic on the healthcare workforce at a biopsychosocial and spiritual level. One of the salient threads within the data was the huge chasm within the healthcare sector with regards to psycho-social support or other wellness related mechanisms that would enable the health and well-being of these healthcare workers. Leaders seemed to have adopted a reactive management style during the pandemic, rather than a proactive approach focused on anticipating and mitigating psychological distress. Many healthcare professionals began relying on religious and spiritual practices and other holistic wellness activities linked to music, gardening, mindfulness, and yoga, to cope. These wellness strategies coupled with those derived from sample five, which was a group of wellness experts, coalesced into a multifaceted wellness program. The newly designed wellness program embodied a range of holistic wellness strategies that was intended to help healthcare workers transcend the huge levels of post-traumatic stress encountered during the pandemic, whilst supporting their overall biopsychosocial and spiritual wellness.