COVID-19 Society

The pandemic’s compassion fatigue

April and May were tough on Bengaluru-based Ankita Kumar. The travel influencer worked as a COVID volunteer, helping coordinate hospital beds, medicines, plasma and oxygen for those in need. As the situation worsened in Bengaluru and across the country, she found herself ‘numb’ to news of deaths that were pouring in, even of those she had been trying to find resources for.

“In the initial days when an ‘attendant’ [person accompanying the patient] would tell me that they didn’t need the resource I had found as the patient had died, I would break down. But as time progressed I wasn’t feeling anything. Every bit of bad news became ‘normal’ for me. I felt like there was a vacuum inside me,” says Ankita.

She had to take a step back from active volunteering and now helps with with vaccination drives.

A few days later, at a group online psychiatric therapy session for volunteers like herself feeling the strain, she found out that there was a term for what she, and many COVID-19 volunteers across the country, are feeling — compassion fatigue.

The American Institute of Stress website defines Compassion Fatigue as “the emotional residue or strain... of exposure of working with those suffering from the consequences of traumatic events. It differs from burnout, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.”

Also referred to as ‘second-hand shock’ or secondary stress reaction, it is caused by helping or wanting to help those in distress, which leads to a diminished ability to feel compassion. “I felt relief knowing that there was a name for it,” says Ankita.

When COVID-19 peaked in April-May, people in their late teens and 20s — students, professionals and others — threw themselves into volunteering, many for the first time. ‘War rooms’ were being set up via social media as they worked, almost non-stop, finding hospitals, oxygen and medicines, and verifying information, all the while speaking to families of the affected.

Getting emotionally involved in the lives they were working so hard to save, was natural. What made it more difficult was that they were working together — but in isolation, from their homes. There was no comfort of physical camaraderie.

Guilt and burnout go hand-in-hand

Rajiv S (name changed) has been volunteering with The Hope, a helpline in Bengaluru. Besides arranging for oxygen supply, he spends three hours daily at a crematorium near his house. He helps conduct the last rites of those who have died of COVID-19 and whose families live abroad or outside the city. There were days when he would perform the last rites of six or seven people in a single morning.

“My flatmate of 11 years lost his father to COVID, and it didn’t feel any different from the other deaths I saw. If he had passed away at another time, I would have grieved differently,” says the 27-year-old.

“The threshold of compassion or empathy has been crossed,” says Mumbai-based psychologist Ritika Tejwani who has been counselling volunteers online. “Volunteers, and others too, don’t have the usual response to death and loss. Their emotional resources are exhausted,” she says.

She puts it down to anxiety and burnout — the two most common conditions among volunteers according to her. “They are constantly on the lookout for resources — a third person’s life depends on whether they can find help or not. In addition, there is anxiety for self and family. These factors add to burnout, mental and physical,” Ritika says. Of her five online consultations daily, one or two are invariably volunteers.

As the second wave peaked and cases mounted, mechanical engineer Prasanna Athi, a volunteer from Hyderabad, found that she didn’t feel as emotionally connected as in the initial days. “Requests started pouring in and we were hustling to meet them. There was no time to grieve or process what was happening around us. It was disturbing to see up close that there was no dignity in death,” says Prasanna.

“There were days when we worked overnight making phone calls,” adds Dr Saisree Simhadri, who works alongside Prasanna. She continues, “One such case was a 32-year-old patient in Visakhapatnam who needed a ventilator. It took seven hours of phone calls and amplifying the request across social media to find one. Were we able to save him? No, he passed away that night.”

Prasanna echoes the underlying sentiment there: “I felt I could have done something more or sooner. I felt guilty…”

‘Survivor’s guilt’, as Dr Swati Netam calls it. The Bengaluru-based psychiatrist has been volunteering, working with those grieving COVID-related deaths. She sees 20- to 30-year-olds affected by ‘survivor’s guilt’ — at having survived a life-threatening situation in which others have died. “They question their existence... when people are dying unexpectedly around them. That there are no definite answers brings up feelings of helplessness and hopelessness,” she says.

Moving forward from the trauma

The second wave has begun to simmer, easing some of the pressure. The time volunteers are spending scouring resources is coming down, and there is now space to take care of their mental health and focus on the positives accomplished.

For instance, Rajiv’s group of volunteers has regulated their work such that nobody spends too much time on the cases. Some have got together for group therapy and others are being encouraged to take a step back to recuperate.

A collage of thank you messages received by COVID-19 volunteers

A collage of thank you messages received by COVID-19 volunteers  

The group of volunteers that Prasanna and Saisree are part of has begun focussing on what they have been able to achieve. “That was the only way to move ahead. We have a ‘Good Vibes’ channel on Slack [a business communication platform], where we share the good news. It could be screenshots of messages of people thanking us, people who had been cured and cases we resolved. The team decided to concentrate on that,” says Prasanna, who now volunteers on alternate days.

Dr Simhadri has begun seeking help from mental health professionals, and says she is already feeling better after weekly sessions over the last month with the psychologist.

Pre-existing mental health conditions were exacerbated during the second wave and those dealing with the stress could be affected in the long term, says Dr Netam. “A lot of things come to the surface [during therapy] such as anger and distress. Some people need medication when mental health begins to affect physical health; I have even asked people to step back seeing how it impacted their mental health,” she says.

There is another side to it, however. For some, volunteering is validation. Even a means of dealing with the loss of a dear one. “We had a volunteer who lost her father to COVID-19 in January this year, helping others was her means of coping with the death. She was putting in eight to nine hours to help,” says Ankita.

Some need to be proactive to feel useful, explains Dr Netam. “They question themselves if they don’t do anything. The thought of ‘What are we doing for people at such a trying time?’ worries them,” she adds.

Dr Simhadri confesses that volunteers like herself will not stop despite the emotional toll. “We will keep finding ways of helping.”


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Printable version | Jul 25, 2021 2:57:09 PM | https://www.thehindu.com/society/covid-19-volunteers-face-compassion-fatigue-in-india-mental-stress/article34790774.ece

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