SA healthcare workers been experiencing burnout long before Covid-19 pandemic

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  • Healthcare workers have been experiencing high levels of burnout since long before the Covid-19 pandemic
  • Not many of them have been making use of employee assistance programmes
  • Healthcare workers need to develop their own anti-stress toolkit to help them cope

South African healthcare workers were experiencing burnout even before the Covid-19 pandemic hit the country, according to Dr Saeeda Paruk, a psychiatry lecturer at the University of KwaZulu Natal.

Paruk was speaking at a webinar hosted by the university’s college of health sciences on Tuesday. The webinar focused on healthcare workers burning out. The panellists included Prof Suvira Ramlall, the Clinical Head of Psychiatry at King Dinuzulu Hospital in Durban and Prof Peter Milligan, Chief Psychiatrist at the department of health in the province.

Burnout before Covid-19

In her presentation, Paruk stated that South African healthcare workers were experiencing burnout even before the emergence of Covid-19. She says a 2013 study revealed that 100% of junior doctors in the Western Cape experienced burnout.

She also quotes a 2020 study that found that 59% of state doctors in KwaZulu Natal reported burnout before the pandemic.

Paruk added that 46% of nurses around the country were found to suffer from burnout in a 2019 study.

Burnout during the pandemic

According to Paruk, during the Covid 19 pandemic, surveys reported even higher rates of burnout, with many studies suggesting a prevalence rate of around 40% amongst all healthcare workers, i.e. not only doctors and nurses, but all allied staff and teams, including healthcare workers in psychology, physiotherapy etc. 

She adds that there is a lack of data on the current Covid-19 pandemic burnout in healthcare workers in South Africa, as most recent studies only measured psychological distress, anxiety and depression.

“During the Covid-19 pandemic in the past year studies have suggested that anxiety disorders in healthcare workers have escalated, and a systematic review by Robertson suggested a prevalence rate of anxiety disorders of between 10 to 44%, which is quite high.

"Approximately half of all healthcare workers are anxious,” she says. Depression was also found to be common among healthcare workers.

She says that the normal population prevalence rates for major depressive disorder are around 9.8%. But even before the pandemic, doctors in KwaZulu Natal had more than double these prevalence rates, standing at 21%.

Low mental health literacy

Despite high levels of anxiety and depression, Ramlall says that not many healthcare workers were using the available mental health support.

“in KwaZulu Natal, we have had no more than 30 requests for assistance from May last year until this last weekend. Several of these declined support when contacted; a few had secured help since contacting us; and in a few instances, there have been requests for interventions for affected groups at public healthcare facilities.

"Unfortunately travel to these sites was not possible due to lockdown, and sadly these facilities, like most healthcare facilities in KwaZulu Natal, have no WiFi to enable webinars or online therapy,” Ramlall says.

She adds that a survey was conducted by her colleagues among doctors and nurses during the pandemic last year, and they found high levels of depression, anxiety, stress and trauma. 

“Yet, almost 75% of those participants felt they were unsupported by the employer – even though 90% stated that they did have access to support from EAP [employee assistance programme] and the occupational health clinics in the institutions.

"So while stigma is partly responsible, the more common reason is low mental health literacy, low prioritisation of our mental health needs and understanding of its importance in our wellbeing,” she says.

What healthcare workers need to do

Milligan recommends that healthcare workers need to give themselves permission to take care of themselves.

“I really want to encourage healthcare workers to engage in self-empathy and self-compassion,” he says. 

He encourages healthcare workers to build their own anti-stress toolkit. This includes ensuring that they eat well, and get enough exercise and sleep.

Milligan says that creating social connections can help alleviate stress.

“As health workers working long overtime hours we so easily become disconnected, so working deliberately to maintain meaningful social connections with others is a key element in reducing stress and burnout,” he says.

He says that psychotherapy is an important part of dealing with burnout and should be part of the tool kit and adds that healthcare workers should also look after their spiritual needs.

“The broader spiritual aspects, and I mean it's in a really broad sense – things like spending time in nature and expanding your spiritual self through meditation or art or music, or prayer or meaningful service,” he adds.

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