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| The Psychological Impact of The Covid-19 on Frontline Workers: A Study of District Kangra, Himachal Pradesh | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paper Id :
16069 Submission Date :
2022-05-16 Acceptance Date :
2022-05-20 Publication Date :
2022-05-25
This is an open-access research paper/article distributed under the terms of the Creative Commons Attribution 4.0 International, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For verification of this paper, please visit on
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| Abstract |
This study focuses on the psychological distress among frontline workers of district Kangra Himachal Pradesh during COVID-19. The outbreak of COVID-19 had a significant impact on the healthcare workers and frontline workers. When the world went into lockdown, the healthcare workers had to go to work. These frontline workers had a heavy burden, as they had no choice but to put their health and lives at risk to help their communities. The fear that the pandemic might result in mortality, seclusion, or quarantines has psychological, emotional, and physical consequences on every individual and frontline workers in particular. The study had undertaken the perspectives of frontline workers, including female and male health workers, community health officers, and ASHA workers.
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| Keywords | COVID-19, Psychiatric disorder, Lockdown, Stigma, Social Distancing. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction |
On December 1, 2019, COVID-19 made its maiden appearance in Wuhan, China. Corona viruses are abundant in animals, and a human can be infected by an animal corona virus. When an infected person coughs or sneezes, droplets of the Corona virus are released into the highly communicable air. Cold, cough, fever, chills, loss of taste and smell, and shortness of breath are some of the prominent symptoms of it. It has the potential to be severe and even fatal. Although there is no treatment for this virus, physical separation and maintaining good health and cleanliness are the only ways to protect oneself.
It was evident that everyone was affected by it whether it was on the social, psychological, or economical grounds. Various studies showed that after the pandemic the most prevalent problem was the problem of mental distress which affected everyone irrespective of caste, class or group, etc. The researcher studied one social group (frontline workers) who was the first one to get infected from the virus but remained behind the cameras, was abused by the public or bears the loss of family separation, etc. There are many studies also done previously which brought out the reasons for mental distress among the frontline workers.
Frontline employees are more likely to acquire mental diseases, according to the National Center for Biotechnology Information (NCBI). According to other research studies it was observed that Post-trauma stress syndrome (PTSS), sadness, and anxiety are the most common psychiatric disorders among health care personnel during the pandemic. Fear of becoming infected and threats of death were the two reasons that contributed to the high incidence of mental distress among frontline workers. They were worried not only about their health but also for the health of their loved ones since they frequently expressed concern about spreading the infection to their family and co-workers. Even many of their loved ones also become infected which increased the problem of depression and insomnia. The pandemic had a social and cultural influence on frontline workers' life more because they were cut off from all forms of social support, including family gatherings, time spent with friends, and any other sort of social interaction. (Bennett, 2021)
A study conducted by Accountability Initiative staff examines the role and experiences of Frontline Workers (FLWs) during and after a nationwide lockdown. Only 6 percent of frontline workers in Himachal Pradesh (Kangra & Solan district) had reported receiving transportation or funds for transportation, despite having to cover long distances. Instead, 31 percent had to provide transport for themselves. It was reported that there was an increase in the working hours of the frontline workers during COVID-19 which was 91 percent in Himachal Pradesh and 79 percent FLWs reported that they had to work harder for each task. However, looking closer at the data shows that the intensity of most services decreased during the lockdown. The distribution of supplements (Zinc, ORS, and IFA) took place at a lower frequency as reported by FLWs which was 44 percent, and a drop-off in Antenatal Care provision which was 34 percent in Himachal Pradesh.
According to National Health Mission, Himachal Pradesh a circular was released by the state government which entitled ASHA workers in the state to 1,000 per month for COVID-19 related work from March to June 2020 which was later increased to 2,000 per month from July to August 2020.
According to WHO it was estimated that between 80,000 and 180,000 health and care workers could have died from COVID-19 in the time of January 2020 to May 2021. Available data from 119 countries suggested that 2 in 5 health and care workers were fully vaccinated on average across regions by September 2021. (WHO, 2021)
Dr. Roopa Dhatt, Executive Director of Women in Global Health, and two scientists produced COVID-19 vaccinations. On International Women's Day 2021, she spoke during a WHO bi-weekly briefing. She described the year as a "rollercoaster" because she was treating COVID-19 patients while still managing household responsibilities. She also cautioned that the pandemic's basic weaknesses and inequalities must be addressed promptly before the next global crisis. She stated that while women in the healthcare industry did outstanding work during the pandemic, they had not earned an equal seat at the decision-making table, and as a result, we have all missed out on their ability and knowledge. She added further that “COVID-19 does not discriminate, but societies do”. (United Nations news, 2021)
According to WHO Director-General Tedros Adhanom Ghebreyesus, the pandemic has disproportionately affected women, who have experienced issues ranging from increased violence to increased unemployment. Even though women make up the majority of health workers (70%) internationally, they only make up a quarter of those in leadership positions. (UN news, 2021)
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| Objective of study | 1. To know the socio-economic background or profile of the frontline workers.
2. The social and psychological problems faced by the frontline workers during COVID-19.
3. The challenges faced by the frontline workers during COVID-19. |
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| Review of Literature |
Kumar et al. (2020) expressed in the article that the low and middle-income nations were the hardest affected by the pandemic. During the crisis, medical resources, infrastructure, medicine, equipment, and human resources were diverted to COVID-19. COVID operations took priority over the work of Community Health Workers (CHC) and ASHA Workers.
Cabarkapa et al. (2020) highlighted that COVID-19 and the changing response harmed the well-being of hospital employees functioning as frontline workers. The rapid transmission rate of COVID-19 led to increased tasks that Health Care Workers may not have been fully prepared to handle, both professionally and psychologically. The numerous threats to Health Care Workers' well-being were little understood. Traumatic stress, anxiety, and depressive symptoms are all negative effects.
Billings et al. (2021) mentioned in their article that the rising number of COVID-19 patients had increased treatment demand and put a strain on healthcare providers' resources, all at the expense of their health. It impacted frontline employees' mental health, prompting calls for psychosocial support. In investigations, it was discovered that insufficient PPE (Personal Protective Equipment) had also contributed to the fear of contamination. Furthermore, these PPE kits made it difficult for frontline staff to work and communicate. Health professionals were stigmatized, and their families were discriminated against as well. |
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| Methodology | It was exploratory research and the quantitative method was used. The data was collected from primary sources. The researcher interviewed 40 frontline workers in the study. |
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| Sampling |
The
researcher used purposive or convenient sampling. The proposed study was conducted in Kangra district, Himachal Pradesh. The
researcher had covered 9 Health Sub- Centres and 1 Primary Health Centre under
Shahpur block, Kangra district, Himachal Pradesh. |
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| Tools Used | The tool used for data collection was the semi-structured interview schedule. The data was analyzed through Excel. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Result and Discussion |
The researcher interviewed the frontline workers in said
area of research and analyzed the data in tabular form. Data analysis means
ordering or categorizing and summarizing the data to obtain answers to the
research questions. The researcher had made different categories to summarize
the data. The summary of the data collected by the researcher is based on these
tables:
Age is an important factor to analyze as through this one can distinguish between different groups like adult or old. In this table, the researcher found out that the data has different age groups: there were the persons who have reached the age of adulthood and also who have reached the old age or retirement age. The maximum number of the population found was between the 30-35 years age group.
Sex is biological; the person is born as a male, female or other. Through this table, the researcher found that the health sub-centre has the maximum number of female health workers. The researcher found only one male health worker in all the 10 sub-centres. Table No. 3 Educational Qualification
Educational qualification is another important factor to get the basic information about the respondent. The researcher got to know that the maximum numbers of the respondent were those who have completed their senior secondary schooling and some of them were now in the post of health worker. While knowing more about them, the researcher found that those who have the experience of 20 years or more than 20 years were appointed to that post, as at that time, the health worker needs the maximum qualification of 12th and on that basis, they were appointed but before joining they had to complete the 2 years training on medical health which was provided to them in Dharmshala.
The researcher visited the 9 health sub-centres and 1 Primary health centre for collecting the data. These all sub-centre came under Shahpur block, Kangra district. The researcher covered the area which was on the roadside and also which were in the outskirts. According to the Indian Public Health Standard's amended recommendations of 2012, a Sub-Health Centre (Sub-centre) is the most peripheral and first point of contact between the primary health care system and the community in the public sector, In rural health, the goal was to build one Sub-centre for 5000 people in the plains and 3000 in tribal and hilly areas, one Primary Health Centre (PHC) for 30000 people in the plains and 20000 in tribal and hilly areas, and one Community Health Centre (CHC/Rural Hospital) for a population of one lakh.
Marital Status means the state of being married or not married —used on official papers to determine if a person is married, single, divorced, or widowed. The respondent collected the data from different marital status groups of the respondents. The above table shows that the maximum number of respondents were married, some were widows and the minimum number of respondents was unmarried. Table No. 6 Type of Family
Family is an important part of our life. A family is a group of people who are linked by marriage, blood, or adoption who live together in a single household, interacting in their social roles, which are commonly those of spouses, parents, children, and siblings. The researcher collected the data about their families also and found that out of the total respondents half of the respondents belonged to a nuclear family and the rest to the joint family system. Table No. 7 Profession
The researcher collected the data from different professional groups of health sub-centres. The maximum number of respondents were ASHA workers. The researcher got to know that in 1 health sub-centre there was 1 Male/female health worker, 1 Community health officer, and 4-6 ASHA workers based on the population of the village. Of over 800 people there was 1 ASHA Worker. Table No. 8 Regular/ Contractual
The researcher found that the respondents who have experience of more than 15 years were on regular posts and those who were in the post of ASHA worker and Community health officer were on the contractual post. Table No. 9 Impact on Social life during COVID-19
The researcher found that the social life of the maximum number of frontline workers was disrupted during COVID-19. They had a lot of burden of work, they were at risk, their families at risk, and they were unable to manage with both families and work together. Table No. 10 Impact on family time during COVID-19
The researcher found that most of the respondents said that they do not have time for their families. They rarely got time to spend with their families. Even 1 respondent said that her mother got infected during COVID-19 but due to the overburden of workload she was unable to take care of her mother. After some time her mother died due to COVID-19 and for that, she was blaming herself. Table No. 11 Duty/Working hour effects on the family relationship during COVID-19
The maximum number of respondents said that their working hours disrupted their families. They said after work when they reached their home then also they had to make phone calls, attend to phone calls, visit the household for giving medicines, etc. There was no time to even talk to their family members. One respondent said that her husband died suddenly during COVID-19, she only got leave of 10 days and on the 11th day, she had to resume her duty. Even their children's education was disturbed as the ASHA worker told that they bring their smartphones with them because of which the child was unable to attend the online classes. Table No. 12 Impact on the mental health during COVID-19
The research found that most of the respondents had mental stress due to workload, disturbance in family life, etc. During an interview one of the ASHA workers told that she managed to balance her stress by writing songs about their situation. Those who said that there was no impact on their lives or mental health during COVID-19 were having a small family size, single mother-child or all the family members were frontline workers. Table No. 13 Anxiety/ Fear while interacting with the public during COVID-19
The researcher found that the respondent had anxiety issues while dealing with the public during COVID-19. It was the time when everyone was avoiding meeting anyone but as per their duty, respondents had to go to the field for a survey, giving medicines to the corona positive person, collecting samples, etc. They were worried about their families because they had to go home after their duties and they could be the carriers of the infection. But slowly-slowly they became habitual in the situation and followed the operational standard behavior like taking bath when reaching home, changing clothes, washing the duty dress, and sanitizing their hands properly.
The respondents also got infected during COVID-19 because as per their duty they had to meet with the corona positive person, collect their samples, etc. meanwhile during their work they also got infected but they said that they were treated at home quarantine. Some respondents said that they had mild symptoms and by following proper diet and medicine they recovered. Soon they said that one of the reasons behind their recovery was the vaccination. Table No. 15 Challenges/Issues faced during COVID-19
The researcher found that there were different issues and challenges faced by the respondent but the maximum number of the respondents faced the problem of the burden of work and transportation. During the lockdown, the new problem that emerged for the frontline workers was the unavailability of public transport. The respondents found it difficult to come for the duty. They found its alternative by hiring a private taxi at a high price, or one of their family members came with them to the office in their vehicle and sat there for the whole day and then goes home along with them. Table No. 16 Monthly camps of vaccination/immunization organized during COVID-19
The frontline workers said that the monthly camps of vaccination were organized during COVID-19 and lockdown also. It was not affected; it was delayed during lockdown for 2-3 days due to their COVID-19 duties otherwise it was organized as usual. They called the pregnant woman on a fixed-time basis so that no crowd was collected outside the hospital. Table No. 17 Getting PPE kits during the field visit
The frontline workers said that PPE kits were provided to
them only during testing or sample collection. They had to protect themselves
on their own during vaccination camp or survey/ visit to the suspected or
infected person's house or the medicine distribution to them. The shortage of
safety equipment like hand gloves and sanitizers was also reported by them. Table No. 18
Most of the frontline workers were vaccinated in the initial phase of the vaccination drive. Some of the respondents were vaccinated late because either they were pregnant at that time or were lactating mothers.
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| Conclusion |
The study showed that the frontline workers faced various challenges and problems during COVID-19. The major impact of the COVID-19 was on their mental health. Their personal and professional life was disturbed totally. The frontline workers were packed with the long duty hours, no time for families, unsafe working conditions, etc. During the interview one more important thing that came into the limelight was to convince the people to be in isolation, to get them tested, and to reach the work every day because during lockdown no public transport was available and it was difficult for them to fulfill their basic need during COVID-19 as they did not get any support from the higher authorities over this problem. |
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3. Cabarpaka, S., Nadjidai, S. E., Ng, J. M., & H., C. (2020). The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health.
4. Kumar, C., Sodhi, C., & CP, A. J. (2020). Reproductive, maternal and child health services in the wake of COVID-19: insights from India. Journal Of Global Health Science.
5. Kapur, A., Sinha, S., Shukla, R., John, J. S., Ranjan, U., Kumar, D., et al. (2021). Experiences of Frontline Workers in Rajasthan and Himachal Pradesh during COVID-19 pandemic. New Delhi: Accounatbility Initiative, Centre for Policy Research.
6. Nations, U. (2021, March 8). 'COVID-19 doesn't discriminate but the societies do' say women frontliners. Retrieved April 2022, from United Nations: https://news.un.org/en/story/2021/03/1086692
7. Mission, N. H. (2020, December 9). Notification regarding ASHA incentives 29-12-2020. Retrieved April 2022, from National Health Mission, Himachal Pradesh:
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8. Organization, W. H. (2021, October). Health and Care Worker Deaths during COVID-19. Retrieved March 2022, from World Health Organization: https://www.who.int/news/item/20-10-2021-health-and-care-worker-deaths-during-covid-19 |
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