Pakistan

Violence and stigma experienced by health-care workers in COVID-19 health-care facilities in three cities of Pakistan

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ICRC study: Over 41% health workers experienced violence in last 2 months

Over 41 per cent of health-care workers reported having experienced some form of violence in the last two months, with verbal violence, false accusations and stigmatisation being the more commonly experienced forms.

This finding is part of a recent study conducted by the Jinnah Sindh Medical University Karachi, Khyber Medical University Peshawar and the University of Lahore with support from the International Committee of Red Cross (ICRC).

The study surveyed 356 health care workers, including, doctors, paramedics and laboratory technicians, from 24 health care facilities in Lahore, Karachi, and Peshawar.

The study revealed that most patients and attendants were unaware of the places they could seek medical care for COVID-19, with numerous complaints about unresponsive helplines. "I called three COVID-19 care units to inquire about bed availability but none of them attended the call," one patient said. While admissions and tests were not chargeable in public hospitals, interviewees complained about the high cost of admissions and diagnostics in private facilities.

The issues highlighted in the study related to patient care, including perceived gaps concerning "irresponsible behaviour" of people and "gaps in quality of care". Some other reasons specified were resistance to compliance with extremely strict patient access and infection prevention and control protocols in the hospitals, confusion over treatment protocols and lack of periodic updates about patients' condition due to heavy burden of work.

The reasons that led to the development of violence in hospitals also included the demand of the attendants to hand over dead bodies immediately and not to mention COVID-19 as the cause of death. A doctor from a public-sector hospital in Peshawar added, "They wanted to take the body immediately as they feared the community will otherwise not attend the funeral of the deceased".

Similarly, among reasons related the quality of care due to high inflow of patients, there were complaints about prematurely discharging patients to make space for new ones and delays in test reports that led to aggression and some events of violence.

"There is an erosion of trust between patients and health care workers in Pakistan," Dr. Mirwais Khan, who heads the Health Care in Danger (HCiD) initiative of the ICRC. "We needed to see if COVID-19 was making it worse."

The experience of violence had a profound psychosocial impact on the front-line warriors, with a very high proportion of them reporting feeling stressed, threatened and scared. Many of them reported to having remained super alert, feeling stressed, disturbed, scared or threatened.

A doctor at a private hospital of Lahore expressed, "I felt very disheartened, tired and stopped fighting it. I almost agreed to all the accusations and would just relent to them." Family concerns and pressure to quit the job or take temporary leave were also a major fallout.

What can be done?

As a strong second wave of COVID-19 emerges in Pakistan during winter months, preparing to prevent any possible upsurge in violence against health care must be our top priority.

To achieve this, the study suggests a way forward by building trust between health-care workers and the public, dispelling myths and misinformation, enhancing institutional practices to address issues related to patient care and finally, improving the response to any untoward incident by enhancing security and surveillance.