COVID-19’s Impact on Health Care Workers — Suzie Durocher-Hendriks and Dr. Abdo Shabah

Alex Maheux

With the COVID-19 pandemic evolving at a rapid pace, it’s possible that circumstances may have changed since this interview was originally recorded, and may not accurately represent the current situation

Hello, and welcome to the Canadian Health Information Podcast. I’m your host, Alex Maheux. In this program from the Canadian Institute for Health Information, we’ll be taking a look at Canada’s health care systems with the help of some highly qualified experts. Stay with us to hear more about our health policies and systems and the work being done to promote the health of Canadians.

Today, we visit the front lines of COVID-19. CIHI has published numerous reports about health care workers during the pandemic, which reveal the risks they face on a daily basis. Statistics show nearly 92,000 COVID cases and over 42 deaths among health care workers. These numbers have decreased recently, but health care workers continued to be exposed to risks every day. In today’s edition, we hear from Suzie Durocher-Hendriks, a nurse for 39 years and professor of acute and critical care at the Université de Moncton, Edmundston campus. We are also joined by Dr. Abdo Shabah, a Montréal-based emergency physician and public health specialist, who also commutes to the northern part of the province. Dr. Shabah also teaches at the Université de Montréal.

Keep in mind that the opinions and comments of our guests do not necessarily reflect those of the Canadian Institute for Health Information. So let’s get down to business.

Hello, Suzie and Abdo. And thanks for joining us on the podcast today.

Dr. Abdo Shabah

Hello.

Suzie Durocher-Hendriks

Nice to be here.

Alex Maheux

Abdo, let’s start with you. I realize this might be a rather serious opening question, but can you talk about your experience over the last year, beginning with the panic of the first wave and the waves that followed?

Dr. Abdo Shabah

In those first moments, we were a bit in disbelief. We just couldn’t believe this was going to happen. Then, once it did happen, it was really difficult to get any answers. As clinicians, we like it when we can get a clear picture of the situation. When we can get the right profile and make the right diagnosis. And in this case, all that was extremely complex. So it was harder at the beginning and, as more and more information became available, the information began to evolve. At the beginning, we had some criteria. At the diagnostic level, the criteria evolved, and in terms of interventions, several different therapeutic treatments were proposed. Many of them were disputed. For some interventions, we had what we needed; but for others, the treatments were either unavailable or inaccessible. We’re always concerned about having the most effective treatments based on evidence, but in this case there was no evidence. It was a difficult time, even professionally, but we had to be there and we had to do what was necessary.

So, we did our best. That’s more or less what my colleagues and I were doing. We knew we weren’t alone. So, it was difficult, but at the same time we also felt that we were part of the same international family. It affected all of us.

Alex Maheux

Mm-hm. Suzie, you have quite a remarkable story. You retired from nursing education in August 2020 to completely relaunch your career as an intensive care nurse, during the worst of the devastation in your home region of New Brunswick. What made you decide to return, and what have the last few months been like for you?

Suzie Durocher-Hendriks

I’d planned my retirement for a while and I knew I would stop teaching in August, after 23 years. But I wasn’t really ready to retire completely, because I believe that I’m still young and I still have a lot of energy. I was also concerned about being bored at home, and there was also the fact that all our plans, my husband’s and mine, had been completely disrupted by what was going on. So, I started in the ICU in the fall and it was slow, very few cases, everything was really, generally well-managed in New Brunswick, until it wasn’t.

Alex Maheux

Mm-hm.

Suzie Durocher-Hendriks

The last few months have been... Besides getting adjusted to a work environment that’s quite different from a classroom or meeting, being with students and all that, I had to adapt to being a senior bedside nurse, compared to my younger colleagues, many of whom had been my students. On the other hand, when we started getting COVID cases… Because we’re a regional hospital, for about 100 or so kilometres to the east and 250 kilometres to the south, there are no other regional hospitals. So that means that we see a lot of people from the Quebec region, Témiscouata and of course this entire region. So I really appreciated that my manager and the nursing care directors had established a number of contingency measures. We had simulated admissions, in the sense of, okay, here’s what’s happens when a patient comes in, we have designated intubation rooms, ventilation rooms, other more isolated rooms off to the side for our COVID patients. So, we were ready.

But what you can’t prepare for is actually experiencing it. We had to constantly… not reinvent these plans, but modify them. I found it very surprising that with all my years of experience, this disease was unlike anything I had experienced in the past, in terms of respiratory failure or distress. So the physical impact was challenging for me, psychologically as well. What made it worse was that it was a relentless environment. Just relentless. There wasn’t one day that was better than another for a long period of time, for at least 2 months non-stop. And we also had to deal with a shortage of staff. We know that there’s a very, very serious nursing shortage all across Canada, and it was even more obvious in this situation.

Alex Maheux

Mm-hm. The work that the 2 of you do is really incredible.

Dr. Abdo Shabah

Today’s hospital is not the same as it was a year and a half ago. One challenge at the beginning of the pandemic was that we had protocols, but no equipment. We had equipment protocols, but the spaces hadn’t been redesigned yet. There’s been an extremely important shift in our system, and I think there are upsides to any transition, any shift. There were after-effects in terms of fatigue and psychological impacts, but also serious commitment, a great deal of mutual support, people helped each other, and people began to recognize the importance of emergency measures in public health, more so than ever before.

Alex Maheux

Mm-hm. You’ve both mentioned the need to adapt and change frequently. Abdo, you brought up protocols, the fact that the structures have changed. Beyond the precautions that we’re used to now, such as masks, distancing, how have your roles evolved since the start of the pandemic and, Suzie, was it maybe different than you expected?

Suzie Durocher-Hendriks

Yes, because... Actually, I wasn’t expecting this at all, because there was a certain naiveté in the community, and in fact the whole province, and it hit us really hard. On the other hand, I think we were ready precisely because we’d implemented certain measures, the criteria were clear and our course of action was also very clear. Our provincial government issued very clear directives to both the public and health care providers. I never imagined, as a nurse, that I would live through something like this. I’m grateful to have experienced all this, because I’ve learned a great deal, I’ve seen things and and there are things that I appreciate much more now.

Alex Maheux

Abdo, I’d like to ask: I know you’re an emergency physician in Montréal and you also commute to northern Quebec, so let’s get into your experiences and how your role may have changed in both locations during the pandemic.

Dr. Abdo Shabah

My story is the exact opposite of what Suzie just described, because our experience with the first wave was very intense. The mortality and morbidity rates were very high in Quebec. We saw what was happening elsewhere, in France, Spain, and we thought it wouldn’t happen here. I offered to go to even before the request... as soon as I saw that seniors’ homes would be affected, I volunteered and had already reserved my weeks. I spent 2 weeks working in CHSLDs in COVID units and saw how living environments had to be transformed into care environments. It was extremely difficult to see: lack of contact with families, difficulties in providing treatment with a shortage of staff, 2 to 3 nurses per floor. We had one nurse for 3 floors. So we had to deal with a lot of shortfalls. As a clinician, it was a difficult experience.

It reminded me of some of my deployments, for example when I was in Haiti for cholera, after the earthquake. We were more certain about our impact, because we knew we could make a difference. There was a response already in place. We had proven approaches to work with, but in this case we didn’t have anything like that.

Alex Maheux

Both of you have been through some truly difficult experiences, which are really hard to imagine. And we know that there was burnout in the health care workforce even before COVID. And we’ve seen that it’s gotten much worse in the last 15 months. Have you been experiencing or seeing this yourselves?

Dr. Abdo Shabah

Maybe I can start. In Quebec, there have been a number of reforms. When the pandemic came along, it just reinforced that fatigue among our colleagues. We had barely had a chance to adjust to the changes that had taken place over the years when the pandemic hit us, challenged our structures, and challenged our coordination and cooperation. Obviously people are more attentive during a pandemic. We’re all united against this disease. So that makes it easier to communicate and to get people to work together. On the other hand, the structures hadn’t been firmly established yet and there was already a noticeable sense of fatigue. So, several of my colleagues retired, some of whom had been planning to do so for a long time and were one or 2 years away from retirement. So some of them left.

There is also a career choice, as far as whether or not to stay in acute care and get involved. From what I saw, that fatigue affected the overall mood of health care workers, but there was a growing awareness of the critical role of workers in the field. I’d say that fatigue is still with us today. There are staffing shortages in many of the emergency rooms that I’m familiar with, and where I’ve worked. You have to really pay attention to the health of your co-workers. We need to really try to support everyone who contributed during the previous waves, so we can maintain our services in the health care system.

Suzie Durocher-Hendriks

If I can add something. I found it very difficult to express compassion, to be a genuine presence, because when we’re fully covered from head to toe, visor, N95 mask, gown, 2 pairs of gloves at all times, the nurse and caregiver who normally communicate compassion and empathy through a smile, through a simple expression… all that was gone. All that’s left is what people can see in your eyes and what you say, how you say it. It was the only way, because there was no visiting allowed in the ICU for a long time, people were dying alone, families couldn’t be there and share the final moments. Whatever the circumstances, the nurse was always the link between the family and the patient who was unresponsive, but who... I always said to the families, “We can hear you, say what you have to say, talk about anything and everything, anything at all, it’s like having a regular conversation with your mother or with your brother or....” So I tried to encourage that as much as possible, using an iPad and Facetime.

Alex Maheux

Suzie, your answer brings me to the next question. What was the biggest challenge for both of you personally and professionally during COVID?

Dr. Abdo Shabah

For me, I think the main challenge on the professional side was the newness, the uncertainty we had to live through, not just for days, but weeks and months. On a personal level, it was the isolation and the separation. Once the pandemic started, I was isolated from my family, my new living space, and I didn’t want to spread it. I was at risk in my environment and it was unthinkable for me to bring this home to my parents, for example.

Suzie Durocher-Hendriks

It’s quite similar for me too. I personally found it difficult to isolate because my family is in Quebec and Ontario. My daughter, who’s a nurse, works in the northern communities in Quebec, and I have 2 other daughters here in New Brunswick, which is fortunate. But New Brunswick was separated into yellow, orange and red zones. So it was pretty common that I couldn’t visit my daughters and my daughters couldn’t come to see me, either. Or to see us, me and my husband. So we were in our own little bubble, pretty much isolated. At this point in my career, I felt that I had a contribution to make. That’s the only way I can say it. And I guess it helped me to survive in a way, because I never had any fear of getting the virus. I don’t really know why. But I thought, if I follow the rules, if I do what I have to do, I can protect myself.

Alex Maheux

Mm-hm. That brings me to the next question. It’s about vaccines, a topic that may be a bit more hopeful than my last few questions. But we know that vaccination efforts have ramped up in the last few months, and that’s helped reduce the number of cases as well. Are you comfortable sharing whether you’ve been vaccinated? And if so, do you feel safer?

Suzie Durocher-Hendriks

I feel more protected, because I have a certain level of immunity now. There’s still a lot of research to do on the vaccine. I’m very confident about the vaccine that I received, I’ve encouraged a lot of people to get the vaccine. I often say that it is a social and human responsibility to get vaccinated.

Dr. Abdo Shabah

Around me, people are incredibly happy, in terms of the vaccination. In my circle, there are some skeptics. Obviously, it’s a bit of a... it’s an individual choice. But as Suzie pointed out, it’s a collective choice, but ... All public health strategies are important, including vaccination. So I think it’s a very good thing, as Suzie mentioned, in terms of vaccination, there’s the fear that people will let themselves go and I think that it’s inevitable, with all the restrictions the population has had to deal with, that there will be some kind of a comeback. Is it going to be a strong comeback or is it going to be a careful comeback where we’ll try to go slowly? But we have to be vigilant.

I’m sure, Suzie, you’ve mentioned this before, that health care workers have been running on adrenaline for some time. How do you both think this is going to affect mental health for you and your colleagues, and do you think that maybe we’ve gained some insights for a better future?

Suzie Durocher-Hendriks

Mm... that’s a good question. I think the impact on mental health has been tremendous and continues to be so. I’ve had some really tough times, especially at the end of a shift where I’d think, what are we doing here, what’s going to happen? I’d think about the people. I was always thinking about the people who were most deeply affected, their families. I often cried alone. It was a really difficult ordeal, but on the other hand I saw the very best of humanity too. The thing we have to learn from this, and Abdo mentioned it earlier, is that health is an international issue. We have to stop thinking that what happens somewhere else doesn’t affect us. It does affect us. I think we need, as people on this earth, to be a lot more altruistic. As we’ve seen with the sharing, the vaccine technology, we should be less competitive between ourselves, between countries.

Alex Maheux

Abdo, what do you think we have learned for a brighter future?

Dr. Abdo Shabah

I think it brought about a recognition of how vulnerable the elderly are. Unfortunately, we already knew, but there hadn’t been any action taken with regard this population, at least here in Quebec, and now, we’re more and more aware and it looks like the system is going to get an overhaul. People are in favour of this transformation. They want it, they don’t want the same thing to happen again, and there’s a fear of going to live in CHSLDs. People don’t want these resources anymore. We need to reinvent the health care system, at least for the elderly. We can also see the reorganization of people’s lives in terms of urban sprawl. A lot more people are living in the suburbs, and they want a certain lifestyle, because now we allow remote work. It’s a transformation we’ve been expecting for a long time, but now it seems a lot clearer. People don’t work in the same way anymore. And then, directly in our own field, remote work means virtual care. There’s been a lot of strong support for virtual care, and it’s hard to imagine that’ll just go away. Quite the contrary, I think it will grow in importance, but will be part of a system-wide transformation.

We haven’t heard the last of this pandemic. I think it’s going to be a topic for the next few years, in terms of its impact on people all over the world.

Alex Maheux

Mm-hm. There’s definitely more to come on this subject. Abdo, Suzie, thank you both so much for your sacrifice, perseverance and caring. It was really a pleasure to talk to you today.

Dr. Abdo Shabah

Thank you.

Suzie Durocher-Hendriks

Thank you.

Alex Maheux

Thank you for listening. We hope you enjoyed this episode. Join us again soon as we continue to present interesting perspectives and dive into health-related topics that interest you. To learn more about CIHI, visit our website at icis.ca If you liked today’s discussion, please subscribe to our podcast, drop us a comment and follow us on social media. This episode was produced by Jonathan Kuehlein, with assistance from Amy Chant, Marisa Duncan, Shraddha Sankhe and Ramon Syyap. Thank you for listening to the Canadian Health Information Podcast. Until next time!

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