France: nurses struggle

Worse still, some of these unvaccinated patients are adding additional strain by refusing medical care even while hospitalized, sometimes becoming verbally abusive or violent. A worldwide shortage of caregivers that is soon becoming its own epidemic raises concerns about how systems will continue to provide medical aid. But this crisis is also an opportunity to take a global look at how to build more resilient healthcare infrastructures to support the people who keep us alive.

While France’s socialized healthcare system is one of the best in the world, the pandemic has put a hard strain on workers, especially those in public hospitals, as France24 reports. Some 20% of beds in public hospitals have closed because of staffing shortages, and 2%-5% of jobs in these facilities are currently vacant, according to the French Hospital Federation.

One of the most important ways to imagine a more sustainable hospital model is to center the voices of doctors themselves, as French daily Les Echos recently did. Many expressed frustration with those who refuse to be vaccinated.

The nursing staff are upset when they hear these (unvaccinated) patients.

Olivier Joannes-Boyau, head of an anesthesia-resuscitation center in Bordeaux, recounted the case of an unvaccinated woman in her fifties, accustomed to marathons and mountain treks. She’s currently intubated, with her chance of survival uncertain.

Joannes-Boyau says, “We avoid making them feel guilty but, between them, the nursing staff are upset when they hear these patients say: ‘If I had known…’ Because we know: it has now been proven that the vaccine can greatly reduce the risk of serious forms of COVID.”

Joannes-Boyau adds that not only is their unit full, but they also had to close 20 critical care beds (out of 120) because of a lack of staff. He noted the “cracking” healthcare system and the fact that salaries have not met rising living costs, with many having long commutes from places where they can afford rent.

U.S. - The for-profit factor

In the United States, some three in 10 healthcare workers have considered quitting their jobs, according to a Washington Post-Kaiser Family Foundation poll, which also found that approximately six in 10 felt that the pandemic had negatively impacted their mental health. Since February 2020, the US healthcare sector has lost close to half a million workers, according to estimates from the US Bureau of Labor Statistics.

Justin Meschler, a physician anesthesiologist, wrote an op-ed in the Denver Post about how his decision to quit being a doctor traces back to before the pandemic. Meschler had experienced how the input of private capital into the medical system impacted the care he was able to provide.

Ironically, he received a pay cut during the pandemic because the types of care COVID patients need are not as profitable as other treatments. After acquiring his own PPE early on in the pandemic when the hospital didn’t have a large enough supply, he was told wearing an N95 face mask would scare patients.

As he wrote, “I foresee a massive shortage of physician specialists right when our country and healthcare system will need them most. The corporatization of medical practices, the mismanagement of hospitals and COVID created a perfect storm for many of us to decide it is time to hang up our stethoscopes.”

A doctor brain drain in Africa

In some developing countries, the fear is less that doctors will leave the profession, but more so that they will emigrate to other parts of the world — a trend that started well before the pandemic. Many of these healthcare workers had to wait months (or are still waiting) while their peers in Western countries received vaccines in early 2021.

In Nigeria, for example, the brain drain of highly trained professionals to countries like the United Kingdom and the United States was already a serious issue before the pandemic: 88% of Nigerian doctors were considering leaving the country according to a 2018 study by Nigeria Health Watch.

Africa accounts for 22% of COVID burden

The situation was so dire that despite the African continent accounting for more than 22% of the global burden of disease, it had access to just 3% of healthcare workers.

As German newspaper Deutsche Welle reports, poor working conditions and better opportunities abroad are important push and pull factors; in countries such as South Africa, corruption and not receiving funds that were supposed to be dedicated to fighting COVID-19 also play a role.

South African anesthetist Caroline Lee coordinates a network providing psychological support for health workers. Lee told Die Welt that while there are no reliable figures to confirm numbers of people leaving the country, “all around us, in the medical and business world, people talk about emigrating. Patients tell me this, too.”

Facing racism in Asia

This exodus is also proving an issue in the Philippines. Before the pandemic, the archipelago was one of the biggest providers of healthcare workers to foreign countries, particularly the UK and the US, with some 17,000 nurses working abroad. At the beginning of the pandemic, the Filipino government temporarily halted these visas in order to support domestic needs; it later allowed just 5,000 foreign healthcare worker visas to be granted.

Last year, the government increased this number to 6,500 visas to meet global demands. Filipino online news source Rappler reports that nursing advocacy groups believe this change isn’t big enough to account for the number of workers seeking employment in other countries.

Although while working abroad, some medical personnel also saw an increase in racist attacks. Based on the false claims that China played a role in spreading COVID, East and Southeast Asians in the UK recorded a 300% increase in hate crimes since the start of the pandemic, according to End the Virus of Racism, an advocacy group. Al Jazeera reported last year about how Britain's Asian healthcare workers have faced an increasing amount of racial verbal and physical attacks.

As the long shadow of the pandemic continues to darken any optimism of a return to normal times, it’s necessary that healthcare workers continue to fight for the health of both their patients and themselves. But it’s also important to acknowledge that they too are just humans and to think of ways that their work can be sustainable, especially in the middle of a global crisis when they are most needed.