ASOURCE Times

Coronavirus and Fukushima nuclear accident
Commonalities and Differences of Mental Problems of Supporters

I have been involved in mental health care for victims of natural disasters, victims and families in the event of an accident, and their supporters (healthcare professionals, fire departments, police, government officials, etc.). I have gained a lot of experience. The first was the care of victims of the Garuda Indonesia aircraft accident at Fukuoka Airport in 1996. Five years later, in February 2001, a collision between the training ship "Ehime Maru" of Ehime Prefectural Uwajima Fisheries High School and a nuclear submarine in the United States occurred off the coast of Hawaii in the United States, resulting in four students, two teachers, and three sailors. In the accident where a person died, the rescued students suffered from feelings of guilt for awakening their memories and surviving after the accident. I went to Uwajima City every month for more than two years to care for the students' minds.
Since then, whenever various disasters occur, we have practiced medium- to long-term mental care for the victims, victims, and supporters. We have been sitting in Fukushima for a long time to care for the victims and evacuees of the Fukushima nuclear accident, and even during the 2016 Kumamoto earthquakes, we have provided advice to many local experts.
From that experience, I strongly felt that the spread of the new coronavirus infection was similar to the nuclear accident disaster. For example, neither radiation nor viruses are visible, and in addition to being uncertain how long this situation will last, it causes strong social reactions such as prejudice from fear. And not only the direct victims and patients suffer, but also the supporters are very vulnerable to damage. In the nuclear accident, firefighters, police, medical staff, and government officials responded to sleeplessness, and many people left the site with insomnia and mental exhaustion and insufficient mental care. And with the new Corona, the exhaustion of healthcare professionals and government officials is still ongoing.

Conspicuous exhaustion of female nurses and caregivers
Hurt by not being close to the person/family

On the other hand, there are some differences between the disaster and the impact of the new corona. In natural disasters, supporters' burnout (burnout syndrome) and empathic fatigue (affected by the victim's painful experience and becoming tired both physically and mentally) are common, but the most prominent part of the corona disaster is occupation. It is a moral injury. I want to complete my job as a healthcare professional, but I feel sorry for the inconvenience to the team and patients because I can't do it enough.
Regarding the mental care of medical workers due to the spread of the new coronavirus epidemic, the International Standing Committee, the Inter-Institutional Standing Committee (IASC), summarized in January 2020, "The Heart of the New Coronavirus Epidemic. A manual called "Care" was created, and in our course, we translated this manual with the permission of IASC and released it as an electronic version in March 2020.
With this as a reference, we have been providing mental care to the staff of facilities where mildly ill people are isolated in Fukushima Prefecture and the staff of medical institutions and long-term care facilities where clusters have occurred since the spring of 2020. There were many occupational moral injuries, especially for female nurses and caregivers, as described in this manual.
Healthcare professionals who care for people with corona infections, especially nurses at the forefront, are initially very anxious about the infection, but wear personal protective equipment (PPE) and repeat training to gain confidence. Will be. However, with care that literally maintains a social distance with the patient by wearing PPE, the patient does not understand the staff's face well and cannot take care of the patient. In such a dilemma, nurses and caregivers who place importance on empathic treatment sometimes feel guilty as apologetic.
Also, since the family cannot see the patient, they have to explain to the family the painful limitation of "I can't see them now", which also hurt the staff themselves. Furthermore, when the patient died, the feeling of helplessness that he could not snuggle up to him, and the inability to perform angel care such as carefully cleaning the body and making up, deepened his injuries.
Without knowing how long this situation will last, it's not surprising that some staff will burn out. Originally, medical and long-term care workers such as doctors, nurses, and caregivers are said to be overworked, but the burnout of nurses in Corona is due to physical exhaustion and the combination of such occupational moral damage. I think.

Going home is also stressful
Acceptance is more important than respect

The tendency to be isolated also hurt the hearts of healthcare professionals. Occupational morals are hurt even in normal times, but I think that I was able to resolve them by complaining and comforting each other during lunch and post-work communication with my colleagues. However, nowadays, far from having dinner at night, even lunch in the staff room is silent, and the situation where we cannot communicate well with each other continues, and we gradually become isolated.
In addition, medical and long-term care workers are much more worried and worried that they may become infected not only in their work but also in their personal lives, causing great inconvenience to the workplace. In particular, many women working in such workplaces often have a sense of responsibility for childcare and housework, and returning home can be stressful.
Community reactions can also be painful for healthcare professionals. According to the "Survey Results on Prejudice / Discrimination and Efforts, etc." published by the government's Coronavirus Infectious Disease Control Subcommittee, healthcare professionals are exposed to various prejudices rather than being respected. I found out. For example, a child of a nursing or long-term care staff who is not a close contact is refused acceptance of nursery center or after-school care, a spouse is ordered to stop working from work, a child is bullied at school, a beauty salon Reservation is refused from stores such as, taxi is refused, attendance at the nursery school graduation ceremony is refused, etc.
Especially when a cluster occurs, hospital names and facility names become known, and this situation becomes even more widespread. Even if they are harassed or exposed to prejudice, many people will feel more guilty, saying, "I have created a cluster and I am sorry for the community." These negative social reactions significantly reduce work motivation and morale, increase the damage to the person's occupational morals, and lead to a vicious cycle in which on-site staff are increasingly exhausted. In addition, such incomprehension of the surroundings can lead to staff turnover or even leave. We want local residents to know that staff are working in such risky areas, where no matter how careful you are, the potential for clusters cannot be eliminated.
Blue lights are often used to pay homage to the medical staff and long-term care staff who fight Corona, but I think it is more important for society to properly accept medical workers than respect. thinking about.

External/remote listening is useful
Long-term support while accumulating experience

Self-care and line care (organizational response) are the first requirements for mental health care of medical and long-term care staff in such situations. Many guidelines, including the IASC manual mentioned above, state that proper rest is needed first, and it is very important to get enough sleep. I would like you to avoid the situation where you cut your sleep and continue working to prevent infection. However, in reality, when a cluster occurs, self-care may not be successful in stress care.
I think that line care often does not work in the current situation. In a situation where communication was difficult due to the Korona-ka, one nurse chief complained, "I have no idea what the nurses in the field are thinking." It is difficult to respond systematically without sufficient communication and understanding of the staff's feelings, and the intervention of the manager may worsen human relationships and anger upper management. Facilities with clusters can be out of control on the line and endanger the survival of the organization.
That's where the support of an external team of experts like us becomes more important. However, in medical institutions, external organizations rarely intervene, and the benefits and stress of support are just as great, so a delicate balance is required on both the support side and the medical institution side.
It can be said that the center of the support we have provided is listening to the suffering of the staff. Originally, I would go to the site to hear the story face-to-face, and if I decided that counseling was necessary, I would take appropriate intervention, but since Korona-ka cannot do that, the "remote support" method using video by a psychologist. I used a lot. At first, I was groping, but as I gained experience, I realized its usefulness.
There are various things that the staff will tell you. Self-care and line care, as mentioned earlier, such as being unable to provide the nursing care that you should aim for, leaving you apologetic, having prejudices against yourself and your family, and not being able to see your future career even if you are in charge of the Corona ward. It was clear that the staff had anxieties and dissatisfactions that could not be resolved easily. And many people said, "I felt calm just by listening to the story." I realized that it is extremely important not only to endure but also to speak in Korona-ka.
The period of such support lasts for several weeks, but if we decide that we need to continue counseling at the end of the support, we may have referred a professional counselor.
In the current situation where Omicron strains are prevalent, medical institutions will continue to accept infected people, but there is insufficient support for mental health care for field staff. In Korona-ka, counseling including remote support, that is, listening and dialogue by professionals, is very useful, so I would like you to utilize the IASC manual etc. and put it into practice.