OPINION | Lizette Rabe: Don your socks for our docs!

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Psychiatrist Dr Cobus McCallaghan has already selected his mismatched pair of happy socks for coming Friday. (Photo: Ithemba Foundation)
Psychiatrist Dr Cobus McCallaghan has already selected his mismatched pair of happy socks for coming Friday. (Photo: Ithemba Foundation)

Friday 4 June is #CrazySocks4Docs Day – a day to raise awareness of the mental health needs of our frontline healthcare workers, especially under Covid-19, writes Lizette Rabe.

CrazySocks4Docs Day, or #CS4D for short, is a day on which awareness is raised of the mental health needs of all our healthcare workers. Especially under Covid-19, their already crisis-level needs have given rise to another pandemic – mental health – and it is happening in a sector that needs to care for us, the public.

What can we do to show our support and turn awareness into action? That’s easy – wear a pair of the most mismatched socks you can find in your cupboard to show you care!

But on a serious note: Surveys and studies show the immense pressures, not to say trauma, that healthcare workers have been working under since the outbreak of Covid-19. Yet, even before Covid-19, this sector already took strain, as budgets were cut regarding mental health services, while, simultaneously, the need among the public was growing. And healthcare workers find themselves right in the middle of this conundrum.

Burnout, depression and anxiety 

With Covid-19, what is called the "moral distress" of deciding who should get help, now adds to the immense pressures frontline healthcare workers have to deal with – besides the physical distress of long and hard hours. This leads to conditions from not only fatigue and "brain fog" – caused by trauma, uncertainty and isolation that affect our minds and memory – to burnout, depression and anxiety.

The tragedy is that it can develop fatally. Statistics already indicate that suicide is an "occupational hazard" for physicians; under Covid-19’s immensely stressful conditions, spikes in suicide are an even bigger concern. Also, in the UK it was estimated that 1.1 million Britons suffered from what is called Long Covid, with healthcare workers affected more than any other sector. In fact, 122 000 healthcare workers suffered from Long Covid, ahead of teachers (114 000) and social workers (31 000). The picture in South Africa is probably the same. 

#CS4D Day originated in 2017 in Australia as an initiative by cardiologist Doctor Geoff Toogood after his traumatic experiences concerning his own mental health. The Ithemba Foundation, a non-profit that raises awareness around mental health – ithemba means hope – liaised with Doctor Toogood and brought the campaign to South Africa for the first time in 2018. The next year it was launched as one of Ithemba’s major projects as it was clear that #Caring4OurCarers is of the utmost importance. Doctor Toogood’s message for 2021 is simple:

"With crazy socks, we want to remind everyone to walk the talk. No one should walk alone with mental health issues."

And Ithemba Board member Dr Marita van Schalkwyk agrees: "Wearing a crazy pair of socks means that you are standing with your colleagues and friends in these stressful times and situations, trying to get a smile and hoping to put hope – and joy – back in their hearts." 

Because, indeed, by #Caring4OurCarers, healthcare workers should know also they should reach out for help when needed. Covid-19 not only caused a global health pandemic, but also a mental health pandemic, and frontline health workers are bearing the brunt of this. Indeed, suicide as "an occupational hazard" is "the only cause of mortality that is higher in physicians than in nonphysicians".

The #CS4D campaign also focuses on health sciences campuses across South Africa in order for our next generation of carers to realise, as part of the preparation for their careers, that they need to care of themselves. Studies show that increased suicidal ideation already begins in medical school. These students are top achievers and put enormous stress on themselves.

Students and staff on health sciences campuses across South Africa participate enthusiastically in #CS4D Day, with their deans fully endorsing the need for such awareness campaigns. As Professor Jimmy Volmink, dean of Stellenbosch University’s Medicine and Health Sciences Faculty, says: "We recognise that medical and health professionals work under conditions that can lead to severe mental stress, especially in the ongoing Covid-19 pandemic". Conversations regarding mental health challenges experienced by students and health care workers are absolutely essential.

Invincible goodness 

Professor Gert van Zyl, dean of the University of the Free State’s Faculty of Health Sciences, refers to the concept of "Invincible Goodness"

"It is fine not to be well, but it is not fine to pretend to be healthy and mentally stable. If you believe in this, you also need to believe that we collectively need to take care of one another, staff and students alike. The foundation to take care of one another lies in the ‘small goodness’ of individuals to lift and support, and ensure not only the wellbeing of the individual, but the wellbeing of the community we function in to ensure a healthy and stable community, and so, improve the mental health for all. We are responsible for each other with 'small goodness' as the tool to achieve mental wellbeing."

Indeed, just wearing a pair of mismatched socks on #CS4D Day, is one such simple gesture of a "small goodness".

Professor Tiaan de Jager, dean of the University of Pretoria’s Health Sciences Faculty, stresses that the pandemic highlights the importance of mental health. "Students, frontline workers, counsellors and caregivers all deserve a moment of recognition and a call from you to check on their wellbeing. Let CS4D 2021 remind us to not leave anyone behind." Professor Ncoza Dlova, Dean of the Nelson Mandela School of Medicine at University of Kwazulu-Natal, puts it succinctly: "One only reaps wealth from good mental health."

Students on our health sciences campuses will be sharing their sock-selfies on Friday by posting them on @IthembaFoundation1 (https://www.facebook.com/IthembaFoundation1) and asking family and friends to like their sock-selfies. On each of the campuses the student with the most likes of her/his sock-selfie will win a cash prize of R1 000, sponsored by Netcare.

The severe stress of the healthcare environment is reflected in, e.g., studies that indicate that desperate, indeed, suicidal physicians "face unique barriers to care". These are additional barriers than those experienced by the public. Both groups face stigma, lack of time and lack of access to care, but physicians, amongst others, "have the added burden of concerns regarding confidentiality, and fear of discrimination".

Doctor Cobus McCallaghan, a South African psychiatrist currently practising in Canada, says: "Doctors and health workers are ordinary people, not Supermen and -women. Their mental health should get the same attention as that of their patients. So, on June 4, look at our multicoloured crazy socks – and be reminded that we need to support one another with compassion."

Breaking the stigma

Professor Stoffel Grobler, head of the Clinical Unit at the Elizabeth Donkin Hospital in Gqeberha and associate professor at Walter Sisulu University’s Faculty of Health Sciences, says the healthcare system needs to acknowledge that healthcare workers are in a total situation of burnout, with moral distress a daily reality. Mechanisms need to be put in place to address this. "And it should not be a plaster, like one or two sessions of 'baby goat yoga', but continuous attention to the mental health of employees."

Doctor Toogood says the support for the #CS4D campaign is humbling to see, "but it also reflects the issues for our doctors, students and healthcare workers". What is needed is to break the stigma around mental health and "create a safe place to seek help". And his message includes: "Thanks to all in South Africa for joining in the day. From Australia we share distant hugs of support at this most troubling time."

So, all you need to do now, is to get those happy socks ready, join the conversation and help by #Caring4OurCarers on #CS4D Day this coming Friday!

 - Professor Lizette Rabe of Stellenbosch University is the founder of Ithemba Foundation, a non-profit with the public benefit goals of raising awareness of mental health and raising funds for research (ithemba means hope in isiXhosa; registration number: 2012/171250/08; PBO number: 930/048/019; https://www.ithembafoundation.org.za).

If you need help, please do not hesitate to call these numbers:

Lifeline 24-hour helpline: 0861 322 322

Sadag 24-hour mental health helpline: 0800 456 789 or WhatsApp 076 882 2775.

On https://mentalhealthsa.org.za/ you can get a list of psychologists or psychiatrists in your area, or call them on 021 9389229, or email mhic@sun.ac.za.

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