The demographic characteristics of respondents on age, sex, marital status and identification is shown in Table 1.
Table 1: Demographic characteristics of respondents
s/no
|
Age
|
Sex
|
Marital Status
|
Occupation
|
Identification
|
1.
|
47
|
Male
|
Married
|
Medical Doctor
|
M1
|
2.
|
50
|
Female
|
Married
|
Medical Doctor
|
M2
|
3.
|
43
|
Male
|
Married
|
Medical Doctor
|
M3
|
4.
|
48
|
Male
|
Married
|
Medical Doctor
|
M4
|
5.
|
37
|
Male
|
Married
|
Medical Doctor
|
M5
|
6.
|
47
|
Male
|
Married
|
Nurse
|
N1
|
7.
|
49
|
Male
|
Married
|
Nurse
|
N2
|
8.
|
36
|
Female
|
Single
|
Nurse
|
N3
|
9.
|
40
|
Male
|
Married
|
Nurse
|
N4
|
10.
|
36
|
Male
|
Married
|
Nurse
|
N5
|
11.
|
40
|
Male
|
Married
|
Nurse
|
N6
|
12.
|
53
|
Male
|
Married
|
Laboratory Scientist
|
L1
|
13
|
51
|
Male
|
Married
|
Laboratory Scientist
|
L2
|
14
|
52
|
Male
|
Married
|
Laboratory Scientist
|
L3
|
15
|
50
|
Male
|
Married
|
Laboratory Scientist
|
L4
|
16
|
37
|
Male
|
Married
|
Hygienist
|
H1
|
17
|
33
|
Male
|
Single
|
Hygienist
|
H2
|
18
|
27
|
Male
|
Single
|
Hygienist
|
H3
|
19
|
26
|
Male
|
Single
|
Hygienist
|
H4
|
20
|
35
|
Male
|
Married
|
Hygienist
|
H5
|
Theme One: Early stage of the pandemic
The early phase of the pandemic was characterized by anxiety, socio-economic impact, a call to duty for the FHCW and the need for more engagement by the government in the fight against the pandemic (Table 2).
Subtheme: Effects of the pandemic
The effects of the pandemic expressed by the respondents were; repatriating of foreign citizens’, worries about the country’s level of preparedness, skepticism about the future of the country, anxiety, public fright, high impact on life, economy and social aspect (Table 2). Others saw it as a professional responsibility and the need for the government to step up its support in fighting the pandemic (Table 2). Some participants narrated their experience as follows.
“In February, we had a few exposures to people who were suspect cases but were never confirmed. By March, it all started, there was anxiety all around, there was a lot of uncertainties too; people didn’t know what to expect, people were not sure, there were lots of predictions with regards to Africa, lots of predictions with regards to Nigeria. We saw foreign countries repatriating back their citizens, there was a lot of fear and anxiety in the air. For us, it was not any different because we knew we were going to face those cases when they come over. On our path too, there was a lot of fear because this is the first time we are experiencing a pandemic like this. We were also worried about our preparedness; can we sustain the tempo? can we sustain the esteem? All that we heard of in terms of protection; are we going to receive protection? Was it going to be there for us all the time? Our families? So? Yeah! A whole lot! It was climaxed with lots of uncertainties but we were just looking forward to what the deeds are going to present in time” (M3).
“It is worldwide, it is global and cuts across every aspect not only in terms of education. It has put the whole country in a standstill, and is one of those things that I have come across that everybody’s hands just have to be on desk to ensure that we curtail the disease” (M4).
“It is a global emergency; it is a new disease that just came out which we have not really understood it very well and the impact on lives, economies and social aspect is much. It is something that has no regard for any nation whether developed or under developed and requires prompt attention because of the highly infectious nature of the disease. We are equally privileged; we are among the frontline health workers that are battling with this condition. Although the task is much, but with equipment and dedication we are winning the battle” (N5).
“It’s a novel disease that we are not too familiar with and because of that, when it came in, there was so much fear when we started seeing it in other countries, so that fear has been in us, in our families, until when it came into the country, and with the casualties we are seeing in other countries, we were also having that fear that it might also happen in our country” (L2).
“When it came it was scary, even now, though we are not that scared, we are very much careful with what we do. It is something that is seriously affecting people’s lives and we have to be careful about it and know how to go about doing our jobs” (H5).
Subtheme: A call to duty
The FHCW felt that it was their duty to engage in the care and treatment of patients. Some saw it as a privilege and honour to serve their country and a challenge that needs to be addressed (Table 2). A respondent was skeptical on accepting the task and a respondent expressed disappointment in loosing of clients on accepting the task (Table 2). Some of their responses is narrated as follows.
“Well, the task is on infection and my specialty is in infectious diseases, so, it’s something I wouldn’t mind on me. So, is something that I had to participate. Though it was said that it’s optional, but it will look somehow if I back out. It is something that you have to do if it comes to your field of profession. So, I didn’t feel anything negative about it, it’s okay” (M1).
“I felt it was something I had to do being an infectious disease physician and we are dealing with an infectious disease. So I felt it was my duty to be part of the team even though I was not forced to be part of it, I accepted the challenge. Of course there was this fear of the unknown, we were dealing with the pathogen we have never seen before and there was a lot of fear associated with the virus. I was afraid that I might get infected along the way but even with that I felt it was my duty to be part of the team” (M2).
“For me it wasn’t difficult because the initial reservations I had, I really didn’t think it was going to come, I thought it was going to be like what we had in previous epidemics that occurred in which we were spared. I thought it was going to be the same kind of setting but certainly I knew if called upon, I was going to respond. By virtue of training, I am a respiratory physician, I knew very well that COVID affects the respiratory system. Is like having a military general who is ask to go to war and he says, he is not going because of fear or something. For me, even though there were uncertainties, I was looking forward to the challenge. There aren’t much reservations really. From the beginning, I have calculated the risk and I just felt that it was worthwhile throwing myself in. For me, it was more of if I could just make an impact where I can save people. I wasn’t even bordered about the outcome for me was going to be. It was a challenge I picked from the beginning and I was looking forward to doing it” (M3).
“Well, I see it as a good experience. Yes, I was brought in by the management and initially I felt skeptical because I felt I am a gyneacologist, so, what am I doing with infectious disease but considering the fact that nobody is immune to this disease, everybody can be exposed. We had pregnant women, we had some postpartum and antenatal patients that have been exposed to COVID. So, I see it as a wonderful experience when I came in, I discovered though we had less than ten of such patients since inception but it’s a wonderful experience and I picked up the challenge” (M4).
“I didn’t think twice because somebody has to do it and the knowledge that God has deposited on us is not for the fun of it and failure to use that knowledge is also a sin in the sight of God. I have been endowed with the knowledge and I should be able to use it to save others” (N1).
“Well, I feel it is an honour and a responsibility to the profession, to the country and generality of humanity at large” (N2).
“Well, as someone who specializes in microbiology and biomedical virology, I feel it’s a challenge to me to go in there and see how we will fight it out because that’s my area of specialization” (L1)
Subtheme: Treatment of FHCW
Participants expressed the need for the government to show concern to the FHCW; need for emotional support and motivation (Table 2). They also expressed the commitment of the hospital management in meeting the needs of FHCW (Table 2).
I am exhausted and I feel frustrated and sometimes I feel like I should dump it. In fact, I feel neglected, I feel there is nobody apart from my friends that has ever bordered to enquire about how stressful it has been or how I cope with it. Nobody has done that. At all levels, in fact, people try as much as possible to evade or to pretend not to notice. So that they don’t give me an opportunity to even talk about it to bring up a topic or something that will make the work not to flow, but if you need something to flow, I feel engaging and interacting is essential. As I have said, from government downwards, in fact, the only thing sometimes you get from government, is not that is official but something perhaps I cannot confirm, I cannot say with degree of certainty is, that there are perhaps certain threats that you must do this, it’s your work. Yes, it’s my work but not to the extent of just risking my life. When I always say that as far as I am concern, some of the people that feel that they are at the head, at the top, have never bordered to even visit from a distance to say that is an isolation centre and wave to people; how are you? They have not done that. They have severed themselves as far as I know” (M1).
“From the aspect of the management, our management has been supportive in trying to meet our needs, the needs of the frontline health care workers working at the isolation centre. From the side of the government, they have done some support with the materials that we are working with like the PPE, consumables and all that, we’ve had support and we have not lacked materials to work with. In terms of emotional support, we have not gotten because nobody from the side of the government has bordered to come and find out what we are doing and what has been our challenges so far. In terms of financial support, we’ve not really gotten much from the federal government, they promised to give us additional 20% of our basic salary to all the frontline health workers, they paid for 2 months and that was it; based on the number of months we have worked here it’s really not encouraging as far as that aspect is concerned, the government has not done well” (M2).
Theme Two: Working with COVID-19 patients
Subtheme: Taking care of patients
Participants were excited working with people recovering from COVID-19 which is associated with their healing while taking care of them (Table 2). Some of their experiences is narrated as follows.
“I feel very excited to work with them because I see them coming in a very bad state, we commence treatment, they get better and go home. I am very happy because I see them come with a lot of symptoms, we commence treatment and they get better” (M5).
“Oh great! If there is anything that gives me passion is to count myself among the people who give other people hope to live. To me, it’s a privilege” (N1).
“My relationship with them has been cordial because this disease can infect anybody, it doesn’t respect who you are, where you are from. So, that they are COVID positive doesn’t mean that I am better than them. I didn’t really feel somehow, all I need to do, is just to put in my best, put on protective measures such as the PPE, well kitted, go and see them, talk to them like we have known each other before, and even that in one way or the other helped them psychologically. For them to leave their houses and come here, the stigmatization outside and coming to the hospital environment, the health care workers will now be looking at them with that stigma, will not help them. Mostly, when I go, I relate well with them, we talk to them, we give them reassurance, we do what we want to do to them and then most of them, they feel happy about the care they are getting especially those that came from other hospitals. There was a patient that said; wow! You mean you people can come and talk to me and touch me? She was impressed because, from the hospital she was coming from, nobody borders to come close to them. Here we are, not just coming close to them but on several occasions, we just pat them, like reassurance, don’t worry, you will get well, so, all those things also helped” (N3).
Subtheme: Types of patients
Some of the patients were described as accommodating while others were difficult to work with (Table 2). Majority of the patients that were admitted in the isolation centre had difficulty in accepting their disease status, they had to be counselled before accepting their disease status (Table 2). Some participants narrated their experiences as follows.
“Ah! That’s a damn lot of issues now. Well, you know, they always come in different forms and their approach to issues generally. Some do understand with you, so we could categorize the patients. For instance, back then we knew that some had this notion that you are doing a government job; so, their whole attitude was, you just do the job irrespective of the safety measures and mechanisms that we put in place, sometimes you just see them breaking these rules to our own detriment. The notion in their mind was, it’s your job, you just face it and face your business. Then you have some patients who on the other side are very obedient, they keep to the rules, they understand you, appreciate what you are doing, they don’t want you to get infected, they understand you and when you explain to them, they are very forth coming. So we had a range of patients from those who understood what was going on, to those who have a different attitude towards the services we were rendering. We were the second isolation centre, so when we threw in ourselves, there wasn’t any health insurance, there was nothing, so we just submitted ourselves for the national assignment. So when you hear some of the patients talk about us, as if is something that was optional to us, it is a little bit discouraging, you source for strength for yourself and keep pushing” (M3).
“Yes, at first, the truth is, most of the patients, you need to convince them that this virus is real. At first, none of them will believe and tell you that; I am positive. That is the first difficult task. Eighty percent of them that come, don’t believe that they have the virus. So, as a nurse, the first thing I do is to convince them that; this disease, this is how it happens and the only thing is about acceptance. The anxiety of them accepting that they have COVID, you have to counsel them, educate them, before they accept and you take them into the ward. The first 12 to 24 hours, there is anxiety, high level of fear and rejection, after 24 hours they relax and have free mind. The environment too contributes and you see that interaction between them, we take all our patients as family and that is the joy in this place. That family thing, discussing with them one on one, they see how we take care of them, talk to them, come close to them, that rejection that they feel from outside is no more there so they feel at home and that is what gives us our quick recovery of patients in this centre. Most of the patents testify to that (N4).
Subtheme: Enormous task
Participants expressed fear of being infected and discomfort when waring PPE for a long duration while others described the task as enormous (Table 2). The experiences of some of the participants is narrated as follows.
“Though it has not been easy, because most of them you need to spend much time with them and then with the nature of the disease, you know, we have limited time to spend with them. But sometimes we go the extra mile to stay with them because of their condition. Some patients are in severe distress, which requires prompt attention and adequate care, we cannot just neglect them because the disease is deadly, we just have to do our best. When you are in PPE you know, it is usually not comfortable but we are still adapting and doing our best” (N5).
“The task is enormous but because it is what we are ready to do, you know, where there is a will, there is always a way, because we have taken it upon ourselves to do, and we are ready here, it doesn’t matter what it will cost us. It’s just like you have put in your head, you cannot go back again. In difficult times; you say ah! I have not rested. You know during this COVID many of our colleagues and in so many places, even all the ministries, everywhere was shut down, people were resting at home without coming to work, even when there was ease of the lockdown, they come once in a while. We are coming every day, 24/7, no weekend, no Saturday, no Sunday, yet we are doing it, believing that God is a rewarder” (L3).
Theme three: Psychological, mental and emotional trauma
Respondents were psychologically, emotionally and mentally challenged while carrying out their duties (Table 2). Some respondents were psychologically traumatized; they felt exhausted, frustrated, neglected, demoralized and depressed. Others include lack of health insurance for FHCW at the isolation centre, discouragement from doing the job among their loved ones and emotionally down due to loss of patients. Some of their struggles were movement restriction, separation from family/friends and cut-off of relationships (Table 2).
Subtheme: Psychological and emotional trauma
A respondent felt discouraged and withdrawn when their colleagues in the isolation centre tested positive which made him not to come to the isolation centre for some days (Table 2). A respondent had psychological fear of dealing with a highly infectious virus (Table 2). Some of the participants narrated their experiences as follows.
“Sometimes I get depressed and the depression sets in when I see one or two of my colleagues who we started this work with coming down with infection and you would expect that we have a good health coverage that will carter for those people and it’s not just there. The people will have to source for their own treatment themselves and you start thinking, is it really worth all the struggle? So, at some point in time, when I am faced with some of these experiences, it really, kind of weighs me down and I start thinking that maybe I should have a rethink on the whole thing” (M3).
“When we talk of performance, the one that really affected me was when I discovered that seven of my colleagues were affected. We had to admit them and these are my colleagues we were walking with day to day. At that point I felt like, do I still have to continue this work? At that point, a lot of thoughts came to my mind; I felt that if anything should dare happen, who will take care of my family? What will become of my family? At that point I felt withdrawn. I remembered, one day, even our General Overseer had to send a message to me personally, asking if I am okay? I hope all is well with you? Is just that I felt withdrawn. We have been discharging people and we have seen the success rate. I think the only thing that affected me was the fact that I felt withdrawn and I wished I could be exempted from the work. What I mean by withdrawn, was that completely, I don’t even come to the isolation centre to work and even if they comment on the platform I don’t comment on it; that is for that period. I wished I could go back to my day to day activity, before COVID” (M4).
“Ah! Psychologically you will be demoralized, for the view of the society, my colleagues outside and my loved ones. At the initial stage of COVID-19, I have received call from family and well-wishers; we heard that you have decided to work in the COVID-19 outbreak, this disease that is killing everybody, do you want to kill yourself? All sort of things and it took me a great task to convince them that I am not going there to kill myself but to save lives and somebody else has to do it. When you go to the gate to buy orange, they will ask you, what are you doing here? Are you not supposed to be with your people? They keep their distance and if someone is talking to you, they will ask him why and inform him that you are working with COVID-19. Psychologically, it is traumatizing. It cannot be over emphasized, I am having a lot of psychological challenge because of doing this job” (N1).
“Yes, there is not much difference, the only difference now is psychologically within you, you are dealing with a highly infectious virus that you cannot see. Then, you don’t even know when you will come in contact with this virus despite the PPE you are waring. Are you getting this virus when you are duffing? Are you going to come in contact with this virus when you touch the patient or when you interact with the patient? Is your PPE anywhere breached? So, all these things play a role in the sense that you just have to be careful compared to when you are working in the ward you were working before” (N4).
Subtheme: Mental challenge
Some of the experiences of participants (Table 2) regarding mental challenge is narrated as follows.
“Mental health has been a big challenge, initially when we started we were not going home to our families, that was a very big issue because staying away from your family for months is actually a very big challenge, for me, that was an issue” (M2).
“The first challenge is being confined in to a room and being separated from my family. The truth about it is when we started, we spent more than 2 or 3 months without seeing our loved ones because from the isolation centre, to your hotel room, from your hotel room to the isolation centre. The first time I saw my loved ones, everybody was scared of coming close to me because they just believed that if they touch me, they will be infected. That mental ability of curtailing that rejection from my own family and my colleagues at my place of work, it really weighed down on me but with time I picked it up and said these are some of the challenges I have to carry; and that gave me the courage when they started coming back to interact with me” (N4).
Subtheme: Stress
Some of the stress that was encountered by participants on their line of duty was the log duration in waring of personal protective equipment (PPE) and fever (Table 2). Narration by some of the participants is presented as follows.
“There is difference because before at our various departments, we don’t need to put on PPE while attending to patients, but now before going into the isolation centre, we have to put on complete PPE which is discomforting; we have to stay like 30 minutes, an hour, two hours, so, it’s really affecting us” (N6).
“When we started about a month or two, it was a kind of fever experience, I don’t know whether it was a result of the anxiety, fear or whatever but we don’t know. Three of us working in the laboratory, had fever and we took medications. We don’t know if it was COVID but we called it fever because none of us tested for COVID. Mentally we assumed that anything can happen since we will be dealing with COVID. A day before I came, there was a consultation I had with heaven and He gave me a verse that settled my mind; lo, I will be with you and nothing will happen. Thinking of anything outside God who has given me the assurance, I don’t have that fear” (L3).
Subtheme: Priming the mind
A respondent expressed the need to brace up in living with corona virus (Table 2). The participant narration is as follows.
“Well, COVID-19 as far as I am concern is something that will not be eliminated easily and we have to just prepare our minds to live with it” (L1).
Theme four: Stigmatization
All respondents felt stigmatized while working at the isolation centre (Table 2).
Subtheme: Stigma associated behaviours
Participants were stigmatized by family, friends, colleagues and their resident communities (Table 2). Some of their experiences is narrated as follows.
“That’s the part I am asking you, which part of stigma? I think I can write a book about stigma. From the beginning, my colleagues have zeroed us as if we were the corona virus itself. It was like a corona virus moving around. Of course, our colleagues will not associate with us and any site of us was like we were transferring the infection, since they viewed us as the virus and we are just coming to infect them. At the early part of the pandemic, we needed to take care of our basic needs too, feeding and all of that. If you need to go out, because you are providing services at the isolation centre, you can’t cook, you can’t do anything. You can’t walk out even to just pick up food from an eatery without people watching and saying, oh he is here! He is here! At some point in time, I had a terrible experience of a colleague asking me to leave the eatery. So, from family I understand with them. My colleagues, I try to understand with them because these are hospital health care workers who should know better and who should have been in the forefront of educating people but because everybody was afraid, let me just be frank, even they were afraid of COVID. So, we were just restricted in one place. It’s as bad as even buying things outside because when they see you outside, it’s like; oh God! what’s this man doing here!” (M3).
“What made it worse was if my colleagues who should know better treat me like this, how much more of somebody outside who is not a doctor or nurse or who doesn’t know anything about me? That was just the issue. Initially, I discovered that once I enter the department, they call me COVID doctor. If I come, nobody wants to interact with me but now everybody does, probably because time has already taken over and some even come to my office to ask questions on what to do? In the department, we had a suspect case they called me and asked of what they should do. At the early stage there was stigma that nobody wants to interact with you. They run away from you and all that” (M4).
“A lot! Not immediate colleagues here, our colleagues in the Teaching Hospital. A lot! A lot! When you have cause to go and get drugs in the hospital and as you reach there, they will tell you, stop there! Stop there! Don’t touch our things. A lot! It happens often“ (N1).
“Yes! Some of them will tell you that, had I know you will work at the isolation centre, I would not have consented from the beginning. I had to tell them and educate them that it is not a death warrant, to even the victims as well, there is hope for them. if some of us back out, what of the patients that are out there? Who will be there for them? It could be them, it could be we and if everybody backs out, who is going to do the job? So, sometimes, you have to take responsibility” (N2).
“Yes! Yes! The issue of stigmatization is there; from your family, from your colleagues. When we started, you cannot even cross to the main hospital, everybody will be running away from you. I remembered when I went there to pick something; I was reported straight to my coordinator; they just gave me federal warning that I should not come close to their unit; I should remain in the isolation centre. Later on, when they found out that there was not just community spread but hospital spread, they felt they are more at risk than those of us working at the isolation centre, so they became friendly. That stigma was there and everybody was scared of people working at the isolation centre” (N4).
“The stigmatization is that you are a corona patient, even within the hospital. In fact, initially when we started working in the laboratory here, there are some things we needed to get from the main laboratory, as you are coming, your colleagues will be running away from you because you work at the corona centre. It is assumed that you are infected and you are coming to infect them. These are the experiences we had at the initial stage. Up till now there is the way they feel about you; they say he is at the corona centre, because they know you are working at the corona centre. The fact that we are here is another issue on its own” (L3).
“Much! Much! Some people that know that I am working here totally don’t want to associate with me. last week, I went to a compound to fetch water, tap water, in the compound they know I am working here, the owner of the compound, the woman, asked me not to touch her tap, she called her son to come and open the tap for me, the only thing I touched was my gallon that I came with, even her gate, they opened it for me. So, I was embarrassed but I know it is normal to some people” (H2).
“It is the same thing with the community. It took the head of the community to meet me and told me that since I am working at the isolation centre, I have to isolate myself from others because of the news they heard about the virus. It was something scary and since I am working there, I might get the virus and bring it to the community and spread it. So, they need me to leave the community for the period of time, so as to know how the situation goes. So, I had to leave and I thank God for the management that provided a place for us to stay, that was when I felt relieved” (H3).
Subtheme: Effects of stigma
some respondents had to withdraw themselves from family, friends, colleagues and their residential communities due to the ongoing stigmatization of FHCW working at the isolation centre (Table 2). Some of their experiences is narrated as follows.
“When we started even our colleagues that are health care workers that are not part of the isolation centre workers do not interact with us. Even now, some don’t feel comfortable interacting with us. So, because of that, it has restricted what I do, where I go. I keep to myself most times because I don’t want to go to where I know people will have in their minds that this person is inside COVID. Some people see us as people who can give them COVID infection. So I try not to go to some places so that should there be anybody that comes down with COVID, to subsequently link it to me and blame me as a source of infection to that person. So the stigma especially from health care workers is there” (M1).
“Even at home, my neighbour since he knew that I work here he stopped my children and grandchildren from going to his house and stopped his family from coming to my house. Even some people from my state and people I know very well that used to come to me stopped coming to my house because I work in the corona virus centre. it’s like I have the infection, maybe it is lying on my body, I don’t know. I stopped visiting, I don’t go to people’s houses, I manage to go to church and I have a corner I sit, I don’t stand up to go to places in the church, once the service is over, I go straight to my car, wait for my family members and drive away“ (L1).
Subtheme: Reasons for stigmatization
Reasons for stigmatization as narrated by some of the respondents ranges from fear of getting infected, limited or the lack of knowledge and working at the isolation centre which has to do with treating and taking care of people recovering from COVID-19 (Table 2). Some respondents that stated fear of infection as one of the reasons for stigmatization narrated their experiences as follows.
“It’s fear; fear of getting infected. They are afraid of getting infected and they know that this infection doesn’t have a cure. So once they get infected, they are thinking that their chances of dying are high. So, as much as they can, they should avoid anything or anybody that can expose them to the infection; health care workers at the isolation centre, have a high chance of transmitting infection or getting infected if there is any breach in the protocol” (M1).
“I think it is just the fear, it’s better now. Back then at the onset, with the prediction and what was happening, thousands were dying globally, we were seeing thousands needing ventilators. So, of course, every other person around too was afraid. If I come down with it there is some uncertainty; will I survive? will I die? The real issue will have been the fear factor; people were not sure of what to expect” (M3).
“I guess is because of the fear of the disease, the high infective rate of the disease and the possibility of death. Nobody wants to die, because they think by going closer to them, I will infect them. They felt that if I am going inside the isolation centre, I may be a source of infection to them” (M4).
“Of course, I think I know; one is because everybody is scared and that this disease once you get the disease, it’s a death sentence. If you are coming close to them, they think you are coming with the disease. Not knowing that with the knowledge you have gathered, you know all the necessary percussions to take. They even think that when you talk to somebody on phone you will be infected. Your coming, they see you as a danger to their own health. I think there is need for more sensitization about the disease. They should know that there are precautions you can take while you are in the mist of other people” (N1).
“Because of the deadly nature of the virus, people are scared, they know that once they come close to you, or you come close to them they will get the virus if you are infected. That is why the people are scared but now that they have been enlightened, the level of stigmatization has reduced” (N5).
“Of course you know as a pandemic, everybody is afraid, so that he or she will not fall victim. Immediately they say we are the frontline health workers working at the isolation centre here; any time they see us, they don’t want to come close to us, they will be running away from us, despite wearing of facemask, they are still running away from us” (L4).
“Uhmm! The reason people are scared is because they know that I work here. They think I must have been infected and since they think the disease is air borne, by going close to them, they will become infected. Now, I think the scare has reduced” (H5).
Some of the respondents attributed limited knowledge of corona virus (Table 2) as the reason for their stigmatization narrated their thoughts as follows.
“Lack of adequate knowledge about the disease, because we should not be people that are stigmatized but people that are celebrated, at least for being a frontline health worker. So I think proper education will go a long way in stopping all these stigmas” (M5).
“It’s due to ignorance; when you have professional colleagues and they are running away, they have fear, it is ignorance. When you have people that don’t have medical knowledge; those ones can run away because of general fear” (L1).
“Lack of education; when people are not educated, they don’t even know how to go about it, the implications and all that. So, they will stigmatize you because they feel you are carrying the virus in your body and you are coming to transmit it to them. If they are enlightened, trained and educated on that, both in the community and their working place, they will not stigmatize you” (L2).
“Lack of knowledge! Lack of knowledge! At first when the disease came, it was not well known, the knowledge was not vast. So, their ignorant in that aspect, if they have orientation, I think it will help a lot” (H3).
Some respondents stated that working at the isolation centre and public misinformation (Table 2) was one of the reasons for the stigmatization and narrated their feelings as follows.
“It’s simply because I am working with the corona patients and the disease is contagious, you can be infected through the air or through hand shake. All of these is what is responsible for the stigmatization” (L3).
“It is because they know I am working at the isolation centre. Those that know that I work here are the ones keeping their distance. Like in my compound, my next door neighbour at first she does the same thing to me but I made her understand that is not what people are saying or thinking; if you follow the social distancing rule, waring facemask and disinfecting your hand, you can relate with them. It is not a killer disease, even if you are infected, by the grace of God, you will get back on your feet, if you follow the prescription” (H2).
Theme five: Recommendations
Subtheme: More knowledge on infection, prevention and control
Education and awareness creation along with the observation of preventive measures were recommended by respondents as part of measures in curtailing the spread of the outbreak (Table 2). Some of the respondents’ narrations is as follows.
“More education about the virus; creating awareness among the populace will help to reduce the stigma. Letting people know that the fact that someone is working in the isolation centre does not mean that he/she is having the virus all over their bodies. We need to educate people to understand that we are human beings and we need their support. If everybody runs away from us, it will be very traumatizing for us. We are doing something that is honourable and we expect the people to appreciate what we are doing and not to stigmatize us. I think with more understanding and more awareness education, the stigma will reduce” (M2).
“Education; in my own opinion I think that at some point in time, the information that was coming out was not synchronized because you have on one end government have an idea of what they want to do, but the end users; the message wasn’t passed in the same magnitude, in the same perspective that it should. You find government say you need to use a face mask and the person says why should I use a facemask? Government will say using a facemask will protect you and the other person and the man will say that he doesn’t want to protect himself. I think that a lot should have gone into educating and sensitizing people. I think that the religious bodies and a few key people should be making advocacy on what to do. Education was the real missing link. The method of message delivery did not come out in such a way that people could appreciate the magnitude of the problem that we are going through” (M3).
“Proper education of the population starting with the health worker; tell them that this disease is not just infectious because you work at the isolation centre, we ware complete PPE before attending to the patients and we ensure as much as possible not to contact the virus. So, proper education to accept everybody and even to see them as heroes instead of stigmatizing them will go a long way in solving it” (M5).
“Enlightenment, you need to enlighten the society on the disease, the mode of transmission and also to make them realize that in many situations someone has to take a bold step to contain the disease. Instead of being stigmatized, they should be praising us like it is done in a civilized society” (N1).
“The most important thing to do is regular hand washing, maintaining social distance, waring of facemask and enlighten the community and the populace, let them know, that things are not the way they are thinking” (N5).
“There is need for health education, a lot of sensitization needs to be done everywhere; both to health personnel’s and the communities. I think it is also important in the health sector, not only for frontline health workers but for everyone as long as you are in the hospital community. I think it is important for everybody to be trained, so that they can have understanding of the virus and can also be educating people out there. Let people have some basic knowledge about the virus. Community education and sensitization will go a long way, because if people have this understanding, I don’t think there will be much stigmatization” (L2).
Subtheme: Improvement of services of FHCW
Some respondents expressed the need for more government involvement in the fight against the pandemic, motivation of FHCW and increase of manpower (Table 2).
“Motivation! Motivation! Motivation! Financial motivation, encouragement, honouring people. There are frontline health workers that are supposed to be honoured. Promotions and others as at when due” (N2).
“I know the management are doing their best but maybe they can increase the manpower, so that the time of exposure will not be much on me. if you are many, you know that you will just come and work once or twice and have your rest, you boost your immunity before you come back, that can help. If they can just give stipends as motivation” (N3).
“Everybody needs motivation but just like I told you, we have a wonderful team here; The Chief Medical Director of the Hospital, is also a member of the team, he is the General Officer, we have team lead, we have house manager, in fact, it’s a pleasure working with this wonderful team and we need motivation” (L1).
“For the service, if there are some of the things we need that are supposed to be here which are not, some of the investigations which we need to do because the equipment are not there we couldn’t do them but for the available ones, we are running the them. We need the government to supply the needed equipment’s in the laboratory so as to carry out other functions” (L3).
Table 2: Themes, subthemes, codes and frequency of codes mentioned by participants
Themes
|
Subthemes
|
Codes
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Frequency of codes mentioned by participants
|
Early phase of the pandemic
|
Effects of the pandemic
|
Fear and anxiety
|
(M2)*3/(M3)*16/(M5)*6/(N1)*2/(N3)*1/(N4)*5/(N5)*2/(N6)*1/(L1)*3/(L2)*8/(L3)*6/(L4)*6/(H1)*2/(H2)*2/(H3)*5/(H4)*1/(H5)*4
|
Global, social, educational and economic impact
|
(M3)*4/(N5)*4/(N6)*5/(L2)*2/(H2)*2/(H5)*1
|
A call to duty
|
My responsibility
|
(M1)*14/(M2)*5/(M3)*6/(M4)*1/(M5)*3/(N1)*12/(N2)*4/(N3)*5/(N4)*5/(N5)*7/(N6)*3/(L1)*1/(L3)*9/(H1)*4/(H2)*3/(H3)*5
|
An honour to serve
|
(M2)*1/(N2)*1/(N4)*2
|
Feeling skeptical
|
(M4)*2
|
Loss of clients
|
(M3)*6
|
Fighting the challenge
|
(M1)*2/(M2)*3/(M3)*2/(M4)*1/(N1)*1/(H1)*2/ (H3)*1
|
Treatment of FHCWs
|
Government need to do more
|
(M1)*10/(M2)*8/(M5)*1/(N2)*2/(N6)*3
|
Kudos to hospital management/ partners
|
(M1)*1 /(M2)*7
|
Working with COVID-19 patients
|
Taking care of patients
|
Excited working with patients
|
(M2)*4/(M4)*3/(M5)*3/(N1)*3/(N2)*2/(L1)*5/(L2)*5/(H2)*3
|
Caring for patients
|
(M2)*2/(N3)*18/(N4)*9/(N5)*9/(N6)*10/(L1)*5/(L2)*2/(L3)*6/(L4)*1/(H3)*4/(H4)*2/(H5)*4
|
Types of patients
|
Difficult patients
|
(M3)*6
|
Accommodating patients
|
(M3)*8
|
Difficulty in accepting status
|
(N4)*7
|
Enormous task
|
Enormous task
|
(M1)*4/(M3)*5/(L1)*2/(L3)*6/(L4)*1/(H2)*5/(H5)*2
|
Psychological, mental and emotional trauma
|
Psychological and emotional trauma
|
Feeling tired, discouraged and depressed
|
(M1)*7/(M3)*5(M4)*5/(M5)*2/(N1)*4/(N5)*2
|
Fear of infection
|
(M4)*8/(N4)*7/(H5)*1/(L2)*2/(L3)*1
|
Mental challenge
|
Cutoff of relationships
|
(M2)*4/ (N2)*1/(N3)*5/(N4)*5
|
Stress
|
Fever experience
|
(L3)*5/(L4)*1
|
PPE stress
|
(N6)*2
|
Priming the mind
|
Living with the pandemic
|
(L1)*2
|
Stigmatization
|
Stigma associated behaviours
|
Feel stigmatized
|
(M1)*3/(M2)*13/(M3)*1/(M4)*3/(M5)*4/(N1)*6/(N2)*2/(N3)*2/(N4)*5/(N5)*6/(N6)*3/(L1)*1/(L2)*2/(L3)*1/(L4)*3/(H1)*2/(H2)*5/(H3)*1/(H4)*1/(H5)*3
|
Stigmatized by family/friends
|
(M2)*3/(M3)*3/(M4)*2/(M5)*2/(N2)*2/(N4)*2/(N5)*2/(N6)*3/(L2)*4/(H1)*1/(H5)*1
|
Stigmatized by colleagues
|
(M1)*4/(M2)*1/(M3)*11/(M4)*5/(M5)*3/(N1)*9/(N2)*1/(N3)*8/(N4)*7/(N5)*4/(N6)*5(L1)*3/(L3)*6/(L4)*4/(H1)*3/(H2)*5/(H3)*6/(H4)*4/(H5)*2
|
Stigmatized by community
|
(M1)*3/(M2)*1(M3)*6/(M5)*1/(N1)*3/(N2)*2/(N6)*1/(L1)*4/(L3)*4/(H2)*9/(H3)*4/(H4)*3
|
Effects of stigma
|
Withdrawal behaviour
|
(M1)*4/(L1)*6/(H2)*2/(H5)*1
|
Reasons for stigmatization
|
Fear of infection
|
(M1)*8/(M2)*2/(M3)*4/(M4)*3/(M5)*1/(N1)*3/(N3)*4/(N4)*3/(N5)*4/(N6)*1/(L1)*3/(L4)*2/(H1)*1/(H4)*1/(H5)*3
|
Limited/lack of knowledge
|
(M2)*3/(N2)*2/(N3)*6/(L1)*3/(L2)*3/(H3)*5
|
Working at the isolation centre
|
(L3)*2/(L4)*4/(H2)*2/(H5)*1
|
Recommendations
|
More knowledge on infection, prevention and control
|
Education and awareness creation
|
(M1)*1/(M2)*4/(M3)*12/(M4)*6/(M5)*2/(N1)*2/(N4)*8/(N5)*2/(N6)*1/(L2)*7/(L4)*1/(H2)*2
|
Observation of preventive measures
|
(N5)*3/(N6)*3
|
Improvement of services of FHCWs
|
Motivation of FHCWs
|
(N4)*8/(N3)*1/(L1)*2/(H1)*1/(H3)*4/(H5)*5
|
Need for more laboratory equipment’s
|
(L3)*1/(H3)*1
|
Increase manpower
|
(N3)*1
|
Health insurance
|
(M1)*1/(M2)*1/(M3)*4/(M4)*2/(M5)*2/(N1)*4/(N2)*1/(N3)*1/(N4)*1/(N5)*1/(N6)*1/(L1)*1/(L2)*2/(L3)*1/(L4)*1/(H1)*1/(H2)*1/(H3)*1/(H4)*1/(H5)*1
|