Goal 3: Good Health and Well-being


India is now the second worst affected country in the world. This MSF psychologist shares the reality of working on the COVID-19 frontline.

By emma elms

India now has the second largest number of confirmed cases of COVID-19 in the world, at over 9,500,000, only surpassed by the US which has had over 14,100,000 cases. The country has also reported over 130,000 deaths, the third highest in the world, after the US and Brazil. 

Pooja Iyer, 30, is a mental health manager for Médecins sans Frontières (MSF), working in a purpose-built, 100-bed treatment centre for COVID-19 in the city of Patna in Northeast India. She lives in Mumbai with her parents, but over the past eight years her MSF work has taken her around the world to countries including Malawi, Bangladesh, Ukraine and the Balkans. She also works as a health promotion manager, teaching patients about COVID-19 safety measures. Here she shares in powerful detail how it feels to help patients at a time of emotional distress and the shocking misconceptions about the virus that she’s encountered…

What does your work involve?

As a mental health manager, I’m helping to improve the resilience of patients in the COVID crisis and improve their coping strategies. I head up a team of counsellors who work on the fears patients have around COVID. We receive referrals from doctors and nurses and provide psycho-social counselling for patients suffering symptoms of distress. We see over 10 patients a day.

The health promotion side of my role relates to teaching patients the health practices we need to manage COVID in the community, like the importance of proper handwashing, as this is the main way to stop the spread of COVID. We also teach them about self-isolating for 7-10 days after they’ve left the centre, so as not to transmit the virus to family members. We run group education sessions three times a day – some patients are mobile and others are on oxygen support machines – and we also provide individual education at people’s bedsides.

Mental Health Manager Pooja Iyer at work

What’s the treatment centre like in Patna?

It’s like a big sports stadium. It was built very quickly, with tent structures on the side, but it’s well-equipped with a separate ward for isolation and palliative care. There are also glass structures so if a patient is at the end of their life, their relatives can come and see them through the glass. With COVID, it’s very difficult to be able to come inside the facility. It’s built in a way to support patients and their family members through tough times.

What are the most common mental health issues patients have shared with you?

Mainly fear and anxiety because COVID is considered to be a deadly disease. Our patients often have a fear of dying. Being in isolation can cause feelings of sadness. We have iPads we take to patients in their beds, so they can connect with their family via video calls. It really helps so we always encourage them to keep in touch. 

How do you help patients cope with the stigma surrounding COVID?

More than 80 per cent of our patients have gone through stigma, either from other healthcare workers or within their community. Most of the patients tell us that the healthcare workers they saw before us, in other clinics and hospitals, would just throw their medication to them and make them pick it up from the ground. Even though the staff were in PPE, they were just so scared of catching COVID. 

We are very well protected in PPE, so here we go close to patients, touch their arm, take their temperatures and so on. People tell us they are very moved by our caring approach. They often become quite teary when they tell us what a different experience this is. Emotions run high, especially at a time when they can’t meet their family members, so we need to be extremely compassionate.

Tell us about one of the patients you’ve helped…

One man, who was 33 and married with three young children, was crying in the night as he was so worried about how his family would cope without him. He was head of the household; he lived with his parents, his wife and their children. The community feared they were all COVID-positive, so they couldn’t even leave the house to get essentials like milk and bread. He wanted to leave the facility to go and help them so it was very important we intervened. We helped him find a friend to look after them and arranged for them all to be tested so that they wouldn’t face stigma in their community.

What are some of the misconceptions you’ve encountered around the virus?

The most common myth we’re seeing which is prevalent all over India is that drinking very hot water can prevent COVID. One 35-year-old man came to us who had been drinking near boiling water for four months – he had severe burns in his throat. It was so sad. He was COVID-positive but once we’d educated him and he recovered, he became a pioneer helping others, telling them, ‘Please don’t do this.’ 

As in many countries, in India drinking warm water is a common way to cure sore throats, so some people started thinking very hot water might somehow kill the COVID virus, which of course it doesn’t. These beliefs become so embedded they can be difficult to change. The one thing I’ve learned during a pandemic is that people develop some very unusual coping mechanisms. People are susceptible to any information without checking the facts.

What other unusual coping strategies have you seen? 

We had a young man of 25 who had been using hand sanitiser on his whole body to try and prevent himself catching COVID. During our education sessions, we taught him that sanitiser should only be used for your hands. 

What’s the most emotional moment you’ve experienced?

There was a woman, a mother of three children, who was co-infected with HIV, TB and COVID. We were losing hope because her condition was deteriorating but she was a fighter. It was a very complicated case. Our centre is for moderate to semi-severe cases, but it soon became clear she needed more help (we don’t have ventilators here) so we referred her to another hospital. While we looked after her here, I held her hand and told her we were by her side. I was in touch with her eldest daughter throughout too, who was 15. Sadly, she lost her battle in the end. I met her husband afterwards and it was the most difficult meeting ever. It was very emotional. He thanked us for our support and everything we’d done.

How do you cope with the trauma of caring for patients?

I’m very aware of what’s called ‘carer fatigue’. MSF has systems in place for staff, offering mental health support from an external psychologist if needed. I’ve worked in emergency settings for many years, but this is a new situation. I try to keep one day a week just for myself, that’s my way of coping. I try not to talk about COVID that day, but it’s very difficult. I speak to my family and friends and I work out regularly, so that helps me.

How else do you spend your precious day off?

Usually sleeping! Also, catching up on the TV series I never end up finishing. I’ve just finished The Handmaid’s Tale. I started it two years ago, so I’m very proud of myself!

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go to Médecins sans Frontières, The Covid-19 Solidarity Response Fund and World Child Cancer