Stigma: A silent threat to the mental wellbeing of healthcare workers during Covid-19

Suntosh R Pillay is a clinical psychologist at King Dinuzulu Hospital Complex in Durban and is an executive member of the Community and Social Psychology Division of the Psychological Society of South Africa (PsySSA). He is currently helping coordinate the Healthcare Workers Care Network in KwaZulu-Natal.

A nurse told me something last year that stuck in my mind. We were in the middle of the first wave of the Covid-19 pandemic and all healthcare workers were taking strain. She said that prior to the pandemic — “when life was normal” — she wore her uniform with self-assurance and dignity, standing tall as her epaulettes shone proudly as she walked through a shopping mall.  

Now, this has all changed. In public, her nursing uniform became a symbol of dread. She wouldn’t even stop at a grocery store after work. She felt people looked at her with suspicion and fear, wishing she wasn’t there. She was, after all, a nurse coming straight out of a hospital, and the risk of her spreading the coronavirus was reasonably high given her daily duties of interacting with patients. The smiles and unspoken gratitude that greeted her in public places in 2019 were replaced with paranoia in 2020.

She felt stigmatised. Her uniform had become a mark of this stigma.

She was not alone in her experience. Timothy Dye, from Rochester University in New York, led a global study of Covid-19-related stigma and bullying with 7,411 research participants from 173 countries. He and his colleagues discovered that healthcare workers are significantly more likely to experience Covid-19-related stigma; they more frequently believed that people gossip about others with Covid-19, and they felt that people with Covid-19 lose respect in the community. 

The World Health Organisation warned against the effects of social stigma in an outbreak. It results in unfair labels, stereotypes, discrimination and loss of status because of a perceived link with the virus. Cognitively, stigma and fear are intertwined, because Covid-19 is a new disease with many unknowns and humans are afraid of the unknown. It’s easy to project our phobias onto “others” — ironically, the very healthcare workers saving lives are the ones who become stigmatised and even bullied. 

Research shows that Sub-Saharan Africa (14.0%), Southern Asia (10.7%) and Northern America (10.6%) had the highest rates of reported experiences of Covid-19-related bullying. Among a range of recommendations, they note the urgency of providing healthcare workers with psychological support.

This reminded me of a doctor who told me she didn’t like the media calling her a hero. Healthcare workers were not heroes, she said. They were simply doing their jobs, under extraordinary pressures and with limited resources, and by calling them heroes it took attention away from the fact that they are suffering — emotionally, physically and socially. 

Many others echoed her sentiments and called on the government to put their money where their praise was. Hire more staff. Buy more ventilators. Procure vaccines faster. Offer psychosocial support to frontline staff. These pleas for assistance were reminders that healthcare workers are humans — not superheroes with superpowers — and need help like anybody else. 

Indeed, healthcare workers are not treated like heroes. Quite the opposite. Steven Taylor, at the University of British Columbia in Canada, led a study on the public’s attitudes towards healthcare workers during Covid-19. He surveyed 3,551 people in the US and Canada and concluded that fear and avoidance of healthcare workers is a widespread, under-recognised problem. 

In fact, more than 25% of respondents believed that healthcare workers should have severe restrictions placed on their freedoms, such as being kept in isolation from their communities and their families, and more than a third of respondents avoided healthcare workers for fear of infection. Paradoxically, other research showing support for healthcare workers (like the clapping and cheering outside hospitals) was unrelated to whether they held stigmatising attitudes.

We must therefore not downplay the emotional turmoil this causes for healthcare workers, who contend with daily occupational demands in addition to stressors in their community. Ironically, healthcare workers’ reluctance to ask for psychological help also has to do with the stigma of feeling judged by their colleagues for not coping. Many healthcare workers pretend to be okay and brush off anxiety and suppress trauma. Healthcare workers are often socialised early on in their careers into an unhealthy system in which they are socially rewarded for staying silent about their suffering. 

And herein lies another problem.

We must disrupt the discourse around healthcare workers’ mental health that relies on an unspoken code of secrecy that says, “Leave us alone, we’ll cope with this individually, silently, in our own way.” This catalyses a vicious cycle of isolation and mental distress.

Covid-19 must change this — dramatically. Conversations about mental health need to come out of the shadows and into the forefront of our everyday language. When a nurse says she feels stigmatised by her uniform, or when a doctor is burning out because they’re afraid to ask for help, it highlights the challenges of protecting our most valuable and vulnerable human resources right now. 

Stigma is dangerous. 

If we can’t care for our health workers, then we’re failing in our response to this pandemic. DM/MC

For professional mental health support, call 0800 212121.