Experiences of our health workers in the pandemic

Professor Marie Bismark, a public health physician and health lawyer, has collaborated with three colleagues to publish a book, Experiences of Health Workers in the COVID-19 Pandemic: In Their Own Words. It draws upon nearly 10,000 responses to a survey examining the psychological, occupational and social impact of the COVID-19 pandemic on frontline health workers in Australia. In 2020, at the peak of the second COVID-19 wave, Professor Bismark and her co-authors, Professor Karen Willis, Dr Sophie Lewis, and Associate Professor Natasha Smallwood, conducted the Australian COVID-19 Frontline Healthcare Workers Study. The survey was distributed to anyone who identified as a frontline health worker—from intensive care doctors and dentists to hospital cleaners and support workers. Health workers submitted almost 250,000 words of raw, heartfelt stories. “That was the origin of the book,” Professor Bismark said, who herself worked on the frontline, providing mental healthcare to patients in the ED, intensive care unit, and COVID-19 ward. “We knew we needed to honour our health workers by recording their unfiltered responses and making them available to others.” The book’s primary purpose is to document health workers’ experiences, so they don’t feel alone. It’s also intended as a resource to help us understand the full impact of the pandemic from a diverse range of experiences. Professor Bismark hopes that a historical perspective will be useful for managing global health crises in the future. The study found a high number of mental health issues reported by health workers, despite high resilience scores. Professor Bismark and her colleagues were able to drill down to identify specific demographics who were most affected or at risk.

The study revealed that health workers were overwhelmingly exhausted. People talked about moral injury when they realised the quality of care they could deliver was severely compromised. GPs felt left out of policy-making decisions. Junior doctors found they shouldered the workload on wards without adequate senior support. Aged care workers felt grossly undervalued and underpaid. High levels of post-traumatic stress disorder were reported in health workers who were involved in the separation of families while on duty. “Some of the most moving stories were from nurses who were at a patient’s bedside holding an iPad while their family said goodbye,” Professor Bismark said. The study reflected deep concerns about missed routine screening procedures and delayed diagnoses, and the consequences for patients. Doctors reported that patients were avoiding hospitals because they didn’t want to overburden the system or were anxious about COVID-19 infections. “We heard from a lot of groups who felt left behind.” Professor Bismark said the gender gap in surgery and medicine was widened. Healthcare workers trained overseas were disproportionately impacted by border closures, dealing with work stress while separated from their own families abroad.

“Overall, there was a strong sense that pre-existing cracks in the healthcare system were widened by the pandemic to the point where we can no longer ignore them.” Professor Bismark is a Public Health Law Principal Research Fellow at the University of Melbourne, where she leads a research team focused on the interface between patient safety, clinician wellbeing, and health regulation. She’s currently based in a regional community mental health clinic in Aotearoa New Zealand, finishing her last six-month rotation in psychiatry training. She hopes to become a Fellow next year. Professor Bismark is also a member of the RACS Wellbeing Working Group and contributed to a review of wellbeing support offerings for surgeons. “I think there are many health workers who feel they can’t talk openly about their work; maybe even the people closest to them don’t really understand what they do or the sacrifices they made.” Professor Bismark hopes that frontline health workers can identify with and find themselves in the stories shared in Experiences of Health Workers in the COVID-19 Pandemic, available via the RACS library (https://bit.ly/3xZFTZz)

“I think there are many health workers who feel they can’t talk openly about their work; maybe even the people closest to them don’t really understand what they do or the sacrifices they made.”

Image below: Professor Marie Bismark