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RUBY:

From Schwartz Media I’m Ruby Jones, this is 7am.

Since the beginning of the pandemic, healthcare workers have faced wave after wave of outbreaks, working around the clock in tough conditions.

Eighteen months in, Australia has more case numbers than ever, and our doctors, nurses and other health professionals are reporting alarmingly high rates of exhaustion, burnout and mental health issues.

Today, Doctor Natasha Smallwood, on the stress that healthcare workers on the frontline are facing… and what that means for the health system after the pandemic.

It’s Monday, October 11.

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RUBY:

Natasha, could you start by introducing yourself?

NATASHA:

My name is Natasha Smallwood, I’m a consultant for the Alfred Hospital. And I'm an associate professor at Monash University, where I am also looking at the best interventions for people with severe lung disease. And I also run a programme of research regarding supporting the health care workforce during crisis events.

RUBY:

And so last year - when Melbourne was in the middle of its second wave of the pandemic what was it like to work as a doctor with Covid-19 patients?

NATASHA:

Yeah, so, every day you'd go to work and you would worry about whether you would contract the virus if you did get it, whether you would bring it home? Y’know there was the worry about what if the hospital becomes overwhelmed? If we have so many cases, how do we continue to care for our usual patients? How do you do business as usual during a pandemic?

So every day I went into work, all these thoughts would go through my head, whether that was in the first wave, the second wave, or now, to be honest, it's some of those concerns still exist.

And one of the other challenges I had that, you know, everybody's had throughout the pandemic is the issue of having children home schooling. So I have three children who are all homeschooling and trying to be--...

RUBY:

And some dogs as well, by the sound of it.

NATASHA:

I know, I'm sorry. What do we do about the dog?

RUBY:

Um is there a door that could be shut at all or?

NATASHA:

Yes. Yes.

[Sounds of walking to shut a door]

NATASHA:

Sorry I’m back, dog has been addressed.

RUBY:

[Laughs] OK, can you tell me a bit more about what it has been like working from home and how that's impacted on the patients that you've been seeing? Has the level of care that they've been able to access been necessarily quite different for the last two years?

NATASHA:

Absolutely, I mean, it's it's so different trying to see someone by telephone or by telehealth because it is so challenging to tell someone, for example, like I did last week, that they had lung cancer and not to be able to see them if they you know, if they're older and can't use telehealth. And it's a telephone consultation. And I'm trying to tell them something that is devastating, but I can't see how they're reacting.

And I can't, you know, pause and take stock and read the room, because, you know, health care medicine is a two way relationship. I'm trying to help people, but I need to understand what they're feeling and thinking. So all of these things just become more challenging. They add to the difficulty of providing good care for our patients, whether they've got covid or haven't during this pandemic.

RUBY:

Mm and can you tell me a bit more about the impact of all of this on health care workers? Because we're all fairly exhausted right now, but I imagine that that would be even more acute if you'd been working on the front line of the pandemic for this whole time. So what is morale like among your colleagues, and how are you?

NATASHA:

So I guess it varies and what's been challenging for health care workers is that it hasn't stopped.

Archival tape:

“You're dealing with people on their very worst day. They're so sick, their families are frightened. And you are the person that has to console them and hold their hand without their family there.”

“I feel like I want to cry in many moments. I mean, I can do my job properly, but I would like to ask people to bear in mind that this is hell. We cannot continue like this.”

NATASHA:

Yes, we've gone from wave one to two to three, but in between those waves, nothing's stopped for us. There was no respite.

Archival tape:

“It's very difficult. And our members, of course, have been doing this for months and months and months on end and are exhausted.”

NATASHA:

So last year, I designed and led with a colleague of mine, Professor Karen Willis, who's based at Victoria University, the Australian covid-19 Frontline Health Care Workers Study. It's the largest multi professional study on this topic in the worlds

And what we were trying to do was understand the psychosocial, workplace and financial impacts of the Covid-19 pandemic on frontline health care workers.

And in terms of the psychological impacts, we found that about 70 percent of people actually had symptoms of emotional exhaustion. So burnout and about 50 percent had symptoms of depression. Quite a large proportion had symptoms of post-traumatic stress disorder and over two thirds had symptoms of anxiety.

And, of course, there is the issue that if a health care worker does have a major health mental health problem, we have mandatory reporting that says that that person, if you think they're a real risk to their patients, has to be notified.

So there are many reasons why healthcare workers will not admit to having these issues. And particularly, you know, I certainly wouldn't trash my own brand by saying I had mental health problems. You know, we have to be seen to be competent health professionals. So there is a huge stigma around admitting to having these problems and then actually seeking help.

RUBY:

Mm and what's happening as a result of that, as a result of health care workers being this emotionally exhausted and burnt out and in some cases traumatised by what's happened?

NATASHA:

I think for the vast majority, we just go on, you know, because there is a job to be done and there are people who are sick and it's straightforward as that.

But there is the issue that some healthcare workers are really fed up and really frustrated. And certainly, again, what came out in our survey was that many people had had thoughts about leaving the workforce because they felt undervalued, under supported and under-appreciated.

And even if people don't leave, there are two other important issues. When a workforce has a lot of burnout, we know that that is associated with poorer quality care. So it's a threat to the quality of the clinical care that we offer and to patient safety.

The second issue, again, is even if the whole workforce doesn't leave and I'd be surprised if they all did, some will. But the issue is how do you attract people into a profession that is unappealing?

How do you get your next generation of doctors, nurses, allied health care workers when they look around and think, gosh, I'll work really long hours, many of those hours may not be paid. I'll work in a highly stressful workplace which can be unforgiving and demanding. In a pandemic I'll be on the frontline and I might die.

And the community may not appreciate what I do.

RUBY:

We’ll be back in a moment.

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RUBY:

Natasha, recently we have seen healthcare workers targeted, attacked in public. What has that been like to witness, and has that had an impact on how healthcare workers feel about their jobs and what they do?

NATASHA:

Oh, absolutely. I mean, I think with the recent protests and there was that alleged case where a health care worker was spat on.

Archival tape -- News report:

“Good evening the anti-tax movement has stooped to a new low, abusing and spitting on medical workers administering covid vaccines..”

Archival tape -- Sounds of protester atmosphere:
“We will not comply! We will not comply!”

NATASHA:

I mean, it's appalling.

Archival tape -- Cohealth:

“Verbal abuse, had liquid thrown at them, had been spat on, and enough's enough.”

NATASHA:

You know go to do your job because, you know, you're motivated, you care. You want to help people. To be spat on because you're a healthcare worker or indeed, the vaccine hubs where some of the protesters demonstrating outside them and the risk to those health care workers was appalling.

Archival tape -- News report:

“Nurses at Health's other clinics are now being told to cover their work, lanyards, even their scrubs, when walking outside as they plead with protesters...”

NATASHA:

Equally, there are lots of reports from both hospital outpatient clinics and primary care of staff being verbally abused.

Archival tape -- Cohealth:

“Let us get on with the work that we need to do. There are many people that are seeking a vaccination and let us do that work.”

NATASHA:

So, you know, you add that to a workforce that's already tired and stressed, worried about being attacked. You need to feel valued in your role, not that you were at risk. Otherwise, again, you don't go to work. So it's a really important issue that needs to be dealt with and it needs to be dealt with decisively and authoritatively to say it's unacceptable.

RUBY:

And on the flip side of that Natasha - there has also been this phenomenon of health care workers being called heroes - they’ve been clapped for, politicians have spoken about how thankful we should all be… I wonder what you make of that way of framing the work that you do?

NATASHA:

So, going back to the survey of 10,000 health care workers in Australia last year, that theme of being a hero actually came up quite frequently and people resented it. Because a hero often does what they do unpaid superheroes or wear capes and fancy clothes, but they're not paid for what they do.

So people want recognition for what they do, but they want to be valued and they want to be, you know, well paid. And actually, payment came out quite a lot in our survey that people felt they were underpaid for what they did. And what's important to understand is that survey included people from every single type of health care role. And it wasn't just doctors and nurses. It was people in allied health roles, security guards who work in hospitals, cleaners, kitchen services staff. Universally, people felt that they were underpaid and under supported.

People didn't want to be called heroes for doing their job, but they just wanted some appreciation from their organisation, from the community.

RUBY:

Mm. And what are some of the other systemic kind of solutions that you might be able to identify? Is this about having better funding for our healthcare system? Is it about hospitals managing their staff better? What would actually help?

NATASHA:

It's a very good question. So effectively, what has to change is the organisational and the systems around them. So we recognise the problem. We've recognised the problem for 50 odd years, but nothing has been done about it in a really concrete way.

So at the moment, a lot of organisations are offering wellbeing webinars and trying to support their workforces. But if you ask me to attend a webinar when I'm actually meant to be in clinic, it only makes me angry and cross because it adds another burden to an already busy day.

So we know that strategies have to go beyond the resilience of the individual because it's not the individual's fault. They don't have a mental health problem because of something intrinsic. It is the extrinsic workplace environment that needs to change.

So I think, you know, there are things that can be done. Certainly investing in the workforce and in health care more broadly is needed. We need a larger workforce because, you know, crisis events, whether it's bushfires or the pandemic, open the cracks up in the system and that was one of the loveliest quotes that we had in the study. Someone who described all the cracks suddenly become open in the system.

So people need to be trained, takes many years to train a doctor or a nurse. So instead of putting a bandaid in, we need longitudinal solutions with investment in the the environment, improving the workplace environment, improving the number of people in the workforce, but also about how we support that workforce.

RUBY:

Hmm. And what happens if all of this isn't addressed? Because I think Australia is particularly proud of its public health system. We see it as one of the best in the world, I think probably rightly. But is that at risk? Is the quality of care that Australians have come to expect something that we shouldn't be taking for granted anymore? Is it something that could disappear?

NATASHA:

Absolutely. Australia has one of the best healthcare systems in the world, and we should be extremely proud of what we can do and how we care for people and our open mindedness within that health care system.

So protecting that health care system is important, again, these issues around the quality of care and the safety of care and, you know, a burnt out workforce have been recognised for so long, 30 to 50 years, we've known there is a problem that if we have a workforce that is overtired, overstretched, burnt out, that it is a threat to the quality of the clinical care that we deliver. It is a threat to the safety of the care that we deliver, and it's a threat to the workforce.

So it's time, I guess, for action. And it's a bit of a call to arms that. Let's have long term vision and strategy to try and address these problems in a meaningful way. And again, let's be the leaders in this in Australia so that we can show other countries how that this is done.

RUBY:

Natasha, thank you so much for your time today and for all of your work.

NATASHA:

Thank you so much. It was lovely to talk to you.

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RUBY:

Also in the news today…

The Victorian government has announced 10,000 patrons will be able to attend the Melbourne cup in November.

All attendees will be required to be fully vaccinated. The state’s premier Daniel Andrews said the event was “a really important day for every single Victorian”

And NSW Premier Dominic Perrottet has urged residents in the state to treat each other with kindness and respect as lockdown ends today.

The state government is hoping to have its vaccine passport system ready by October 18.

I’m Ruby Jones, See ya tomorrow.

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