Types and sources of mental health problems reported
Our respondents generally reported three most common forms of mental health disorders which include depression, anxiety and post-traumatic disorder. Several respondents reported having experienced one of the three forms of mental health disorders. These findings are in line with what studies elsewhere have shown regarding what types and severity of mental health challenges among health workers during their fight against COVID-19 [6, 2, 7, 3]. Several Ugandan frontline healthcare workers highlighted that the sources of these disorders included long working hours, lack of proper equipment, lack of sleep, exhaustion, and experiencing high death rate under their care. The following sentiments from some of the health workers illustrates this
“Feelings of loss. Wishing I could have done more to save a patient, wishing resources were readily available to enable me do my work and save a life efficiently”
“We are working around the clock with little sleep and yet the cases keep increasing. Many of us are just exhausted and the public doesn’t quite get how overstretched we have been during this pandemic”
“Too many deaths and it looks like we are helpless. Bodies keep piling up, how can you sleep at night like that”
Several studies are pointing out that depression, anxiety and post-traumatic disorder among healthcare workers have been exacerbated during this pandemic [8, 9]. The situation is not any different in Uganda. This has been linked to the fact that there has been less government support in expanding healthcare response in general, and is a reflection of what many scholars have long-warned about the risks of poor healthcare systems in times of pandemics. The burden on healthcare workers is a reminder of the neglect health facilities have suffered over the years [5, 10]. Other studies also show that the poor state of the mental health of healthcare workers in Uganda has greatly affected the response to the pandemic [11, 12]. Failure to address the causes of mental health problems among frontline workers as observed above counters any sacrifices that many healthcare workers have been making since the start of the pandemic. This also further threatens the whole response strategy.
Despite the high prevalence of mental health disorders among healthcare workers in Uganda, many demonstrate through their responses a type of agency and coping strategy that is fit for purpose and is imbedded in the cultural fabric of the country. Several of our participants highlighted how community and family networks were a useful source of support.
“Talking to colleagues was useful for coping”
“Without my very supportive big family, it would have been difficult to continue in this job. Their prayers, help in terms of taking care of my chores and preparing food for me has been a huge boost for me..”
“In Uganda we are lucky to have a society that stands for each other. Neighbors, friends and strangers have really supported us in many ways during these struggles. Their help does not just end at clapping for us, they really physically show up when you need them..”
Further, a sense a reciprocal sense of responsibility to society was also a motivating element for the continued effort. Our healthcare workers pointed out that they and the people they serve were ‘one’ meaning that their very survival is tied to the many efforts done by other society members. A symbiotic relationship in Ugandan society enables this.
“Here we are one people, one family. We help each other in many ways. The farmers continue to play their part, the cleaners, ‘boda-boda’ drivers etc. They are all pushing their limits to make our society triumph under this scourge. We have a responsibility to them as well”
Rather than boggling down under the veracity of mental health challenges, local health workers in Uganda relied on communal networks for support in order to get through their mentally-challenging moments. A society with strong communal sensibilities and practices seemed to have provided avenues for healthcare workers to cope and be motivated to play their part. These findings present an opportunity of strengthening local responses by relying on feasible networks of survival. Further, as other studies have pointed out elsewhere within most resource poor settings, there exists “unrecognized and sometimes ignored portfolio assets” which are in most cases contextually-profitable [13, 14]. These portfolio assets such as family and communal support have been used for generations and could serve as a useful coping strategy if scaled up.