They carry our pain, cry when no one sees, but who takes care of caregivers?

The trauma of witnessing death and the emotional toll weigh down frontline workers. [Courtesy] Every day, we are vulnerable to a new outbreak, disease, pandemic or virus. Recent ones include the Marburg virus, Mpox, Ebola, Zika and the nightmarish experience we faced during the Covid-19 pandemic. No one was ready. Governments and scientists across the world scrambled to understand and contain a fast-evolving threat. It was a new experience, scary, unpredictable and relentless. However, when one is unwell, the burden of care falls significantly on a select group, those in the medical space. During Covid-19, we all expected doctors, nurses and clinical officers to have the answers. We wanted them to always know what to do. But these healthcare providers were themselves at high risk of contracting the disease. It was overwhelming. Society expected them to be demigods, when in reality, they are human too. This expectation weighed heavily on their mental, emotional, psychological and physical health. They faced stigmatisation not only from the public but also from their own families, friends and loved ones. Every time a new virus breaks out, frontline health workers are among the first to be called into action, often unprepared, unsupported and silently suffering. Covid-19 exposed just how much we rely on healthcare providers in times of crisis, yet how little attention we give to their own mental, physical and emotional well-being. Sharlet Anzazi, the Head Nurse at Munarani Dispensary, Kilifi County, recalls the Covid-19 period as a personal battle, one that pushed her to the limits. "It felt like a suicide mission," she reflects. "You woke up, wore your scrubs, and walked into the unknown. Every single day." As the lead nurse, Sharlet was not confined to a single station. She rotated through emergency zones, worked in isolation centres and dealt with staff shortages. Her team's morale was low, but the expectations from society remained high. "We were perceived as miracle workers," she says. "People expected us to know it all, fix it all. But it was a new disease. Information was limited. Every day was a learning curve." This lack of information only made the emotional toll worse. Sharlet recalls the panic when personal protective equipment (PPE) arrived, many of them were either too small or too large. Later, they learned that many healthcare workers were infected not during treatment but while removing their PPE. The absence of proper training was a significant oversight. The physical exhaustion was immense. "There was a time I worked for 36 straight hours," Sharlet said. "I had to switch off my phone but they came looking for me." At one point, eight of her team members were infected, forcing the rest to work harder. Some maternity units and other departments had to be shut down because staff members tested positive. Yet, through all this, Sharlet never considered walking away from nursing. "It's my calling. Even at my lowest, I knew I was where I was meant to be." The pandemic also brought personal tragedy to Sharlet when she lost her sister to unrelated causes. "I barely had time to mourn. I was expected back at work almost immediately. Grief was rushed. And the world didn't stop." Her call to action is a loud one: "We need mental health spaces in hospitals. We need appreciation, real structural support, not just praise. Because Covid-19 was a war for all of us and we haven't even begun to process the aftermath." The emotional burden placed on healthcare workers during the pandemic was immense, with few spaces to process the trauma. Michael Kilongosi, a counselling psychologist, speaks of this often-overlooked side of healthcare. "Before someone identifies as a nurse or doctor, they are first a person, a daughter or son, a sibling, a parent, a friend. These roles already carry weight. Now add to that the expectation to save lives during a pandemic, and the pressure becomes unbearable." Kilongosi's observations during the height of Covid-19 reflect a pervasive issue: burnout, helplessness and grief among healthcare workers. "They are humans before they are doctors or nurses. The trauma was intense. Seeing bodies everywhere, feeling overwhelmed and living with the constant fear of getting infected. It was too much." This mental toll is often compounded by the cultural stigma surrounding mental health in Kenya. Kilongosi notes, "We suffer from saviour syndrome. Caregivers believe they can save everyone. But they forget they have limits too." The result is a workforce that is emotionally exhausted but unable to seek help. "Mental illness is still treated like a weakness in Kenya," Kilongosi adds. Jared Mutanu* (not his real name), an emergency and critical care nurse, vividly remembers the trauma he experienced during the Covid-19 period. "I honestly don't want to go back there. It was overwhelming," he says. "Any question about it brings back disturbing memories I've worked hard to forget." Jared's role in the ICU saw him face the worst of Covid-19's effects, patients dying alone, the relentless beeping of machines and the suffocating weight of his protective gear. "It was hard. Tough. Traumatic. But I had to do my job." The psychological burden of losing patients without being able to offer the comfort of family was deeply distressing. "The panic in patients' eyes. The helplessness. The emotional numbness that sets in so you can just function." This is the reality for many nurses in critical care: the trauma of witnessing death and the emotional toll of being a frontline worker during a pandemic. Jared, like many others, is haunted by his memories of that period. "We survived. But we were never the same again." The burden of healthcare work extends beyond the hospitals. Naomi Mng'onda, an HIV testing services provider, faced her own set of challenges as the spouse of a frontline nurse during the pandemic. "Each day he returned home exhausted. He wouldn't talk much. He looked drained, emotionally and physically," Naomi recalls of her husband, Malasi Valerian. The couple's home became a place of separation, as they feared the virus. "We kept our son at a distance when he came home," Naomi says. "It was heart-breaking." Naomi's struggles were compounded by the loss of her own job during the pandemic. "I was told to stay home, and eventually, my contract ended. It was frustrating. While he was risking his life daily, I felt helpless." Naomi also noted how healthcare workers, including her husband, were not given the recognition they deserved. "My husband was never formally recognised. But he went to work every day. Risked his life." She strongly believes that healthcare workers and their families deserve more than applause for their service. As Kenya looks ahead, experts like Prof Rodney Adam warn that future outbreaks could cause even greater strain on the healthcare system. "People will be fearful of being in the frontline again," he cautions. "Some will drop out of healthcare altogether. The fear is valid." Regina Muthoni, a nurse at Munarani Dispensary, agrees with this sentiment. "We aren't taught how to emotionally prepare for outbreaks," she says. "You just respond." The lack of preparedness and training for psychological resilience is a serious concern. "If a new virus hits, we won't know what to do. We need training, drills, guidance, not just assumptions." Regina recalls the uncertainty that blanketed the Covid-19 time. "You never knew what the day would bring," she says. "There was fear. But we had to keep going." Initially, patients were referred to Kilifi County Referral Hospital. "We'd see patients already in distress. And though we weren't treating them long-term, seeing them suffer, it broke you." Regina describes feeling unprepared. "We were not trained for this. There was no emotional readiness. It was overwhelming." She recalls one case that still haunts her. "I couldn't help much, and I kept wondering if they made it." She eventually contracted Covid-19 and had to quarantine at home for two months with her husband, who also tested positive. That experience changed her perspective. "Being both a nurse and a patient, it made me see things differently. We're expected to be strong. But inside, we're scared too." She advocates for psychological support. "We have no therapists. No debriefing spaces. You just cry alone or with your fellow colleagues." The calls for mental health support and better infrastructure are urgent. Prof Adam highlights the importance of lab capacity, surveillance and rapid response teams. "We need proper lab capacity countrywide, not just in referral hospitals," he says. "We also need rapid response units that are trained to handle emergencies like viral outbreaks and natural disasters." The crisis among Kenya's healthcare workers is not just about the physical challenges they face. It is about emotional and psychological resilience in the face of overwhelming odds. Nurses, doctors and other healthcare workers are human too. They are mothers, fathers, sons and daughters, and their sacrifice should not go unnoticed. The next time we face a crisis, the question must be not only about how to treat patients but also how we care for those who care for us. Mental health support should be a standard part of every healthcare facility. Hospitals must create spaces for caregivers to talk, process and heal. Without this, we risk breaking the very people who are the backbone of our health system. "We can't just clap for nurses and doctors and then forget them until the next crisis. If we want them ready, we must make their readiness sustainable," Prof Adam says. For Kenya's healthcare workers, the time for recognition and reform is now. They have borne the weight of our health crises, and it is time we care for them as they have cared for us. The WHEELER Study provides deep insights into the challenges healthcare professionals (HCPs) faced during the Covid-19 pandemic in Kenya, particularly in the regions of Kilifi and Mombasa. Nearly 58 per cent of healthcare workers in Kenya are female, and the study sheds light on the emotional and physical toll on these workers, giving a voice to their struggles during one of the most tumultuous health crises in recent history. HCPs' experiences in the study reveal the overwhelming fear and stigma they faced. One healthcare worker noted, "You come into contact with patients during deliveries, but without PPE. You just have to commit yourself and do the delivery, but it was a challenge we faced for a long time." The fear of infection was pervasive, as healthcare workers were exposed to the virus while making life-or-death decisions without sufficient protective equipment. Reports of physical and mental health strain were widespread in the study. "We worked without rest. We were on duty 24 hours every weekend until serious burnout kicked in," one respondent shared, reflecting the unsustainable work conditions. The emotional toll was equally severe, "It was honestly hard to balance. Emotionally we were drained. It was not easy." The pandemic also impacted family dynamics, particularly for women healthcare workers. "I stayed away from home for weeks at a time to protect my family. It was very hard on all of us," one respondent said, highlighting the personal sacrifices many healthcare professionals made to protect their loved ones. Stigma and social isolation were recurring themes in the testimonies of healthcare workers. After recovering from Covid-19, one worker shared,"People stopped talking to me, even after I recovered. They were afraid I might still be contagious." This social alienation compounded the emotional toll of the pandemic. Despite these challenges, many healthcare workers developed coping strategies, such as relying on support networks, spirituality and teamwork. One source highlighted the importance of team cohesion, saying, "We were working like a team. So that all these requirements could be met." The WHEELER Study also underscores the need for systemic changes, including the involvement of healthcare workers in policy development and the provision of psycho-social support, financial safeguards and gender-sensitive policies. The study's findings call for reflection, adaptation and long-term solutions to address the ongoing challenges healthcare workers face. Through these compelling first-hand accounts, the WHEELER Study provides a stark and detailed picture of the struggles faced by healthcare workers in Kenya, urging immediate attention to their well-being and systemic improvements to better support them in times of crisis.

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