Stigma in the time of coronavirus

Care for the carers: We have to make sure that the prejudice and discrimination healthcare workers are experiencing in some countries do not rear their ugly heads in Malaysia. — AFP

STIGMA is a mark of disgrace that sets a person apart from others. We have seen this throughout the history of mankind. In times of pestilence like the Spanish flu and the black death or plague, certain communities were implicated as the cause of it and subsequently ostracised. Incidentally, the Spanish flu did not begin in Spain but – just as China was the first to do during the current Covid-19 outbreak –Spain recorded, and accurately reported in the media, a high number of known cases during the 1918-1920 pandemic, hence its unfortunate association with it.

With HIV/AIDS, we used to see individuals labelled by their illness. They were not seen as individuals but as part of a stereotyped group. In some parts of the world we are seeing a similar development with Covid-19 where negative attitudes and wrong beliefs prevail. This prejudice has invariably led to discrimination – in this case, against healthcare workers.

Instead of being appreciated, they face social avoidance and rejection in some countries. Recently there have been horrifying reports from India and the Philippines on harassment and discrimination against frontline health care workers, and even physical assaults. Fear of being infected by healthcare workers have resulted in them being manhandled and evicted from their homes by their landlords or being shunned by their neighbours. Ignorance and fear is leading mob behaviour against healthcare workers, not unlike the discriminatory attitude Americans had towards European immigrants during the Spanish flu pandemic a century ago.

Such brutal antagonism towards health workers has never happened in Malaysia. Hopefully it will never rear its ugly head here. However, all stakeholders, including government and non-government agencies as well as civil society, must be prepared to speak out against such behaviour the instant it happens. This should include statements on social media concerning the exclusion of people based on a mere perception that they pose a risk of spreading infection in the community.

Malaysians continue to pay tribute to healthcare workers and responders. We are undoubtedly appreciative of their invaluable service to the nation in helping to make sure this disease does not spread further.

Healthcare workers are currently putting in long hours with a heavy workload in a challenging work environment while facing the risk of becoming infected. The fear of being stigmatised for being a “Covid-19 carrier” could be very real.

The surest way to allay any public concerns about the infectiousness of health workers is the declaration of an obligation to minimise the risk of infection among them. This is chiefly by ensuring health workers have appropriate and adequate protective clothing and equipment – what we’ve all come to know as “personal protection equipment” or PPE.

Fortunately for us in Malaysia, our public health interventions have always been noteworthy even going back as far as Independence in 1957. We have made great progress in eradicating many communicable diseases. Our indices on infant mortality and maternal health continues to be the envy of the developing world.

Hence there is every indication that, applying the same vigour with which we pursued public health strategies in the past, we can keep up with raising awareness about Covid-19 without increasing fear. It is important to disseminate accurate information about how the virus spreads.

Our achievements in the past half century or so centred around engaging local communities from the beginning of all response measures. In the context of the movement control order (MCO), such engagements might pose a challenge. However, regular communication with community and religious leaders will go a long way towards building trust and ensuring the effectiveness of this public health intervention. Such engagements that embrace solidarity will also help establish faith in the system, which is instrumental in combating stigma.

While being diligent in taking precautions against being infected, frontline healthcare workers should not neglect their psychological well being either. They could be especially vulnerable because even when they are off duty they are expected to play a diligent role by taking a responsible attitude towards social distancing and hygiene practices.

They should accept their limits and speak to their supervisors if they are struggling to cope. To function optimally, self care is crucial. Adequate rest and nutrition is essential. It is also important for frontliners to avoid unhealthy coping strategies like using tobacco, alcohol or illicit substances or taking sleeping tablets.

Healthcare workers should use whatever personal strategies that worked for them during previous occasions when they experienced excessive stress, including spiritual support. There is no need to try new, generically prescribed stress management techniques.

Frontline health workers are advised to get support from colleagues through debriefing sessions at the workplace. Such sessions should preferably be held at the end of the shift and at least once a day.

Debriefing may take only a few moments but can very helpful in allowing health workers to reflect and recover. Debriefing also aims to provide an opportunity to clear up any misconceptions or rumours.

Such daily sessions must be made compulsory at least during this challenging period.

In cases of serious psychological decompensation or breakdown, professional help from mental health experts should be facilitated.

Prof Datuk Dr Andrew Mohanraj is a consultant psychiatrist and president of the Malaysian Mental Health Association. The views expressed here are solely his own.