Freedom and The Front Lines In The Time Of COVID-19
“Despite all the protective measures, the desired effect is not occurring. And there is still no cure.”
It is September 2020, in the middle of the COVID-19 pandemic, and this assessment is being shared with me by Dr. Francy Galvis, a worker at the Santa Ana clinic in the city of Cucuta, Colombia, and also my aunt. She oversees medical consultations for patients who come into the emergency room, who have access to the private healthcare system in Colombia. She also monitors COVID-19 patients in isolation in the hospital.
During the course of our discussion, she shares with me the personal fear that has preoccupied her during the pandemic. “I am not afraid of being infected. I am afraid of infecting my family. As a health worker, I know how to use my equipment and avoid contagion, but I am afraid of making a mistake and bringing the virus home.”
Even through the screen, I can see the worry in her eyes, and I remember how the last time we hugged each other tightly was on New Year’s Eve. Last month, because of the virus my aunt had to wear a mask and stand more than two meters away from her own birthday cake while we took photos.
My aunt’s story is just one of countless medical professionals––doctors, nurses, orderlies, social workers, administrative assistants and others––who are on the front lines dealing with this global crisis. They are people with families like you and me, their heads whirling as they care for patients while making sure their own protective suit is correctly put on and everything is properly sealed.
Imagine yourself in my aunt’s shoes, walking to the isolated area where the patient is being kept, trying to remember each step of the management protocol to avoid making mistakes. When you finally get to the door, your heart beats faster than ever, you feel it, each beep beep tries to escape your rib cage. Your breathing is fast and the goggles you are wearing have fogged up so much that you cannot see clearly. When you grip the doorknob to enter, you repeat to yourself that you are a 33 year-old woman, that you are in a third level clinic and therefore, you must behave like the doctor you are.
Both Colombia, the country where I am currently living due to the closure of airports at the international level, and Canada, where I am going to school at Dawson College, have encountered difficulties in encouraging people to practice social distancing, though for different reasons. in Canada many of the people who flout social distancing guidelines – e.g., the Canadian government’s requirement that everyone wears masks inside public venues; their rules against crowded indoor gatherings – seem to believe that their “freedom” is being violated. Never mind the fact that if this pandemic has taught us anything, it should be that our actions affect not only ourselves but others as well. And this sense of violation comes in spite of the fact that Montreal was once the center of the pandemic in Canada and has once again been declared a red zone. In Colombia, on the other hand, people ignore the guidelines because they have no other option; most of the Colombian population survives from informal jobs such as selling coffee or sweets in the streets, and if these people do not go out to do so, they would not even be able to collect enough money to provide their families with one meal a day. In Colombia, the pandemic has exposed the country's biggest problem, namely famine, leading so far as to the looting of shops.
Whatever the reasons why people might not follow the security measures recommended by their respective governments, this lack of adherence to the guidelines is affecting the mental health of the health workers, changing their lives, their way of acting and thinking, and interfering with their family relationships. To appreciate how health workers feel in this situation, we must recognize that they are the ones who deal first-hand, usually in intensive care units, with patients who have severe complications from COVID-19 infections, patients who also constitute the majority of deaths so far in the pandemic. The health personnel see the patients struggling to live and, in the worst scenarios, see them die on a daily basis. So why would they not fear a virus that has the potential to affect not only them but also their families if they were to accidentally catch it and bring it home?
When I ask my aunt about her biggest opponents in this time of anti-masks activists and other people who seem unable or unwilling to put themselves in her shoes, she looks me knowingly in the eye, revealing only as much as her professional impartiality will allow. But I appreciate that look of wisdom, and her happiness every time I ask her about something related to her profession. Curiosity about her story, about the sacrifices she is making, does not seem to be something she experiences often.
“Something supremely important is to learn to understand the facts. Anti-mask activists and others who refuse to socially distance are interpreting the medical information in the wrong way or denying it for political purposes, but health care teams are only interested in the reality of the situation. We have always been neutral, whether in war or other crisis situations. Our job is simply to give people true information.” Her tone as she speaks is relaxed. She is far too busy to worry about anti-maskers or others who flaunt the guidelines, having doubled her work hours and her stress in the past few months. But that is how she is, understanding even towards people who do not make an attempt to consider the potentially fatal impact on others of their personal decisions. “Losing freedom is not easy, but while they fail to mourn that loss, they could be contaminating other people.” Even her message to them sounds passive, as if she is tired of the whole situation. Dark circles mark the area under her eyes. “Citizens should be well informed, have an objective, critical attitude towards the current situation we are experiencing, and not only think about their own interests.”
To my aunt’s point, we must consider how the pandemic is affecting health care workers in the clinical environment and at home. I know some nurses who live with their parents, and most of them have young children. My aunt says that at the start of the pandemic “everyone was tense” and that the nurses had it the worst. “It was difficult to do their job wearing only an extra pair of gloves.” However, as they are truly professionals, they left their fears for when they were alone; they knew that their patients needed extra care, not health workers overwhelmed by their own feelings.
Although many health care workers live with their children, my aunt’s story is different. “It has been six months since I saw my son, who I thought I would see this summer but couldn’t due to the current situation.” Samuel is now in Gatineau with his father while my aunt is working in Colombia. She video calls them daily, as if it were a sacred commandment, and always before her son goes to bed. She tells me how before hanging up, he always looks at her with hopeful eyes, as if to ask, when will they see each other again? It is the question to which she still does not have an answer. It is perhaps the most heartbreaking situation she has ever experienced. I know firsthand that her son means the world to her. I also know that like her, doctors around the world have had to make the difficult decision to separate from their families in order to protect them, even if it means going to live in a hotel room for months.
While in Canada people are already complaining about the cold temperatures, in Colombia, summer is always present, creating another problem for the clinic staff. “It is uncomfortable due to the heat, and with temperatures higher than 30 degrees despite the air conditioning, the body sweats and sometimes the masks get so foggy that one cannot see anything.” In addition to the demanding physical effort that her protective suit requires, it has left physical marks on her. “The mask marks my face, the mask mistreats my ears, the heat leaves dermatitis on my hands from wearing gloves for a long time. Even going to the bathroom is difficult during six hours in a row wearing the suit.” My aunt’s weight loss is evident, and I recall that now, before going to work, she no longer has one cup of coffee, but three. At home, she sleeps most of the time. But I also know that her workload is only increasing because several doctors have been infected. I know it because I helped her with the statistics of the clinic staff when the pandemic started.
How about the doctors who work in intensive care units? What would their opinions be about anti-mask activists and other non-adherents to social distancing guidelines? With this question in mind, I call Dr. Braymir Gonzales, an intensive care internist, who is in charge of the ICU of the clinic. He recognizes that everyone's freedom has been harmed, but he assures me that these people are only doing more damage. “If we want to end this pandemic, we must all contribute.” When I ask him if he has a message for people who behave recklessly, he tells me that there is only one thing that will make them change their minds: “I would like them to spend at least a few hours in the clinic, to see how all the patients in my unit are intubated, how they are struggling to survive, the sound of the machines, of the ventilators that allow them to breathe, to see if after this they want to go out without a mask”. He also shares his emotions from the beginning of the pandemic: “I was supremely scared at first, horrified I would say.” This fear led him to make a difficult decision: “At the beginning of the pandemic I lived with my grandmother, she being an elderly person and therefore high risk, so to protect her, I decided to distance myself. I went to a hotel room where I still continue to live.”.
In search of other personal perspectives, I call Dr. Hector Teran, one of the general practitioners who work with Dr. Gonzales. Teran emphasizes the collective terror that was felt at the clinic but mentions that this was overcome by the forced habit of facing problems and devising the best possible protocols to address them. When asked about the responsibility he feels towards patients and their families, he tells me that “there is pressure from family members, as their loved ones are isolated patients, to give them all the information by phone, which is not good.” He describes the peak of the pandemic as one of the most horrible situations he has ever faced as a doctor. “They were overwhelming shifts not only because of the time but also because of work, the situation and the environment were complicated.” Like all tough situations, though, this one has taught him a lesson. “I value more time with my family and colleagues, I value my patients more, I interact much more with them”. He himself experienced what it was like to have Covid-19; however, he thanks God that he had it only briefly in an acute way without any complications. “I tried to clear my mind, not think about it,” he claims.
For him, the process of seeing more and more patients through screens feels impersonal: “Nothing compares to giving the information in person”. Dr. Teran also shares his views on why people do not respect social distancing: “Ignorance is daring.” From his point of view, these people do not know the real danger to which they are exposed and may be exposing others, their actions reflecting a lack of respect for the ones who use masks and take precautions. “Not wanting to follow guidelines is not an excuse to disrespect people who could be affected by the virus.” Additionally, Dr. Teran tells me about his experience distancing himself from his family; for him, the interaction has decreased due to the fear of infecting them. “When the pandemic began, I tried not to have any type of contact with relatives.” It was a difficult task for him. He lasted 142 days without seeing his children. He recounts to me that, as the need to see them increased, he took several COVID-19 tests before going.
Regardless of the country in which the doctors are located, what they shared with me applies to health personnel around the world. Health workers in Montreal and across Quebec and all of Canada are still going through similar experiences. Doctors are human beings, who despite their profession are not immune to stress, illness, and even death. If anything, we should appreciate them more since they are worried not only worried about their personal well-being but also for that of their families, even as they try their best to deliver to their patients the most effective human care they can offer.
For the sake of my aunt, and of all our front line health care workers, I can only implore anyone who is tempted go without a mask, to not respect social distancing, to think about the experience of health care workers who are facing such stress, risk and isolation from their families, and to weigh whether they consider asserting their “freedom” in a foolhardy manner to be more important.
Photo of Dr Francy Galvis and her colleagues by Amada Herrera Galvis.