Solutions to prevent and address physician burnout during the pandemic in Mexico

Abstract

Background:

The COVID-19 pandemic has tested the level of preparedness and readiness of governments globally. The demand for services exceeding the capacity of the health systems in both developed and developing countries has been the rule rather than the exception. Physicians and the rest of the health-care personnel have been put through unprecedented levels of demand, within a field of uncertainty, from an evolving and insufficient understanding of the pathophysiology of the viral process, the unclear benefit of face coverings used by the general public, numerous pharmacological candidates, insufficient personal protection equipment, and the highly expected vaccine.

Aims and Objectives:

Design a program to address the emotional and psychiatric needs of COVID-19 first response Healthcare personnel in Mexico.

Materials:

in march 2020, the Mexican Psychiatric Association was invited to be part of the Workgroup for the fortification of Mental Health during Disasters of the Ministry of Health in Mexico. The charge was to develop a program to address the needs and prevent burn out in physicians and the rest of healthcare personal. The details of how this program was planned, implemented, and launched will be presented.

Results:

The program was launched in two phases. Phase A through a chat with text messaging capability was launched on 25 April, 2020. B through telepsychiatric video calls, was launched on 15 June, 2020. Phase A had a very limited demand. Phase B also had a very limited demand until the month 5 September, 2020.

Conclusions:

from the time of program launch through the first four months, the demand was very low, what may be explained due to “normalization” of stress and/or stigma among healthcare professionals. Our personnel deserve the utmost support from their society.

INTRODUCTION

The severe acute respiratory syndrome-2 COVID-19 pandemic has tested the level of preparedness and readiness of governments globally. In many cases exceeding the capabilities of high, middle, and low-income countries.

In Mexico, the first confirmed case occurred on 28 February 2020. The first official communication of the Ministry of Health became available on 23 March 2020, explaining that the COVID-19 infection was of considerable interest. The second communication was published on 24 March, 2020, recommending measures for mitigation and risk control, and on 30 March, 2020 the “epidemic” was declared a public health emergency.[1] On 8 July, 2020, there were 31,119 confirmed deaths placing Mexico on the top five countries worldwide, representing 5.7% of total deaths, while there were 204,826 recovered cases making Mexico the 7^th country worldwide and representing 3.2% of the total recovered cases.[2]

Features common to other countries and others peculiar to Mexico have occurred in such a way that our physicians, especially first responders, have entered a pathway of stress and burn out. Burn out is a well-recognized clinical condition among health professionals and an unresolved issue, even before this pandemic. Some countries and some organizations within countries have worked more diligently than others in an attempt to properly address it.[3,4]

This paper reviews both global features (i.e., rapid virus spread, lack of pharmacotherapeutic evidence) and internal features (i.e., insufficient workforce, lack of support, harassment, deficient personal protection equipment) contributing to the development of burn out syndrome in Mexican physicians and healthcare staff.

Similar to other countries, Mexican society has shown disagreements and unrest through social media outlets (i.e., Facebook, Twitter, Instagram) about the seriousness of the pandemic and how appropriately or inappropriately it is being managed. Especially about comments that were made by the President during a press conference.[5] Health officials have faced difficulties in striking the right balance between applying preventive measures and yet conserving human rights. The recommendations for confinement, the use of face masks, and avoiding crowded places have to be followed voluntarily.

MATERIALS AND METHODS

In March 2020, the Mexican Psychiatric Association was invited along with other nongovernmental organizations to be part of the Workgroup for the fortification of Mental Health during Disasters, sponsored by the Undersecretary of Mental Health and Psychiatric Services of the Ministry of Health. As such, we were asked to develop a program to address the medical personnel's emotional and mental health needs. The program was planned to have two phases, one to respond rather quickly through an online chat and the second one through telepsychiatry sessions.

Implementing this program required three areas.

Recruitment of volunteers

Through our member database, an invitation was launched, explaining the goals of the program, a timeline, and required training. All volunteers are members of our society willing to donate their time and their skills to assist our colleagues during the pandemic.

Technological development

There was a private provider hired to develop a chat that could be operated from a mobile device or a laptop.

The other platform was developed by the Department of Biomedical Informatics of Mexico's National University. It included a telepsychiatry platform, electronic health record that complied with privacy and security requirements, as well as a team for reception services, scheduling, and IT back up.

Training of volunteers

Training included two sections. The first one was training volunteers in Psychological First Aid, Grief, and Stress Coping Skills and hence that our volunteers could identify a benchmark and then proceed with further services as needed. The second section was to learn how to operate an online chat, electronic health records, and video conferencing platforms.

RESULTS

Since all these activities were to be provided free of charge to the personnel in need, our society had to figure out the way to cover the cost. Fortunately, we were able to find sponsors in the private sector to cover the cost of the IT infrastructure. The recruitment was probably the easiest part, with member psychiatrists willing to donate their time. However, the training part was not as easy. First, the on-line training for Psychological First Aid, Grief, and Stress Coping Skills became nonoperational due to the high demand. It took time to have it reinstated, which delayed the training. On the other hand, the IT training had its own challenges, given the variability among the volunteer's digital skill sets. As these obstacles got resolved, the service finally became active on 25 April, 2020. The service was expanded to provide the same services to nurses, paramedics, respiratory therapists, laboratory technicians, sitters, and janitorial staff. The second phase became operational on 15 June, 2020, a series of clinical scales were included to secure metric and measure the outcome of the program.

CONCLUSION

Solutions to address and/or prevent physician burn-out in Mexico and globally is a clear priority, as the disaster's psychological blueprint unfolds in the ensuing months. The Mexican Psychiatric Association is actively engaged in providing this service, with considerable challenges which reflects the state of preparedness for disasters like the COVID-19 pandemic and how they can be resolved.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.