Care for the caregivers

With India observing July 1 as Doctors’ Day, TNIE speaks to experts in the field about the immense pressure and mental health issues ailing the medicos in Kerala
Representative image
Representative imagePhoto | (Express Illustrations | sourav roy)

KOCHI: Dr Anuradha, 29, had found her residency a heart-wrenching experience. More so because it was the pandemic period. There were fears that she would bring home the virus from the hospital as PPEs and N95 masks were few in the days when Covid was at its peak. Loss of lives was almost a daily affair. Her work sphere was grim, leaving some of her colleagues depressed. What was even more upsetting was the suicide attempt of one of her batchmates.

“Residency is a challenging period in a doctor’s life. With back-to-back night duties and gruelling work atmosphere, and Covid blues on top of that, it was plain hell,” she says.

“I did try to get professional help but was told not to use my own name as it might put my career at risk. It took a lot of soul searching, support from family and friends, and my own understanding of what this profession means to me, to pull myself from that brink.”

Such a support system is rare though for most students, residents or even experienced professionals. Globally too, fears of putting their career in jeopardy shuts medicos from seeking the help they need. And the mental blues are not always Covid-related.

According to 10 years of studies published in academic journals that were part of a 2018 literature review, statistically, doctors succumb to mental afflictions twice as much as the general public. Studies in the US reveal more than one in five doctors report feeling depressed. Male physicians are 1.5 times more likely to attempt suicide than the general male population.

The number is higher among female medicos — 2.5 times more likely than the general female population. In the case of medical students, half of them harbour anxiety, and one-third show depressive traits. The American Foundation for Suicide Prevention states that 28 per cent of residents experience or display major depressive episodes during training.

The Indian situation is more complex with a lot of pressure on the medical sector and a shortage of skilled staff to cater to the growing demands of the booming population. According to a recent study published in the Indian Journal of Psychiatry, as many as 358 doctors died by suicide in India between 2010 and 2019, including 125 medical students, 105 house surgeons, and 128 doctors. Around 70 per cent of them were in the 30 to 40 age group.

Also, half of these doctors are women and are mostly in the specialities of Anaesthesiology (22.4%) and Gynaecology (16%). Experts say a reason for the high numbers among anaesthetists is the easy availability of drugs.

In Kerala, studies are being taken up under the aegis of the Indian Psychiatry Association and the Indian Medical Association (IMA), says Dr K Sudarshan, the chairman of IMA’s suicide prevention project for doctors. However, as per an IMA estimate, about 11 doctors and medical students have died by suicide in 2023.

The issue of mental health in general spans a broad canvas and is a multi-dimensional topic, says Dr Rajeev Jayadevan, gastroenterologist and researcher and the past president of IMA Cochin. While stress is part of every sphere of life, among doctors, it also has to do with the grooming they receive to take care of others.

“There is hardly any focus on them and their health. That is the mindset which should change,” he says. During his tenure in 2019-202, the IMA Cochin brought out a series of awareness materials on different self-care tips for doctors, one of which was on mental health. They were told it is okay to seek help when help is needed.

The other aspect that could trigger stress is the enormous amount of learning doctors have to do. “Those with aptitude will find the learning a thing of joy. For those who enjoy the ride, adapting to this amount of learning will be easier than the ones who entered the field due to different pressures,” he says.

“The trend to start intensive medical education immediately after Class 12 needs to be thought over. Putting students as young as 17 into a high-intensity curriculum is not rational. Even in the West, there are cushions of pre-med or basic degree courses after which the actual medical study begins,” Rajeev adds. 

If the rate of doctors dying by suicide is going up by the year, the number of attempts would be even higher, says Dr Sudarshan. This prompted IMA to devise a helpline that would address the issue.

“We have a panel of 60 volunteers who are senior psychiatrists and are part of IMA’s project — Helping Hands — for ‘Emotional Well-being and Suicide Prevention’. The project has a 12-hour facility where distressed medicos could call up and be heard. In three months, we have had about 300 calls come our way. We take turns to man the facility daily, from 8pm to 8am,” he says.

Most of the calls come from house surgeons and MBBS students. The facility is also for professionals, who are victims of the immense pressure to perform leaving them with a workload that requires them to put in from 52 to 80 hours a week. Families of the professionals also would be covered by the project.

The IMA now plans to make it a 24-hour helpline and create awareness across the state, and the country as well — the first such venture in India. Their mantra is simple: self-care is the first care.

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