When 54-year-old Jenny* finishes her shift as an intensive care nurse at a hospital in one of Australia’s capitals, she doesn’t go immediately home. She’s spent a day on the coronavirus frontline and she needs to offload what she’s seen, what she’s heard, what she’s felt.
Tonight she’s troubled. Patients have been left to die alone in her ward. She opens her phone, clicks a link and records her thoughts.
“The Covid patients who have suffered the most have been patients who have avoided coming to hospital because of the fear of getting the Covid-19 virus, therefore presenting much later, much sicker ... We got them at a time when they are frightened ... Some of them haven’t survived.
“Some families actually used Covid as an excuse not to come to hospital,” she says. “That was quite hard for some of us, when people are dying and families actually don’t want to come … even though we’ve created a safe space.”
When visiting was limited, Jenny said, “people became very aggressive and demanding though the decisions were based on their health and their relative’s health. We used all sorts of other things to keep people in touch with their families. But even the nicest families became really aggressive when they were told to limit their time.”
Tim*, 45, is an outback doctor. Removed from the urban epicentres of the outbreak, his thoughts on how Covid-19 has impacted processes at his specialist care facility are more positive.
“When we understood the reality of a pandemic arriving in Central Australia, there were enormous system changes within the hospital,” he records into his phone.
“We had to make decisions on how to change systems ourselves … So fascinating, very optimistic, that big change could happen so quickly.”
Jenny and Tim (not their real names) are among a growing number of frontline health workers around the world using WhatsApp to diarise how they see their health system’s response to coronavirus.
The Health Worker Voices channel, launched by the Nossal Institute for Global Health at the University of Melbourne, aims to use these real-time audio messages to create a global database of stories.
Workers are encouraged to record their thoughts as often as they would like, for up to five minutes. To protect their identity and to encourage them to talk freely, people aren’t required to leave a name or place of work and their number isn’t stored.
Storytelling is the foundation upon which medicine is built
Dr Stephen Parnis
Some accounts are traumatic, some are sad and some are hopeful. Some are just about the day-to-day reality. But all are expected to be supremely useful.
Dr Dan Strachan, senior technical advisor at the Nossal Institute, says we’ve only recently understood the importance of consulting frontline health workers during crises – those who are not involved in policy making but who have a unique insight into what’s really happening in the thick of it.
“In the past, the experiences and insights of health workers in epidemics have only been captured after the event,” he says. “But the recent Ebola outbreaks in Africa have showed us how testimony from health workers is key to shaping local response.”
Public health experts analysing the Ebola outbreaks saw how ground staff understood the community’s healthcare needs within logistical, historical and social contexts. In the Democratic Republic of Congo, for example, they could demystify why clinics full of foreigners in PPE suits were taking locals away to die.
Dr Oliver Johnson, co-author of Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline, says local health workers are the most important asset in the medical response to an infectious disease outbreak, whether that be Ebola or coronavirus.
Epidemics are uncertain, he says, and there are huge variations between health facilities in terms of infrastructure, equipment and available staff, which can change daily.
“The only way to maintain safety and good patient care is to continuously adapt guidelines to the context. Frontline health workers are the best people, in fact the only people, in a position to do this, so supporting and empowering them is vital.”
If history has shown us the importance of listening to local health workers, modern technology allows us to effectively capture their stories.
The worldwide rollout of the Health Worker Voices channel has begun in countries where English is widely spoken – with pick-up already in Australia, the UK, Canada and India. There are plans to extend to non-English speaking countries as the project gains traction.
Data will be analysed by country, type of worker and theme of response, with key lessons collated and reported. Eventually, says Strachan, we will have an incredible trove of tales with immense historical value.
“We’ve had a diverse response. Some have put themselves in the shoes of people seeking care, others have talked about the logistical challenges such as the supply of PPE. Others have warned of the huge pressure emerging on the system.
“We’ll be able to review the stories against the local pandemic trajectory and compare findings across different settings over time. The analytic opportunities are endless.”
In the years to come, when researchers delve in and tease out the lessons, they’ll hear Nick*, a 40-year-old urban doctor, venting about meetings cancelled by social distancing measures.
“It was hard for a lot of us … Things were changing so quickly. We all had to find our own sources of information,” he tells the channel.
Occupational therapist Sally*, 34, struggled to connect to her patients by video. Some, she no longer saw at all.
“One of the main concerns and challenges, I think for many in my situation, is what’s happening with those clients who are harder to reach,” she says.
As coronavirus cases surge in Victoria, Melbourne-based emergency physician Dr Stephen Parnis believes the Health Worker Voices project “is incredibly timely”.
“Every single person, with no exception, is affected by this pandemic and health workers are front and centre … One of the most important things to do here is share stories so that we can learn from each other,” he says.
“Storytelling is the foundation upon which medicine is built.”
Parnis, former vice-president of the Australian Medical Association, describes the channel as “a wonderful tool” for health workers.
“It has the potential to empower and support a lot of people through this crisis and will enable us to learn during and after the event what we can do better.”
Strachan hopes plenty more health workers will come forward to share their tales, from those in intensive care wards to community and aged care workers and those in disability services.
“All stories are important – it is the perspective of the health worker about what is happening right now, next week, next month and later on that counts.”
At its heart, Health Worker Voices also acts as an outlet. It ensures health workers, nearly drowned out by the chaos of pandemic, are being heard.
The importance of this cannot be overstated, says Johnson.
“If we fail to do this, if we leave staff feeling ignored and abandoned, then that’s a recipe for low morale and increased psychological trauma that will do real harm not only to them, but to patients and the response as a whole.”
The voice of one 26-year-old mental health professional seems to perfectly encapsulate the uncertainty so many health workers are experiencing.
“Yeah, just a prevailing mood of nerves and anxiety,” Richard* tells the channel. “One of the screens in the waiting room has been converted into a display that alternates between puppies and an aquarium and things like that …
“Some of the staff were finding that they needed something.”
If you are a health worker, you can share your story by going to the COVID-19 Health Worker Voices website on your smartphone and opening the link to the WhatsApp channel.