An army to help doctors, frontline workers process the trauma of Covid-19

Before she realised, other therapists, doctors and professionals, who were handholding patients through the pandemic, flooded her appointment schedule. The response from the medical community, and the stories they were telling, had engulfed Bapat’s life. An idea that started out of curiosity to understand how her colleagues were coping, soon became a mission where Bapat was burning out quicker than she anticipated.

Soon, the therapy requests were not only from doctors, but also from frontline workers across the hierarchy of the health care system.

"The emails kept coming. I still have 120 more unopened DMs [Instagram direct messages] in my inbox. Many of them are therapists who are seeking help for themselves. They were everybody. People who call themselves, you know, mamas and mavshis—hospital support staff—are all going through compassion fatigue," recalls Bapat.

"There were staff who confessed that they [Covid-19 patients] had become just numbers (a statistic) and doctors were unfairly pushed to make choices they did not want to. Doctors shared 'we feel guilty that we cannot officially come out and say that we are having these infrastructural hurdles because if we do, then that means we are making choices about who gets oxygen and who doesn't, when in reality we too are victims of the system.’ There are these compendia of issues that became what we call in Marathi a 'gunta' [mess],” she adds.

In April 2021, Bapat got a message from her friend of 21 years and fellow psychologist, Dr Uma C Millner, asking after her. An assistant professor in the Division of Psychology and Applied Therapies at Lesley University in the US, Millner’s conversation with her friend led to the creation of the Indian Network of the Diaspora for Essential Aid and Relief (INDEAR) in the first week of May.

There were some things to iron out: Millner wanted to know how she could alleviate the situation, and work effectively to help with a 12-hour India-US time difference. With the help of her research assistants, Millner sought out volunteers in the US to join the cause. In just 48 hours of the first call for help, 200 people had signed up. Within a week, they had almost 700 people on their list including counsellors, psychologists, social workers, research assistants, and more.

Frontline workers have to visit indear.org and book a session. INDEAR defines frontline workers as essential workers, healthcare workers, journalists, bankers, teachers, police officers, Covid-19 volunteers in any capacity, mental health professionals, and more. The sessions can be individual (30 minutes) or group sessions and listening circles to help process grief. INDEAR also offers sessions that help essential workers build micro-skills around counselling and emotional self-care.

Apart from this, INDEAR volunteers are also training other mental health professionals in India who are working on the frontlines. The training includes helping with group-based support, working with children and youth during the Covid-19 crisis, dealing with family stress due to the pandemic, or parenting during the pandemic, grief counselling, and Psychological First Aid (PFA).

PFA is one of the core programs for INDEAR. "When a disaster like this happens, the immediate response of anybody is almost this dissociative, numbing experience. Especially, if you have to keep going during this process. You're trying to save lives, move forward; you're doing all of this but you're basically not feeling [any emotion] at that point," explains Millner. "One of the most dangerous things [in this scenario] is to sit down with somebody and tell them how you're feeling and talk about your emotions. So essentially, somebody has got a significant wound and you're [therapists] just cutting it open, and they're just bleeding out."

Instead of following a therapy route that works in the long-term, for healthcare workers that have to show up, the PFA program focuses on patching up the person and getting them ready for the next day, next week. "It's essentially this humane, flexible response that meets the person where the person is at and understands the nature of trauma. Indians experience things viscerally, more somatically. PFA is designed to buffer the mental health impact of this long term, prolonged excessive sudden assault on your system," says Millner.

The method tries to find answers to questions such as, 'What are the strategies available right now? What is working for them right now? How can we keep them safe at the moment? How can we give them a sense of hope, a sense of control, in the current environment?’

According to Indian Medical Association's (IMA) latest report, the second wave of Covid-19 has killed 513 doctors. This grim situation is leaving a lasting impact on those who are tasked with looking after others.

"In India, there is such huge concept of doctor being equated to God, that they are the fixers of everything," says Deepti Kumra, behavioral treatment services clinician and a volunteer with INDEAR, explaining how the trauma is playing out for Indian medical professionals. "You have that responsibility, then you have desperate family members (of the patient) waiting to hear from you. You know that you have to make that decision in split second and that's just a powerless, hopeless position to be in. That moment kind of breaks you a little bit."

Diksha Bali, Kumra's sister-in-arms at INDEAR and PhD student at University of Maryland in the US, chimes in, "Uncertainty, helplessness, powerlessness—the stress of all that can impact our body in so many ways that it further reduces our ability to function and have healthy relationships." Based on her interactions via INDEAR's platform, she says that keeping the hope alive is important. For that, talking to someone, talking to a mental health professional, helps. In her sessions, many health workers have confessed that having someone hold their pain, hold their stress, has helped.

Currently, INDEAR is offering its services at free of cost. Volunteers are donating their time, and the initiative is not accepting monetary donations at this moment, however, there are plans to do that in the future.

The collective reaches out to public relations teams in hospitals that can encourage doctors and frontline workers to seek help. The sessions are offered in as many as 20 languages including, English, Assamese, Bengali, Gujarati, Hindi, Kannada, Kashmiri, Konkani, Kutchi, Malay, Malayalam, Marathi, Marwari, Nepali, Odia, Punjabi, Sindhi, Sourashtra, Tamil, Telugu, Tibetan, Tulu, and Urdu. A lot of people, even though they speak English, rather vent in their mother tongue, says, Bapat. “So it is an amazing thing that Uma and the team gave us the option of so many languages.”

According to Millner, this is a grassroots movement. “People in the diaspora who have connections and are invested, want to give back. There's this deep desire to be of service to the people who have given you so much. We don't want people in India to feel that they are alone. So this is why people have come forward and are offering and services,” she says. “It's been an incredibly powerful experience for us.”