OVERVIEW: OF The Psychological Consequences of Ebola Virus Disease{EVD}
Summary Of The Psychological Consequences Of The Ebola Virus Disease{EVD}
>FEAR
>ANXIETY
>STIGMATIZATION
>ACUTE STRESS REACTION
>DEPRESSION
>POST TRAUMATIC STRESS
>INSOMIA
FEAR
The psychological impact of fear should not be underestimated because fear is a feeling of apprehension or alarm in response to an external source of danger. Fear about catastrophic incidents often originates from a feeling of lack of control and a perceived inability to prevent the problem or threat ((Dox & Melloni, 1998; The America Psychological Association, APA).
Fear is the number factor causing alarm and panic on both victims and the health workers taking care of them as well as the affected communities. The Ebola virus creates serious fear because people are afraid to travel, some wearing masks on public transportation, and some people afraid to have people from Africa visiting the schools where their children attend as no one wishes to get sick of other illnesses and be taken to hospital. In some areas schools are closed and children are not able to touch and play with others as they used to.
The fear of secondary infection by Health workers (HCWs) who are both overworked and exposed to the virus is also present. Of 666 HCWs are known to have been infected with EVD up to the end of 21 December, 366 of whom have died. The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the USA (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas). Seven HCW infections were reported in the week to 21 December, 6 in Guinea (including 5 in Coyah and 1 in Kankan) and 1 in Montserrado in Liberia.
Nurse Pauline Cafferkey, Scottish health worker who have contracted the EVD yesterday while returning from Sierrialone has sparked renewed fear among people. Health chiefs are disturbed about the spreading of the EVD because the Ebola victim came in contact with about 70 persons, who may have also came in contact with others as she was able to travel on a plane, go home to her family and use public parts of a hospital after developing symptoms.
There are also fears for passengers and staff who had close contact with the nurse, who flew from Freetown to London via Morocco before reaching Scotland late on Sunday night.
Dr Martin Deahl who sat next to Pauline Cafferkey on service to Heathrow from Casablanca said 'The precautions and checks at Heathrow were shambolic. They ran out of testing kits and didn't seem to know what they were doing. We were told that we were considered high risk but yet were told to make our own way home from Heathrow, either on the Tube, by bus or train or another flight like the one Pauline and others took. I was picked up.'Public Health England told us we should avoid public transport or crowded places for 21 days, but only after we had got home. It defies common sense and we told them that’.
Colleagues who volunteered with her believe she may have contracted the deadly disease after attending a church service without wearing her hazard suit on. Dr Deahl said that medical staff in Sierra Leone always wore hazard suits at work but some did not when they went out into the wider community.
A number of the 30 NHS staff out in Sierra Leone, including himself, worshipped at a local church on Christmas Day. He also said that at Freetown airport in Sierra Leone all the volunteers were 'kissing and hugging' as they left the country, including Miss Cafferkey.
The psychological impact of fear should not be underestimated because fear is a feeling of apprehension or alarm in response to an external source of danger. Fear about catastrophic incidents often originates from a feeling of lack of control and a perceived inability to prevent the problem or threat ((Dox & Melloni, 1998; The America Psychological Association, APA).
Fear is the number factor causing alarm and panic on both victims and the health workers taking care of them as well as the affected communities. The Ebola virus creates serious fear because people are afraid to travel, some wearing masks on public transportation, and some people afraid to have people from Africa visiting the schools where their children attend as no one wishes to get sick of other illnesses and be taken to hospital. In some areas schools are closed and children are not able to touch and play with others as they used to.
The fear of secondary infection by Health workers (HCWs) who are both overworked and exposed to the virus is also present. Of 666 HCWs are known to have been infected with EVD up to the end of 21 December, 366 of whom have died. The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the USA (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas). Seven HCW infections were reported in the week to 21 December, 6 in Guinea (including 5 in Coyah and 1 in Kankan) and 1 in Montserrado in Liberia.
Nurse Pauline Cafferkey, Scottish health worker who have contracted the EVD yesterday while returning from Sierrialone has sparked renewed fear among people. Health chiefs are disturbed about the spreading of the EVD because the Ebola victim came in contact with about 70 persons, who may have also came in contact with others as she was able to travel on a plane, go home to her family and use public parts of a hospital after developing symptoms.
There are also fears for passengers and staff who had close contact with the nurse, who flew from Freetown to London via Morocco before reaching Scotland late on Sunday night.
Dr Martin Deahl who sat next to Pauline Cafferkey on service to Heathrow from Casablanca said 'The precautions and checks at Heathrow were shambolic. They ran out of testing kits and didn't seem to know what they were doing. We were told that we were considered high risk but yet were told to make our own way home from Heathrow, either on the Tube, by bus or train or another flight like the one Pauline and others took. I was picked up.'Public Health England told us we should avoid public transport or crowded places for 21 days, but only after we had got home. It defies common sense and we told them that’.
Colleagues who volunteered with her believe she may have contracted the deadly disease after attending a church service without wearing her hazard suit on. Dr Deahl said that medical staff in Sierra Leone always wore hazard suits at work but some did not when they went out into the wider community.
A number of the 30 NHS staff out in Sierra Leone, including himself, worshipped at a local church on Christmas Day. He also said that at Freetown airport in Sierra Leone all the volunteers were 'kissing and hugging' as they left the country, including Miss Cafferkey.
Therefore, many people fear that the HCWs might act as carriers of the virus into the wider community. Their families are also a vulnerable group, fearing that these workers will catch the disease or inadvertently bring the pathogen home. HCWs and passengers returning from infected countries African have been put on isolation as soon as they return to their countries. And travel ban has also been imposed by some countries out of fear.
Fear is causing unnecessary reactions and that overreaction is often counterproductive. Rationality disappears and irrational inclinations take over people. Despite the almost-zero probability of acquiring Ebola in the US for example, given the EVD terrifying symptoms, often does not register at a time of mass paranoia because of the case of Thomas Eric Duncan, who died Oct. 8 in a Dallas hospital after traveling to Liberia; two nurses who treated him are the only other CDC-confirmed cases in the U.S (Gene Beresin, a Harvard Medical School psychiatry professor).
For example, in Hazlehurst, Miss., parents pulled their children out of middle school after learning that the principal had recently visited southern Africa.
At Syracuse University, a Pulitzer Prize–winning photojournalist who had planned to speak about public health crises was banned from campus after working in Liberia.
An office building in Brecksville, Ohio, closed where almost 1000 people work over fears that an employee had been exposed to Ebola.
A high school in Oregon canceled a visit from nine African— even though none of them hailed from countries containing the deadly disease.
EVD can spread from person to person as a result of direct contact with skin or bodily fluids such as blood or sweat, the deadly virus is extremely infectious.
However the afflicted health worker's fellow passengers are unlikely to have contracted it because it is not airborne. They would not be at risk from breathing the same cabin air and it would be exceptionally unlucky to catch it from an armrest, a touch-screen television or a seat-back tray.
STIGMA
A stigmatised individual is deeply discredited, reduced in our minds from a whole and usual person to a tainted, discounted on [to the point where] we believe the person with the stigma is not quite human. Resulting in varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances, (Goffman 1963).
Individuals and groups affected by the Ebola virus disease are being labeled and treated differently. Thus, reducing their life chances such as less power, a loss in status or some other form of discrimination may then follow whereby neighbors even refuse to buy from or make sales to those labeled. In some cases, neighbors threw stones at them, while others were chased from their houses.
Another vulnerable group is children made orphans by the Ebola virus disease. They are facing deep stigma and isolation because nobody wants to take them in for of fear contacting the Ebola virus. These children will suffer adverse social and psychological consequences for years to come unless this situation is urgently addressed. As a result of the increasingly widespread fear of infection, these children are being ostracized, stigmatized, and discriminated against, partially driven by the low level of knowledge of disease transmission in the affected countries.
Orphanages in Monrovia are starting to accept some children in response. Other groups are working to lessen stigma and reintegrate some of these children into their communities.
In Sierra Leone, the Ministry of Social Welfare is working with child protection specialists from UNICEF and Save the Children to register “unaccompanied and separated children,” as they are termed, and find care for them.
Stigmatisation has also psycho-social on consequences on the survivors, family members of victims and community where the person lived. And because this takes place at community level and workplace, there are also socio-economic consequences. They can lose their source of livelihood, friendships, relationships and connectedness to society. It can lead to isolation, humiliation, feelings of low self-esteem, adjustment problems, feelings of shock, numbness, denial, anger, confusion, and a host of negative emotions at the start before depression, anxiety and disorders set in (Dr. Increase Adeosun, consultant psychiatrist and senior lecturer, BABCOCK University, Ilishan-Remo, Ogun State, Nigeria).
Nigerians Turned Into Social Outcasts By EVD
Nigerians are happy that the country has been declared Ebola-free but survivors of the virus and their families still face stigma from the society, reports Arukaino Umukoro (punchng.com).
For instance, eight weeks after the World Health Organisation announced that Ebola had been eradicated from Nigeria, unknown to Dr. Kelechi Enemuo whose husband (Dr. Ikechukwu Enemuo died of EVD on August 22, 2014), her exit from 10 days in quarantine after being declared free of Ebola was only the entrance into a world of stigmatisation and uncertainties.
Apart from being criticised for being married to the doctor that treated an Ebola patient, (Olubukun Koye, a Nigerian diplomat with the Economic Community of West African States, who contracted Ebola after coming in contact with Sawyer allegedly escaped surveillance in Lagos to a hotel in Portharcourt, Nigeria) the young widow has also been accused of killing her husband by her in-laws and some members of the public.
For Dr. Ada Igonor, another Ebola survivor, months after being certified free after spending 14 days in isolation, some people still refuse to have physical contact with her. Igonor worked closely with the late Consultant Physician and Endocrinologist, Ameyo Adadevoh in treating the index case (Patrick Sawyer) at First Consultants Medical Centre, Obalende, Lagos, Nigeria. She said, “Some people still avoid body contact with me even though I am now free of Ebola. They would tell me, ‘Oh! Sorry, we can’t hug you or shake hands with you. How are we sure you don’t have Ebola on your skin?’ Some of the people that treat me in this manner are quite educated.”
Amara, who worked at Good Heart Medical Consultants, the hospital where Dr. Ikechukwu Enemuo was diagnosed of Ebola, said that the stigmatization she had been experiencing was unbearable so have had to deny that she work at the hospital. Amara’s roommate suffered stigmatisation even after moving out of the apartment they shared. she was immediately sacked from work.
For 32-year-old Dennis Akagha, whose fiancée, Justina Ejelonu, a nurse with FCMC, was one of the health workers who attended to the late Sawyer. Akagha also lost his job as a marketer in an oil and gas firm. Recounting the pains of the stigma he faced, he said, “I couldn’t buy food outside, because people were not willing to sell to me. I had to walk five kilometres just to find food to buy and then come back home to eat and sleep. I couldn’t have a haircut, some people didn’t and still do not want to shake my hands.”
Akagha is now seeing a psychologist to help him deal with the post-Ebola problems and recover from psychological trauma and stigma.
Newly-wed Chinyere left her job as a secretary due to the stigma and would-be employers have refused to employ her. It almost consumed her wedding plans because everybody was running away from her causing husband difficulties and stigmatisation.
Located in the heart of the Rivers State capital, Samstel Clinic and Maternity, a health facility established by the late Enemuo, is now a shadow of its old self because stigmatization has reduced their patients drastically. The hospital, which occupies a two-storey building in Rumuokoro, Portharcourt, Nigeria, was one of the most patronised around the area until Enemuo’s death.
Now not only has the clinic been deserted by its loyal patients, only 14 of its 53 workers are left. The 25-bed hospital with its empty wards and scant equipment looked desolate.
Good Heart Medical Consultants, cardiac centre at GRA, a high brow area in Port Harcourt,where late Enemuo died have lost over 70 per cent of their regular patients because of Ebola according to Dr. Eze Nwuafor, a cardiologist at the hospital. “At a point, it got so bad that when cheques were presented in the bank, some bank workers were scared of touching them. In fact, some banks had to tell their staff who had been to Good heart in the last three months to stay away. It was that disturbing,” Nwuafor added.
A psychologist and a professor at the University of Lagos, Nigeria, Ayobami Makanju, expressed disbelief at the cases of stigmatisation.
He said, “I’m taken aback. I never expected that such a thing would still be happening in this country. They already have immunity against the disease. It is ignorance on the part of Nigerians. It’s a pity because such persons could be going through hell because they are not wanted by people living close to them, and it’s a terrible situation to pass through.
“Government needs to take urgent action, educate the people and legislate a law criminalising stigmatisation in such cases.”
DEPRESSION
Ebola does not directly cause depression. But depression is a mental health condition that can arise due to factors like stigmatization or labeling of survivals and uninfected family members by others in the community.
Depression is a serious medical illness that is more than just a feeling of being “down” or "blue" for a few days. Depression is a disorder of the brain can range from mild to severe. The symptoms and treatment will b discussed in future articles on BabySteps-PsychMag.
STRESS
Report indicates that quarantine conditions for patients with the EVD producing severe psychological stress due to separation from normal support from friends and relatives, along with natural apprehension over contracting Ebola; fear they would infect their family and witnessing deaths.
Health workers on the other hand, are facing extremely long shifts attending to too many patients, with a lack of resources[In Sierra Leone,], while witnessing their colleagues’ deaths and working under lots of fear and stress because of emotional losses and constant reminders of the risk they themselves are taking. (Carmen Valle, Ph.D., project coordinator and mental health specialist for the Enabling Access to Mental Health (EAMH) program in Freetown, Sierra Leone).
UNICEF reports children account for 22 percent of Ebola cases which is having a devastating psychological and social impact on children. As children see their family members and relatives die of the Ebola disease, the affect have deeply distressing for children. Many children have lost one or two parents to this disease.
ANXIETY
Since the outbreak of the Ebola virus disease, (EVD) we are in an extremely difficult time right now psychologically and what we are dealing with is how to separate rational, productive worry from irrational unproductive worry.
The difference?
Productive worry is anxiety that you use to take action to help keep you safe. Unproductive worry is worrying without taking action and, therefore, driving more anxiety (Josh Klapow, associate professor in the University of Alabama at Birmingham School of Public Health).
There is also this exaggerated stigma and hyper anxiety about casual exposure Ebola virus disease, (EVD) in the US. As of October 27, there were 13,703 cases of Ebola reported worldwide. Liberia and Sierra Leone are the most heavily affected, and the disease has also claimed victims in neighboring Guinea.
At that time, the United States had nine reported Ebola cases. Amid hysteria breaking out in the United States concerning EVD, there is a very small chance that Americans who have not been to West Africa or taken care of patients with the Ebola virus will contract it.
George Rutherford, M.D., head of the Division of Infectious Disease Epidemiology at the University of California, San Francisco, advised psychiatrists to reach out to their local hospitals to become part of Ebola preparation teams—which are being formed in hospitals throughout the nation—to provide an adequate mental health resource for hospital workers who treat Ebola patients. “Mental health workers are definitely needed,” he emphasized.
“Being prepared in the U.S. is prudent and appropriate, but what is more appropriate is to be concerned about West Africa. ... If we don’t stop the epidemic in West Africa, it will definitely spread.” “What is important is the epidemic in West Africa, where we need to concentrate our resources,” stressed Rutherford during an interview with Psychiatric News.
For instance, eight weeks after the World Health Organisation announced that Ebola had been eradicated from Nigeria, unknown to Dr. Kelechi Enemuo whose husband (Dr. Ikechukwu Enemuo died of EVD on August 22, 2014), her exit from 10 days in quarantine after being declared free of Ebola was only the entrance into a world of stigmatisation and uncertainties.
Apart from being criticised for being married to the doctor that treated an Ebola patient, (Olubukun Koye, a Nigerian diplomat with the Economic Community of West African States, who contracted Ebola after coming in contact with Sawyer allegedly escaped surveillance in Lagos to a hotel in Portharcourt, Nigeria) the young widow has also been accused of killing her husband by her in-laws and some members of the public.
For Dr. Ada Igonor, another Ebola survivor, months after being certified free after spending 14 days in isolation, some people still refuse to have physical contact with her. Igonor worked closely with the late Consultant Physician and Endocrinologist, Ameyo Adadevoh in treating the index case (Patrick Sawyer) at First Consultants Medical Centre, Obalende, Lagos, Nigeria. She said, “Some people still avoid body contact with me even though I am now free of Ebola. They would tell me, ‘Oh! Sorry, we can’t hug you or shake hands with you. How are we sure you don’t have Ebola on your skin?’ Some of the people that treat me in this manner are quite educated.”
Amara, who worked at Good Heart Medical Consultants, the hospital where Dr. Ikechukwu Enemuo was diagnosed of Ebola, said that the stigmatization she had been experiencing was unbearable so have had to deny that she work at the hospital. Amara’s roommate suffered stigmatisation even after moving out of the apartment they shared. she was immediately sacked from work.
For 32-year-old Dennis Akagha, whose fiancée, Justina Ejelonu, a nurse with FCMC, was one of the health workers who attended to the late Sawyer. Akagha also lost his job as a marketer in an oil and gas firm. Recounting the pains of the stigma he faced, he said, “I couldn’t buy food outside, because people were not willing to sell to me. I had to walk five kilometres just to find food to buy and then come back home to eat and sleep. I couldn’t have a haircut, some people didn’t and still do not want to shake my hands.”
Akagha is now seeing a psychologist to help him deal with the post-Ebola problems and recover from psychological trauma and stigma.
Newly-wed Chinyere left her job as a secretary due to the stigma and would-be employers have refused to employ her. It almost consumed her wedding plans because everybody was running away from her causing husband difficulties and stigmatisation.
Located in the heart of the Rivers State capital, Samstel Clinic and Maternity, a health facility established by the late Enemuo, is now a shadow of its old self because stigmatization has reduced their patients drastically. The hospital, which occupies a two-storey building in Rumuokoro, Portharcourt, Nigeria, was one of the most patronised around the area until Enemuo’s death.
Now not only has the clinic been deserted by its loyal patients, only 14 of its 53 workers are left. The 25-bed hospital with its empty wards and scant equipment looked desolate.
Good Heart Medical Consultants, cardiac centre at GRA, a high brow area in Port Harcourt,where late Enemuo died have lost over 70 per cent of their regular patients because of Ebola according to Dr. Eze Nwuafor, a cardiologist at the hospital. “At a point, it got so bad that when cheques were presented in the bank, some bank workers were scared of touching them. In fact, some banks had to tell their staff who had been to Good heart in the last three months to stay away. It was that disturbing,” Nwuafor added.
A psychologist and a professor at the University of Lagos, Nigeria, Ayobami Makanju, expressed disbelief at the cases of stigmatisation.
He said, “I’m taken aback. I never expected that such a thing would still be happening in this country. They already have immunity against the disease. It is ignorance on the part of Nigerians. It’s a pity because such persons could be going through hell because they are not wanted by people living close to them, and it’s a terrible situation to pass through.
“Government needs to take urgent action, educate the people and legislate a law criminalising stigmatisation in such cases.”
DEPRESSION
Ebola does not directly cause depression. But depression is a mental health condition that can arise due to factors like stigmatization or labeling of survivals and uninfected family members by others in the community.
Depression is a serious medical illness that is more than just a feeling of being “down” or "blue" for a few days. Depression is a disorder of the brain can range from mild to severe. The symptoms and treatment will b discussed in future articles on BabySteps-PsychMag.
STRESS
Report indicates that quarantine conditions for patients with the EVD producing severe psychological stress due to separation from normal support from friends and relatives, along with natural apprehension over contracting Ebola; fear they would infect their family and witnessing deaths.
Health workers on the other hand, are facing extremely long shifts attending to too many patients, with a lack of resources[In Sierra Leone,], while witnessing their colleagues’ deaths and working under lots of fear and stress because of emotional losses and constant reminders of the risk they themselves are taking. (Carmen Valle, Ph.D., project coordinator and mental health specialist for the Enabling Access to Mental Health (EAMH) program in Freetown, Sierra Leone).
UNICEF reports children account for 22 percent of Ebola cases which is having a devastating psychological and social impact on children. As children see their family members and relatives die of the Ebola disease, the affect have deeply distressing for children. Many children have lost one or two parents to this disease.
ANXIETY
Since the outbreak of the Ebola virus disease, (EVD) we are in an extremely difficult time right now psychologically and what we are dealing with is how to separate rational, productive worry from irrational unproductive worry.
The difference?
Productive worry is anxiety that you use to take action to help keep you safe. Unproductive worry is worrying without taking action and, therefore, driving more anxiety (Josh Klapow, associate professor in the University of Alabama at Birmingham School of Public Health).
There is also this exaggerated stigma and hyper anxiety about casual exposure Ebola virus disease, (EVD) in the US. As of October 27, there were 13,703 cases of Ebola reported worldwide. Liberia and Sierra Leone are the most heavily affected, and the disease has also claimed victims in neighboring Guinea.
At that time, the United States had nine reported Ebola cases. Amid hysteria breaking out in the United States concerning EVD, there is a very small chance that Americans who have not been to West Africa or taken care of patients with the Ebola virus will contract it.
George Rutherford, M.D., head of the Division of Infectious Disease Epidemiology at the University of California, San Francisco, advised psychiatrists to reach out to their local hospitals to become part of Ebola preparation teams—which are being formed in hospitals throughout the nation—to provide an adequate mental health resource for hospital workers who treat Ebola patients. “Mental health workers are definitely needed,” he emphasized.
“Being prepared in the U.S. is prudent and appropriate, but what is more appropriate is to be concerned about West Africa. ... If we don’t stop the epidemic in West Africa, it will definitely spread.” “What is important is the epidemic in West Africa, where we need to concentrate our resources,” stressed Rutherford during an interview with Psychiatric News.
Comments
Post a Comment