Anxiety, guilt and stigma add to burden of nurses on the front line
Female health workers are particularly at risk mentally because of their caregiving roles at work and at home
One of the highlights of Nosipho Matshoba’s* day used to be the delirious welcome she received from her two small children after a 12-hour nursing shift.
“They often run to me, kiss and hug me tightly before they tell me everything about their day. That always melts my heart and improves my mood instantly,” said Matshoba, who works at one of Cape Town’s tertiary hospitals.
But now she is on the front line of the war against Covid-19, the hugs with her daughters, aged five and two, have had to stop.
Women traditionally are the glue that keeps families together. They take this role very seriously and it is particularly stressful when they are unable to fulfil it.Dr Angelique Coetzee
“I often ask myself, what if I get exposed to the virus unknowingly and now I have to go back to my children? Nowadays I take off my uniform in the garage and head off to the shower,” she said.
“My kids have accepted that hugs are no longer allowed when mommy comes back from work ... they even say mommy has coronavirus.”
The 38-year-old is a member of an overwhelmingly female cohort of health workers, many of whom are also the primary caregivers at home. Several told Times Select that their mental health was suffering due to anxiety about their families’ safety.
“We are doing everything in our power to stay safe and not to infect our loved ones,” said Cathy Klass*, who works at an Eastern Cape district hospital.
The 59-year-old, who lives with her sickly 13-year-old grandson, said her worst fear was infecting him. “He is going through chemotherapy and his immune system is very weak. I’ve asked my daughter to live with us during lockdown so I can avoid as much contact with him as possible,” she said.
On top of her domestic worries, Klass said she and her colleagues were experiencing stigma. “For the past two decades I’ve used taxis to go to work, but now taxi drivers don’t want to transport us as they fear we will give them Covid-19. Even public transport users are very hostile,” she said.
Dr Angelique Coetzee, chairperson of the South African Medical Association, said while all health workers had been significantly affected by the pandemic, it was women who were likely to be overwhelmed due to their role as family caregivers.
“Women traditionally are the glue that keeps families together. They take this role very seriously and it is particularly stressful when they are unable to fulfil it. Many of these women are facing the challenge of looking after their children alone amid this outbreak,” she said.
Amanda Swartz*, a midwife at a Cape Town hospital and a single mother to a teenager and a six-year-old, said she was struggling with guilt due to the limited affection she was able to show her children.
“There is nothing that breaks my heart more than turning them down when they want to hug me. They sometimes forget the new rules and the whole arrangement hurts me because I’ve become this cold mother,” she said.
Her relationships with patients had also suffered. “Before the virus I would have long chats with my patients and get to know them, but these day I spend as little time with patients as possible.”
A recent survey in China, reported in the Journal of the American Medical Association, found that front-line health-care workers combating Covid-19 “have a high risk of developing unfavourable mental health outcomes and may need psychological support or interventions”.
A Cape Town clinical psychologist and mediator, Ilana Edelstein, said the fear of the invisible virus with possible deadly consequence might lead to exhaustion and give rise to mental health problems such as anxiety and depression among health workers.
“In SA, we have a fairly unique situation where many mothers are single parents and are largely responsible for providing the emotional and financial support for their family,” she said.
“This pandemic places them as health-care workers under additional strain, as their own health is potentially at risk. While it may be easy to keep a distance from parents and older children, this may not be possible with younger children who do not understand social distancing. In addition, during times of stress and crisis, it is common for children to seek more attachments and be more demanding. And the very prohibition on touch is enough to make one feel ‘infected’.”
Psychiatrist Prof Renata Schoeman, head of the MBA health-care leadership programme at the University of Stellenbosch Business School, said women were at particularly high risk.
“Part of the stress is that people are feeling powerless and fatigued. Women are particularly feeling torn into two because of their dual role in society.”
Schoeman said it was understandable that nurses were more worried than doctors because they had more contact with patients and less information. To ease the emotional load, she suggested employers conduct debriefings for staff and give them up-to-date and accurate information about the virus.
Coetzee said: “Ensuring the responsiveness of managers and health-care facilities through lobbying for availability of personal protective clothing, for example, is also of paramount importance.”
Mark van der Heever, spokesperson for the Western Cape health department, said: “We are aware that our staff face many personal challenges and we aim to support them as best we can. We have had many fruitful discussions with organised labour to address a number of concerns. We will continue to remain responsive and supportive.”
* Not their real names.