Championing mental health awareness during the COVID-19 pandemic

Over the last year, thousands of Caribbean healthcare workers have become all too familiar with the personal and professional challenges and sacrifices in facing Covid-19. In the throes of vulnerable circumstances that adversely affect the physical and mental well-being, there has been a concerted effort to provide much needed relief to citizens throughout the region - many of whom are faced with grim realities associated with economic instability, psychological burdens, loss of livelihoods and a pressing need for care in dealing with an uncertain future.

One such frontline worker is Dr. Dev Persaud – one of 75 Guyanese medical workers who participated in the mental health and psychosocial support (MHPSS) Training. Planned by the Ministry of Health, the regionwide initiative was implemented in collaboration with the Pan American Health Organization (PAHO) and the Caribbean Development Bank (CDB).

This accomplished Medical Registrar, who is responsible for one of the teams managing patients in the COVID ICU, tent hospital and transition ward, is a seasoned Internal Medicine and Infectious Diseases Specialist. Persaud’s academic and career accomplishments have taken him on journeys from South America to Eastern Europe, and currently works with the Intensive Care Unit at the Georgetown Public Hospital Corporation. His vested interests in the field have been long-rooted in quality improvement for clinical care, medical education and outreach, and has now involved building individual and social resilience of people and communities across Guyana to cope with the adverse effects of Covid-19. According to him, one of the challenges that healthcare workers have encountered while working on the frontlines during the pandemic is managing expectations of patients’ families. “It’s not easy breaking bad news on almost a daily basis. That definitely takes its toll on us as hospital staff, especially because of the visitor limits – relatives can’t visit their sick loved ones to offer emotional support, so most updates are relayed by one visiting family member or via telephone,” he explained. This sudden loss of intimacy, in his opinion, called for a more cross-cutting approach as it relates to adequate responsiveness in crisis circumstances.

For a period of 2 weeks in late 2020, Persaud took part in the PAHO/CDB self-learning course ‘Psychological First Aid (PFA) in disaster management in the Caribbean.’ With the guiding principles of “look, listen and link”, participants in the training session were sensitized to activating a number of skills. Such proficiencies include acutely recognizing symptoms of distress; using appropriate language to offer support and enhancing the approach to capacity-building for mental health, as well as directing and accessing appropriate social resources. Dr. Persaud believed that the training programme, also helped medical practitioners to better understand patients and families on a personal level. “The knowledge that I would have gained in the course really changes your perspective, and it also enhances the ever-changing working environment because the virus would have evolved over a period of time,” he noted. The frontline worker participants learned how to assess the current situation by looking at who needs support, safety and security risks, the immediate basic and practical needs, and expected emotional reactions. Active listening also added a layer of openness in approaching conversations – more specifically, how to calm someone in distress, the ways in which to enquire about a variety of needs and concerns, and options to find solutions. Providing information and connecting people with loved ones and social support services was a key factor for participants in linking people with addressing basic needs, access to services and other means of assistance.

Dr. Persaud indicated that during the pandemic period when things started to intensify, there was a sharp workload increase for his team. “You’re interfacing with a lot of your colleagues more frequently and you’re going through a lot – mentally, emotionally and physically,” he explained. “PAHO’s Psychological First Aid (PFA) course equipped you with a number of strategies on how to think about situations in different ways, which in turn opened up a number of avenues to deal with a number of stressful situations,” he rationalized. “This includes dealing with pressurized situations with fellow colleagues at work, or even dealing with your own illness.”

Fortuitously, helping to enhance the working environment through “look, listen & link” came full circle for Dr. Persaud when he was diagnosed with COVID-19 while treating his patients. His team reassuringly rallied around him, and he was able to see the psychological support for community from a patient’s perspective. “We formed a Whatsapp group and they kept me lifted and in the know. Coming out of that experience, the knowledge that you would have gained really changed your perspective and wasn’t only useful in our interactions with patients and their relatives, but it also helped at a personal level.” In Dr. Persaud’s experience, the course really allowed him to remain human and not to take things for granted, particularly during a period where frontline workers could become numb to the intensified circumstances as a default coping mechanism. “Given the gravity of the situation, the reality is that there are workers who are dealing with the situation in ways that are not necessarily healthy,” he indicated.

At the heart of the crisis, mental health and psychosocial support have undoubtedly become a critical component in providing fundamental needs in impactful service to patients and families. For Dr. Persaud and the COVID ICU team at Georgetown Hospital, MHPSS became a transformational tool that emphasized a greater need for an integrational approach into all responses in a crisis situation. As a result, he strongly believed that more educational initiatives such as this should be implemented across the board. Hoping that the training can be offered on a wider scale, Dr. Persaud considered the fact that there are workers who are managing the ongoing situation in ways that are not necessarily healthy. In his view, this evolving environment underscores the importance of having a support system for medical professionals, who are often at a greater risk for contracting Covid-19. Admitting to the degree of difficulty to psychologically navigate this new pandemic terrain, the opportunity ushered in a clear reminder for Persaud that everyone has strengths and abilities to help others cope with their life challenges. He highly commended the public-private partnering organizations involved for taking the initiative to oversee the rollout of this programme, to benefit healthcare workers providing national services across communities.

“Healthcare workers have challenges, and they need support in order to support the community. It’s very inspirational to know that PAHO and CDB would have collaborated with the Ministry of Health for this course on more than one occasion,” Dr. Persaud applauded.