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Front Line

'Frontline staff are at breaking point': Healthcare workers on the challenges of working during the third wave

We asked healthcare workers to tell us what they’re experiencing. Here is what they said.

THE EMERGENCE OF the Covid-19 pandemic in 2020 was an unprecedented event. The last 10 months have meant huge pressure on the health system as case numbers have risen, dropped, and then risen again. 

That pressure only increased as the year came to an end, with case numbers rocketing. Now that we are in the third wave, with numbers exponentially growing, there is even more concern about how the health system is coping.

Yesterday, the Tánaiste Leo Varadkar said that he expects private hospitals to step up if the public system needs it.

More than 1,000 people – as of yesterday – were in hospital due to Covid-19, with 95 people in ICU. HSE boss Paul Reid has said: “Staff are literally fighting to save people’s lives. Sadly in some cases we may not always succeed.”

So what has it been like working in the healthcare system? We asked pharmacists, doctors, GPs and nurses, and here’s what they told us. 

Nurse: ‘Colleagues have burned out, and some haven’t recovered’

I returned to work on a Monday in March 2020 following maternity leave and by Saturday we had our first confirmed cases. Staff were all terrified – not knowing what was ahead. We were scrambling for short supplies of PPE. Staff and patients were getting infected and getting sicker.

We had staff shortages and a mad rush to redeploy and secure agency staff and student nurses who wanted to work as Healthcare Assistants. We needed any help we could get to help plug gaps. Entire wards of staff sick with Covid-19. A huge effort to orientate, train and try to support these people who were thrown into the madness with us. 

All hands on deck working around the clock 60 -80 hours a week trying to manage people who were sick, dying or dead. Trying to communicate with families who wanted to be there but couldn’t or shouldn’t. IPhones in plastic bags, us crying through fogged-up goggles as loved ones poured their hearts out to their dying mothers and fathers.

Worrying about colleagues in hospital sick, worrying about colleagues whose mental health was deteriorating in front of our eyes. Worrying about families and people with irrational expectations and complaints about plants and belongings that had been moved when we were trying to clean Covid off surfaces and out of corners.

Worrying about people whose insight and expectations were so deluded and unrealistic, and the enquiries and complaints and professional investigations they would throw at us in the months ahead when this abated.

Worrying about when we last ate or drank. Worrying about our kids at home in front of TVs with no homeschooling and exhausted, traumatised parents when we were home.

Worrying about whether we would have enough body bags, medications, oxygen.

Worrying about whether we should move the dead bodies of those infected with Covid to dress them in funeral outfits. Worrying about filling our lungs with Covid as we did that, and fears of bringing Covid into our cars and homes and infecting our loved ones. Loved ones afraid to touch or comfort us in case we were infected. 

Worrying about whether all of us in these trenches would make it out together… And now… the worry of having to do this all over again except this time we are exhausted, have less reserves and less physical and mental strength.

Colleagues have burned out and some haven’t recovered from the first wave. We now know fully what this entails and the worry is back. 

We absolutely dread having to go at this all over again but have no choice.

You just need to stay at home.

GP: ‘I have missed tears hiding behind a mask’

“I know you are so busy and I don’t mean to be a bother” is a phrase we have become used to in General Practice. It can be the opening line to a multitude of problems which in many cases should have been seen weeks if not months beforehand.

I have had to bite my tongue and not try betray my inner feeling of – this should have been seen months ago. Time matters for most cancers, and delayed diagnoses result in poorer outcomes, but many of my elderly patients are suffering in this new world and I sometimes get the feeling that they don’t really care.

One old man told me that he doesn’t want the vaccine and could he give his dose to his granddaughter who could not start her first job as an accountant in London.

Patients miss the chat in the waiting room, the bit of banter with the front of house staff and the consult itself. Seeing patients on a regular basis builds up a corporate memory of their health in my brain and no phone call or video call can replace face-to-face interactions.

We all have to wear masks but many of my elderly find this very difficult as it is alien to them, as is when I call them in looking like some lost hospital surgeon with my mask and gown on. I have missed tears hiding behind a mask; and having to give an elbow to an elderly lady whose husband has recently died seems cruel and not what I ever expected I would ever have to do. 

Covid has made general practice a somewhat different place but we provide good medical care to patients, as we did by going in over the New Year holiday to ring every patient affected by Covid-19.

I still love this job, and consider myself lucky to be doing what I do – and hope that we can get our old lives back.

GP: ‘The phones ring non-stop’

Normally our practice buzzes with a full waiting room, phones ringing and appointments being made to see one of our five senior GPs, GP registrar, nurse or phlebotomist. Now the waiting room has a few masked patients scattered here and there.

The phones ring non-stop and we have a new member of staff who checks every patient’s temperature as they arrive in the practice, and escorts them to a socially-distanced seat for their appointment.

The administrative and clinical staff work in a bubble divided between morning and evening. As I switch on my computer there are between 130 to over 200 patients to be contacted or seen between usually three doctors, a nurse and the phlebotomist. We have an overflow list of patients to be dealt with when time permits.

Most are dealt with by phone. Most of the patients are looking for non Covid advice unless there is a local outbreak when everyone gets edgy. Patients ring about infections, smears, vaccinations or Methadone review.

Mental health issues now take up a lot of time. Patients with existing brittle mental health need additional support or changes in medications. Those who are confined to their homes by virtue of age or illness vulnerabilities get distressed and need a helping hand.

As a group we are weary, anxious and this current outbreak has been a real gut punch. But we are still upright and proud to be useful to our patients.

NCDH: ‘It’s brought the healthcare staff and system almost to breaking point’

- Eoin Murphy, IMO NCHD Committee 

The pandemic has seen a seismic shift in how doctors live their lives, both at home and at work. Working hours have continued to regularly breach European Working Time Directives in multiple healthcare sites across the country with the looming threat of Covid only a call to the Emergency Department away.

The only thing more relentless than the virus itself has been the 24-hour shifts we are rostered to do week in week out.

The pressure of tackling waiting lists between Covid waves has all but brought the health system and its frontline workers to breaking point.

Virtual clinics have fundamentally altered the way general practice and outpatient clinics functions. However, the changes are not feasible in the long run. Face-to-face consultations are crucial for specialties like surgery and paediatric special needs.

It has been difficult hearing parents awaiting essential speech and occupational therapy talk about how their child’s dedicated therapists have been redeployed as contact tracers and at Covid testing centres. This flies in the face of health care workers trying to run paediatric services during the pandemic, and there is real anger out there.

It is disheartening to regularly see the advice provided by healthcare professionals ignored and the economic concerns of business lobbies influencing the government on their failed policy of pandemic management.

East Asian countries and New Zealand had just one serious wave in the spring and when they got the levels down near zero – as we did with the first lockdown – they kept them down with properly staffed public health teams coordinating test and trace programmes to identify and isolate outbreaks.

The government tells us we must be personally responsible for hygiene, our contact with others, and where we go. However, it is the government that has responsibility for preparing capacity for surges, implementing restrictions based on science, and allowing people stay at home by providing adequate financial supports. This has all been disregarded for the sake of a hasty reopening of non-essential retail and hospitality before Christmas and we are now paying the price.

Our public health system is vulnerable due to years of government underfunding and intransigence in the face of spirited protest from our colleagues in public health. All we can hope for now is that the HSE is up to the logistical task of administering the vaccine on a mass scale.

This will be the biggest public health undertaking since the eradication of TB in the 50s.

The government and the Minister for Health, Stephen Donnelly, owe it to healthcare workers, nursing home residents, and not least to the long-suffering and diligent general public, to get this bit done quickly and effectively at the very least.

Paediatric Doctor: ‘I was struck by a sudden urge to cry’

- Domhnall McGlacken-Byrne

On my way out of work earlier this week, bike helmet under my arm, a member of my hospital’s HR department cheerfully stopped me to ask if I’d like to receive my Covid-19 vaccine. Within a few minutes, I’d signed my consent form, received the jab, and sat down in an observation room with my complementary carton of apple juice.

As my mandatory 15-minute waiting period commenced, my mind wandered. Alarmingly, I was struck by a sudden urge to cry.

I thought back to last March, when Covid became all too real: the masks, the big yellow signs, the utter weirdness of it all. I will never forget those eerie days when our emergency departments suddenly emptied out – like the tide being sucked out on a beach, heralding the wave to come. Coming into work each day on deserted roads, none of us knew what to expect.

I thought about the funeral of my grandmother, Rose Byrne, and all the other funerals this past year in such strange and sad times: 10 mourners instead of 100; ‘elbow bumps’ instead of hugs; distance instead of intimacy. All the empty chairs at tables around Ireland.

Then I thought about the year to come: what will it bring? On the one hand, our current case numbers are gravely concerning like never before; the prospect of our hospitals and ICUs overflowing in the next month is grim, but real.

On the other hand, there is hope. The roll-out of these vaccines is one of the most important undertakings in the history of this state. We must help it succeed. By the actions of each of us – masks, staying home, doing the basics – lives can be saved.

I checked my information leaflet: while “a sore arm” and “mild fever” were listed among the occasional side effects of the shot, “suddenly getting all mushy” did not feature. In any case, my 15 minutes were up. I held it together and headed home.

GP: “The mental health implications have been significant”

I am a GP working in Dublin in a group practice. We have been through more changes this year in our practice than my 20 years to date combined.

We have adapted to a few things but probably the big two have been the use of video consultations and emailing prescriptions directly. These have been positive options but interestingly when numbers are low, people’s preference still seems to be face-to-face consultations (which is ours too! ).

The other major change of job description has been our role as Covid test referrers. I think of people at call centres with much more understanding and empathy now!

The challenges, like any small business to an extent, include keeping staff safe and keeping the income going. We are getting first-hand experience of the Covid impact both directly and indirectly and the mental health implications have been significant.

I do appreciate that I have gone to my workplace as usual during the pandemic. We also have the continuity of working with our great colleagues. This is not a position which many others have had, with job loss and job isolation very common.

Vaccination is now our next challenge and it will be an amazing journey to think we have been through an illness from its start to its immunisation. My wife is also working as a practice nurse and we both really appreciate all the goodwill and appreciation shown by our patients and the public in general.

Pharmacist: ‘We all have a newfound pride in what we do’

I’m frequently asked, when advocating for a zero COVID approach from our political leaders, what impact that will have on cancer patients.

When the community transmission of the virus is out of control: that is when treatment is in jeopardy. Hospital capacity being at full stretch has made it difficult to get patients in beds for chemotherapy. An overwhelmed hospital means clinics work at reduced capacity slowing the patient journey to treatment down.

The show goes on and we adapt and adjust accordingly. Between October and December 2019 there were 58 days that chemotherapy was made in UHW, where I work. We make weekend doses on a Friday. In that period of time we were above capacity (in the red) on 20 days, or 34% of the time. In the same period this year we were in the red on 38 days, or 65% of the time.

The challenge is, we are working in a more challenging environment, with the same number of staff when everyone is healthy. It is busier, the workload is heavier, the stress and strain on the service is greater, but we are still here. COVID hasn’t slowed us down.

The positive? I think we all have a newfound sense of pride in what we do, and appreciation for those we do it with. We couldn’t provide cancer treatment without our cleaners, care assistants, porters and kitchen staff. In the hospital, we truly are all in this together.

GP: ‘We are under serious pressure’

In Kildare, in General Practice, we are now battening down for our 4th Lockdown.

It is complicated and we are under serious pressure. People are being great. Patients are very understanding of the demand, colleagues in pharmacies and at Naas Hospital are being great.

In our practice, we have confidence in our safe work practices, and we are not easily given to panic! We will keep calm, and carry on.

Our patients are inspiring, especially those who are older, and those with significant mental health issues, and also people who care for older relatives, especially those with dementia.

It will get better, and we are very keen to start administering the vaccine ASAP.

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