Calm before the storm? HTAR frontliners take stock of pandemic toll

KUALA LUMPUR (Bernama): Blinking back her tears, forensic pathologist Dr Nur Ayutimasery Abdullah described the unrelenting pressure she and her staff felt dealing with the fourth wave of Covid-19 at her hospital in Klang.

The wave, which began in June this year, has been deadly and as head of the Forensic Medicine Department at Hospital Tengku Ampuan Rahimah (HTAR), Dr Nur Ayutimasery has had to deal with an influx of bodies and other issues associated with them within a short space of time.

"(We had) sleepless nights because we were anxious to know what was coming next, the number of bodies that we were going to face the next day, what are the complaints we were going to receive,” she told Bernama.

At one point in August, when daily new infections in Selangor often surpassed 8,000, her department had 155 corpses on hand. Even now, 27 bodies of foreign workers have been lying for over a month in refrigerated containers the hospital uses as makeshift morgues, waiting for the respective embassies to give the green light to release the bodies for burial.

Not only does Dr Nur Ayutimasery have to follow up with the embassies daily, she and her staff have to deal with angry and traumatised relatives who want to see their loved ones for the last time, wait for lab test results to confirm Covid-19 and match the names to the correct bodies.

The pressure has eased somewhat now as daily new cases in the Klang Valley have dropped to below 3,000 lately, and her department has been using this time to clear the backlog of dead bodies.

Assistance from the Malaysian Armed Forces, Civil Defence Department and non-governmental organisations, such as Mercy Malaysia in partnership with Maybank at HTAR, have also helped to reduce the hospital’s burden.

While the workload has lessened a bit for Dr Nur Ayutimasery and other frontliners, many said they could not totally ease up on their work as they are worried that another wave - be it from a new variant or from the premature reopening of economic and social sectors - was waiting in the wings.

They see it as being prepared for the worst. Psychologists see it as a sign of the continuous toll of Covid-19 on healthcare workers, who have been battling the new disease with barely a break since March last year.

Mental health specialists volunteering their services at the Mercy Malaysia psychosocial support services unit at HTAR said they have observed hypervigilance and anxiety among many of the healthcare workers they have seen. Some reported feeling guilty for not being able to provide the best care they could to patients as well as feeling traumatised over having to make life or death decisions for patients.

Consultant psychologist Dr Hariyati Abdul Majid, who is also the advisor to Mercy Malaysia’s Mental Health and Psychosocial Support, was not surprised, saying that the drop in daily cases may not necessarily mean less stress for healthcare workers.

"Now that cases (in the Klang Valley) are going down, they are actually able to take a breather and process what has happened this past year and a half, and they are now feeling all these combined emotions (and exhibiting delayed grief),” she said.

She added continuous stressors were not good for anyone’s emotional and physical health.

And the stressors have been many.

DARK DAYS

Beginning late June, news reports and social media posts were full of stories of patients lying on floors waiting for a bed to become available and showed hospitals, including HTAR, setting up beds in parking lots to accommodate extra patients.

Similar to soldiers swapping stories from the trenches, HTAR staff have their own horror stories to tell.

The hospital’s Emergency and Trauma Department head Dr Ahmad Tajuddin Mohamad Nor told Bernama the emergency department was quickly overwhelmed at the beginning, unprepared to deal with such big numbers of patients needing care all at once.

"Things were topsy turvy, we were hardly meeting the needs and we did see the queuing up of Covid-19 patients in the department. At one point, there were about 200 patients in various stages of being sorted out - not really receiving total care just yet but just being processed,” he said.

He said what really made the current wave dramatically different from the previous ones was how quickly patients would deteriorate, making it difficult for the staff to find enough oxygen supplies for all of them.

As they worked, he said he and his colleagues had to grapple with this fear of bringing the disease home and infecting vulnerable friends and family members, since not everyone had gotten their Covid-19 vaccine then.

"While personally, I didn’t manage my own friends in my department here but I do know some were actually victims (of Covid-19) too. So it’s something that has not left anybody out. In some ways, when you thought you were going to be safe, you get to be one of the statistics,” he said.

HTAR nurses who spoke to Bernama said they felt overwhelmed in July and early August as they often found themselves short-staffed. Colleagues would be exposed and have to quarantine, leaving the rest to care for more than 20 patients per nurse at times.

One nurse said she felt hurt when people on social media criticised the perceived lack of care from nursing staff.

"They don’t understand how we do things,” she said with a sigh.

Dr Nur Ayutimasery said although her department deals with death daily, some Covid-19 deaths hit them hard, such as a case they had in July involving a man and his wife.

"They both died because of Covid-19. The only person we were able to contact (initially) was their 11-year-old son,” she said, her voice cracking. She added they then managed to get hold of his uncle, who came to claim the bodies.

When asked about counselling, many of the staff said they did not have time to get it.

RELUCTANCE

HTAR hospital officials have praised their staff for being strong, saying those in healthcare tend to be resilient. However, they also acknowledged the unique challenges Covid-19 poses for many.

"Healthcare staff are used to disasters. It’s just that the current disaster is ongoing,” said HTAR director Dr Zulkarnain Mohd Rawi.

He said the hospital is doing its best to reduce stress and burnout among its employees by requiring them to take a day off every three days and also encouraging them to seek therapy from the hospital’s in-house psychotherapists.

However, some hospital personnel may be reluctant to do so, worrying there would be a backlash should they seek help within the hospital system.

Dr Hariyati said so far, more than 162 frontliners at HTAR have chosen to use the Mercy Malaysia psychosocial services, adding many were concerned with confidentiality.

She said Covid-19 has shown the importance of mental health and that there should be no stigma or taboo for anyone, not just frontliners, seeking emotional support. She also said all workplaces need to create safe spaces for employees to seek help, as well as give an assurance there would be no repercussions for seeking help.

"Mental health should not be on the side. It should not just be something we talk about when there’s a suicide case,” she said.

"At the end of the day, it’s very, very important we make people feel that it is OK to seek support and it is OK to speak to a psychologist.”

SIGNS OF MENTAL PROBLEMS

Depression, stress or anxiety, which may develop into a full-blown disorder like post-traumatic stress disorder (PTSD), can present itself in many ways.

Consultant psychologist Dr Haryati Abdul Majid, who is also an advisor with Mercy Malaysia, said the key sign to watch for is long-term changes in patterns and behaviours.

"Look for signs like changes in appetite -- something very simple. Sometimes we hear someone say, ‘I don’t want to eat, I have no appetite’. If it’s only for a day, it’s OK. But if they show a significant reduction in appetite and they lose weight for more than two months, then it’s developed into something more serious,” she said.

The inverse is also true, in which a prolonged increase in appetite could be a sign of serious emotional and mental health problems.

Dr Hariyati said another sign is a disruption in sleep patterns, such as nightmares and the inability to fall asleep and stay asleep that go on for weeks and months.

She added some people may also choose to isolate themselves from others, including friends and families.

While giving space to people may be expected in the short run, she said if someone has been isolating themselves for two months or so, it is a sign of trouble.

She said loved ones should then engage and convince them to seek counselling. - Bernama