Maneuvering Through Stigma and Violence: The Plight of Healthcare Workers

In recent times, there has been a lot of stigmatized discrimination, physical and verbal attacks towards healthcare workers. The underlying belief has been that “they are carriers of the infection” . These instances have ranged from them being spat on to, in one case, a stone-throwing mob chasing two female doctors wearing protective equipment while on duty, in another case (Ravi, April 2020). The healthcare worker can be anyone who delivers care and services to the sick including doctors and nurses or aides, helpers, technicians, or even medical waste handlers. Even though they are being considered to be the pillar of our social safety, hygiene and well- being, the herd mentality is reflecting a very different scenario. Various cases have been reported all over the country where the mob has become hostile towards healthcare workers because of their irrational fear, anxiety, and panic about COVID-19. Therefore it has become important to understand the psychological make-up of the society to reflect deeper into the grave reality of the healthcare workers in the present situation.

Amongst the many cases reported, was one of Trupti Katdare. She was in a slum in the central Indian city of Indore when the mob attacked. She along with a group of other public-health workers had been tracking down a man who might have had contact with a recently confirmed case of the coronavirus. When they found him, he cursed at them, asking why they wanted his information and accusing them of trying to take him away. Almost immediately, at least 100 people surrounded the team, throwing stones and other objects (Altstedter et al., 2020). Luckily, they managed to escape. In yet another case, one doctor endured a campaign by her neighbours to force her out of her apartment. First they cut off her electricity, then her water supply, then they began picking fights over trivial matters. Finally, they surrounded her one day and asked her to leave on fears she would infect the building. The police intervened and that doctor has not had any harassment since. There have been instances where the residents asked the phlebotomist who was conducting the testing procedure wearing a PPE kit, to conduct the procedure in their garden or corridor where the temperatures are well above 40 degrees Celsius. When intervened, they defended their request by saying they are afraid to be contaminated by the concerned healthcare worker.

The population of India is gripped by the fear of inadequate number of protective gears available (Nandan & S, 2020) , the rapid increase in the number of cases reported, and/ or at times grossly influenced by the spread of inaccurate information on COVID-19 over social media. Despite worldwide campaigns against misinformation, rarely we as a community spend enough time to check the facts before forwarding them, or take effort to report the source of those misinformation. Fear is a normal reaction in situations of uncertainty. But sometimes fear is expressed in ways which are hurtful to other people (“Looking after our mental health”, n.d.) Fear brings out the worst in each one of us, but our actions that are guided by this fear, resentment, desperation, and/ or our sense of protection can often lead to social circumstances that may bring harm to others. Therefore, before acting on our fears, as a community, it becomes essential to ask ourselves the following questions:

1. Does being afraid of contamination give us the right to hit back at those very people who are our frontline workers fighting for our safety and well-being?
2. Does panic justify the attitude of turning hostile?

iii. Are we failing to understand that they are fulfilling their oath to serve mankind while jeopardizing their own lives?

Safeguarding the psychological and psychosocial wellbeing of our frontline workers should be prioritized, now more than ever.

Understanding social stigma in the background of the COVID- 19 pandemic:

WHO has defined social stigma as a negative association between people who share certain characteristics and a specific disease (“Social Stigma associated with COVID-19”, 2020). Stigma is rooted in fear; specifically, the fear of contamination. Increased risk of carrying the infection is one of the many reasons why healthcare professionals are often seen as transmitters of the virus. Institute Director from AIIMS (“Don’t discriminate against healthcare workers: AIIMS”, 2020) mentioned “However, this has also created unprecedented issues which are unfounded and mainly driven by fear rather than scientific evidence”. The fear that he speaks about is the fear of contamination. But the doctor briefs about the precautionary measures that are taken by the staff, he further quotes that it takes about half an hour for a doctor to remove all protection gears, so by the time the doctor comes out, the chances of them infecting are close to nil. Despite taking enough precautions, healthcare professionals have been the victims of physical, mental, and emotional abuse. They are more likely to be labeled, stereotyped and  isolated. These psychologically affect not just the person but the whole of their family, community, and friends.

How is stigma impacting society during  this pandemic?

Canadian sociologist Goffman (1963) theorized that social stigma is an attribute or behaviour that socially discredit an individual by classifying them as the “undesirable other” by society.  Firstly it starts with the place where one lives and it slowly creeps into other aspects of their life. But what we often ignore is the impact that it leaves on the individual’s psychological front. While stigma and discrimination are just one among the many concerns that these professionals might face, the others could be aggression towards personnel and intense scrutiny of media both of which leave behind the massive bearing. Some of the feelings associated with being stigmatized are as follows (“Stigma, Discrimination and Mental illness”, 2015) 

• Feelings of shame, isolation, and hopelessness
• Reluctance to seek help
• Lack of empathy from family, friends, and society at large
• Fewer social interactions
• Bullying, social violence or harassment
• Self – doubt

Stigma can occur both, internally and externally (Caddell, 2020). Families are also impacted by stigma as they become the victims of lesser social support. External stigma is often direct and thus easily identifiable; for example when someone passes a derogatory comment. In case of internalized stigma, the individual internalizes the stigma, experiences a loss of control, and accepts denigration. This results in  self-perceptions of shame and guilt (“How to handle negative associations”, 2020) and experiences of fear. As a reaction, the individual will resort to protective action; for example,avoiding others and living in isolation. Navigating this will require effort. Some of the ways this can be accomplished include: 

• Prohibiting stigma from creating self-doubt and shame
• Avoiding self-isolation
• Speaking up against this stigma as there might be others who are in dire need of support
• Speaking to a therapist

1. Prohibiting stigma from creating self doubt and shame:

Empowering individuals is an effective way to reduce self-stigmatization. This involves encouraging people to believe they can achieve their life goals and evade further negative consequences that result from self-stigmatizations. Literature has revealed an association between empowerment and high self-esteem, better quality of life, and increased social support. (Rogers et.al., 1997)

2. Avoiding self- isolation:

According to WHO, social support networks can have a significant positive effect on health (Caporuscio, May 2020). Many countries are now treating loneliness as a health priority. Social connection is crucial for both mental and physical health. During this pandemic some of the ways to stay connected include:

• phone and text
• email
• social media
• video chat platforms

Socializing from a distance, such as via online platforms, can help ease feelings of loneliness and prevent its complications, especially for people who are vulnerable.

3. Benefits of speaking up against the stigma:

Prejudice and discrimination often become internalized by most people and they tend to believe all that is said about them. Mental health and wellbeing has an impact on us  whether on account of our own struggles or of those we know and care about. We all, thus, have a reason and duty to take affirmative action towards creating safe and supportive communities where dialogues about mental health and accessing support for the same would be encouraged. It is always beneficial when we know the facts and educate others too. Knowledge is a helpful tool in combating  myths and stereotypes, within ourselves and in others. Reaching out for help when you feel the need or identify someone in need will always amount to positive change.

4. Speaking to a Therapist:

The pandemic has affected people’s life differently and has brought a lot of thoughts and emotions  along with it. Therapists are trained professionals who can help in interpreting one’s surroundings and experiences. Therapeutic relationships can provide us with a safe space to explore one’s feelings, thoughts and emotions without the fear of being judged.

SWAASTHI and mental health:

If you are a healthcare professional yourself or if know of anyone struggling with psychological distress owing to stigma, discrimination and violence, please refer them to Swaasthi. It is a dedicated helpline that provides emotional and mental support to frontline workers. It consists  of a team of trained therapists supervised by senior psychologists.

Swaasthi helpline number: 9152987824 is available from Monday to Saturday, 10 AM to 6 PM. The languages spoken by the counsellors are English, Marathi, Hindi, Bengali, Malayalam and Kannada. Write to us at swaasthihelpline@tiss.edu

Feel free to connect with Swaasthi in order to get help during these unprecedented times.
You are not alone. Swaasthi provides a safe, anonymous, non- judgemental, confidential space to seek telephonic and email based counseling services to frontline workers.

References:

Altstedter, A., Shrivastava, B., & Pandya, D. (2020). Doctors, hospital workers are also fighting abuse and violence as virus stigma, panic grows. The Print. Retrieved from

https://theprint.in/india/doctors-hospital-workers-are-also-fighting-abuse-and-violence-as-virus-stigma-panic-grows/401144/

Caddell, J. (2020, July 03). What is stigma?. Verywell Mind. Retrieved from https://www.verywellmind.com/mental-illness-and-stigma-2337677

Caporuscio, J. (2020, May 13). How does isolation affect mental health?. Medical News today. Retrieved from https://www.medicalnewstoday.com/articles/isolation-and-mental-health

Don’t discriminate against healthcare workers: AIIMS. (2020, April 21). Times of India. Retrieved from  https://timesofindia.indiatimes.com/city/delhi/aiims-dont-discriminate-against-healthcare-workers/articleshow/75261690.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst 

Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall

How to handle negative associations and reactions to emotional health issues. (n.d.). ULifeline. Retrieved from http://www.ulifeline.org/articles/423-overcoming-stigma    

Nandan, R. & S. S.  (2020, June 14). Doctors in covid-19 wards at risk of burnout. Livemint. Retrieved from https://www.livemint.com/news/india/after-three-months-doctors-in-covid-19-wards-complain-of-burnout-11592132659132.html  

Ravi, R. (2020). Abused, Attacked, Beaten: Frontline Workers Are Risking Their Lives Everyday In India. The Logical Indian. Retrieved from https://thelogicalindian.com/news/covid-19-healthcare-workers-attacked-20665

Rogers, E. S., Chamberlin, J., Ellison, M. L., & Crean, T. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric services, 48(8), 1042-1047.

Social Stigma associated with COVID-19. (2020, February 24). World Health Organization. Retrieved from https://www.who.int/docs/default-source/coronaviruse/covid19-stigma-guide.pdf

Stigma, Discrimination and Mental illness. (2015, September). Better heallth Channel, Retrieved from https://www.betterhealth.vic.gov.au/health/servicesandsupport/stigma-discrimination-and-mental-illness 

World Health Organization and the Calouste Gulbenkian Foundation. (2014). Social determinants of mental health. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=78458EF62BE1B58048F429CCDEAE4C2B?sequence=1 

Looking after our mental health. (n.d). World Health Organization. Retrieved from https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome—mental-health