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The burden of heroism

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Dr Antoinette Miric is a psychiatrist working in private practice in Johannesburg. She is one of the co-ordinators of the Healthcare Workers Care Network, which aims to provide quality free mental health support to healthcare workers across South Africa during the Covid-19 pandemic.

Healthcare workers are human too. This fact gets lost among the rhetoric of ‘healthcare workers are heroes’. I believe that these comments come from a genuinely appreciative place, but I’m concerned about the overall impact these simple words can have on their mental health.

When you think of a hero, you might think of a knight charging into battle, regardless of the impending danger, protecting others’ lives ahead of their own. That is a hero. This situation is different. Healthcare workers (HCWs) are not soldiers and they did not sign up to put their lives on the line. Their actions can be described as heroic and brave, but naming them as heroes inadvertently strips them of their ordinariness.  

Yes, HCWs signed the Hippocratic Oath, but they also have expectations of a system that can protect them both physically and psychologically while protecting others. The South African mental health community is currently concerned about HCWs who are at risk of moral injury. 

The term moral injury was coined by the military on the battlefield, and it describes the after-effects of acting in ways that breach one’s moral code. A moral injury can result in feelings of guilt and shame, can feel very similar to post-traumatic stress disorder (PTSD), and can result in long-lasting psychological damage. Knowing that South African health workers are going to need to deal with increased moral injury in the next few months makes the outpouring of hero rhetoric even more concerning. 

The discordance between the public view of HCWs as heroes and the way that HCWs may view themselves can amplify feelings of guilt and inadequacy. Being considered a hero while being on the frontline and experiencing moral injury is a recipe for psychological disaster. 

We need to consider that specific deliberate actions in times like these mean far more than words. We need to set up psychological support structures for these brave, but burnt-out and anxious HCWs. We need to set up rest stations, provide food, childcare and safe accommodation for those who need to be isolated. Provide personal protective equipment timeously and communicate clearly with HCWs. 

My own experience as a naive young doctor in the early 2000s, when there was no treatment available for HIV/Aids, would surely be considered a moral injury. The mountains of death certificates waiting for me and my colleagues every morning in the wards was enough to cause a tremendous traumatic response, and I still have twinges of PTSD symptoms when I think of individual departments where I worked. I could do nothing at that stage, but hold someone’s hand while they died. I don’t think I truly processed those feelings until much later in my life. Now I think just the act of holding someone’s hand might have made a small difference, even if it didn’t feel so at the time.

The impending emotional states that HCWs are currently facing feels eerily familiar. We have a new generation of HCWs who will have those same feelings of guilt and shame that I felt all those years ago. Thank goodness I could just work my shifts and get on with it, without public clapping every night, memes and rampant social media jumping on the bandwagon to fete us – reluctant heroes and heroines. I think that would have exacerbated the guilt and the shame I felt at that time and resulted in significantly more psychological scars.

So, please thank HCWs, talk about their strength, their bravery, even their heroic actions. Provide them with their basic needs, a safe working environment with compassionate leadership. And please be careful about elevating my colleagues and I to hero status, since at best, it may feel superficially good for some HCWs, but at worst, it could cause considerable psychological suffering in this vulnerable population. DM

If you are a Healthcare Worker who needs mental health assistance, please go to our website www.healthcareworkerscarenetwork.org.za or call our helpline 0800 21 21 21. 

Gallery

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