JDN_22NL_June2021

JUNIOR DOCTORS
NETWORK
empowering young physicians to work together towards a healthier
world through advocacy, education, and international collaboration
Published by the Junior Doctors Network of the World Medical Association
The information, perspectives, and opinions expressed in this publication do not
necessarily reflect those of the World Medical Association or the Junior Doctors
Network. WMA and WMA-JDN do not assume any legal liability or responsibility
for the accuracy, completeness or usefulness of any information presented.
Junior Doctors Network Newsletter
Issue 22
June 2021
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Leadership 2020-2021
Junior Doctors Network Newsletter
Issue 22
June 2021
CHAIR DEPUTY CHAIR SECRETARY
SOCIO-MEDICAL
AFFAIRS OFFICER
EDUCATION
DIRECTOR
MEDICAL ETHICS
OFFICER
MEMBERSHIP
DIRECTOR
PUBLICATIONS
DIRECTOR
COMMUNICATIONS
DIRECTOR
IMMEDIATE PAST
CHAIR
Dr Yassen Tcholakov
Canada
Dr Julie Bacqué
France
Dr Wunna Tun
Myanmar
Dr Manon Pigeolet
Belgium
Dr Helena Chapman
Dominican Republic
Dr Lyndah Kemunto
Kenya
Dr Lwando Maki
South Africa
Dr Uchechukwu Arum
Nigeria/United Kingdom
Dr Maki Okamoto
Japan
Dr Chukwuma
Oraegbunam
Nigeria
Page 2
Editorial Team 2020−2021
Junior Doctors Network Newsletter
Issue 22
June 2021
Dr Victor Animasahun
Nigeria
Dr Nishwa Azeem
Pakistan
Dr Sejin Choi
Republic of Korea
Dr Ricardo Correa
Panama/United States
Dr Giacomo Crotti
Italy
Dr Mashkur Isa
Nigeria/United Kingdom
Dr Jooyoung Moon
Republic of Korea
Dr Jeazul Ponce H.
Mexico
Dr Parth Patel
Malawi
Dr Vandrome Nakundi
Kakonga
Dem. Rep. of Congo
Dr Mellany Murgor
Kenya
Dr Suleiman A. Idris
Nigeria
Page 3
Table of Contents
TEAM OF OFFICIALS’ CONTRIBUTIONS
06 Words from the Chair
By Dr Yassen TCHOLAKOV (Canada)
07 Words from the Communications Director
By Dr Maki OKAMOTO (Japan)
08 Words from the Medical Exchange, Education, and International
Mobility Working Group Chair
By Dr Uchechukwu ARUM (United Kingdom)
10 Words from the Medical Exchange, Education, and International
Mobility Working Group Project Lead
By Dr Maymona CHOUDRY (Philippines)
12 Words from the Publications Director
By Dr Helena CHAPMAN (Dominican Republic)
REFLECTIONS
13 Reflections about Promoting Doctors’ Well-being
By JDN Publications Team
16 Reflections about Promoting Doctors’ Well-being
By JDN Members of the Medical Exchange, Education, and International
Mobility Working Group
JUNIOR DOCTORS’ PERSPECTIVES
AFRICA
18 Echoes from the JDN Doctors’ Well-being Webinar
By Dr Uchechukwu ARUM (Nigeria/United Kingdom)
21 Impact of COVID-19 on Medical Education
By Dr Parth PATEL (Malawi), Dr Steven MUNHARO (Malawi), Dr Robert
MKWEU (Malawi), and Dr Elias PHIRI (Malawi)
Junior Doctors Network Newsletter
Issue 22
June 2021
Page 4
Table of Contents
24 Improving Junior Doctors’ Well-being during the COVID-19 Pandemic
in Nigeria
By Dr Chioma AMUGO (Nigeria)
27 Reflections from the COVID-19 Frontline One Year Later: A Kenyan
Perspective
By Dr Abdullahi KASSIM (Kenya), Dr Amal RASHID (Kenya), and Dr Mellany
MURGOR (Kenya)
30 A Call to Invest in Doctors
By Dr Chukwuma ORAEGBUNAM (Nigeria)
33 Work-life Balance Webinar
By Dr Dabota BUOWARI (Nigeria)
35 Zoom Fatigue: A Pandemic within a Pandemic
By Dr Dabota BUOWARI (Nigeria)
AMERICAS
38 Perspective on Well-being as an Obstetrician-Gynecologist
By Dr Aliye RUNYAN (United States)
ASIA
41 A Junior Doctor’s Journey to Well-Being: Building Resilience to
Prevent Mental Health Breakdown
By Dr Maymona CHOUDRY (Philippines)
45 The Emotional Toll of a Junior Doctor
By Dr Vyom AGARWAL (India)
47 The Well-being of Myanmar Junior Doctors during tha Military Coup
By Dr Wunna TUN (Myanmar)
EUROPE
50 Well-being Helps Examine Hospital Governance during Health Crisis
By Dr Samuel D’ALMEIDA (France)
Junior Doctors Network Newsletter
Issue 22
June 2021
Page 5
Dear colleagues from around the world,
It is my pleasure to introduce this 22nd Issue of the Junior Doctors Network (JDN)
Newsletter on the topic of Doctors’ Well-being.
I wish to congratulate the Medical Exchange, Education, and International Mobility JDN
working group and the Publications Team, for preparing this outstanding special edition of
the JDN Newsletter. This resource serves as a space for junior doctors from around the
world to share experiences and perspectives on this important yet sometimes difficult topic
to discuss. This issue is timely as it follows the Doctors’ Well-being webinar from March
2021.
As junior doctors have been actively involved in the pandemic response efforts, we
understand the direct impact the pandemic has had on our work-life balance. We have
observed unforeseen challenges related to the pandemic, which have placed additional
stress on global healthcare workers and further exacerbated existing workplace stressors.
Together, we can acknowledge these challenges and propose action plans by sharing our
experiences and resources – including articles for the JDN Newsletter.
On behalf of the JDN management team, I would like to thank all participants who joined
the JDN bi-annual meeting and the World Medical Association (WMA) Council meeting held
in April 2021. Lastly, I would like to encourage all junior doctors to learn more about our
activities. We are all approachable and would be happy to share more details about our
work!
Enjoy the read!
Sincerely,
Yassen Tcholakov
Junior Doctors Network Newsletter
Issue 22
June 2021
Words from the Chairperson
TEAM OF OFFICIALS’ CONTRIBUTIONS
Yassen Tcholakov, MD MScPH MIH
Chairperson (2020−2021)
Junior Doctors Network
World Medical Association
Page 6
It is my pleasure to welcome you to the 22nd issue of the Junior Doctors Network (JDN)
Newsletter.
As our JDN family has been physically distanced, we have not been able to interact in-
person at our biannual meetings. However, although we may feel alone and overwhelmed
with our clinical responsibilities, we must remember that we have JDN families all over the
world with whom we can share our experiences and feelings.
Over this past year, junior doctors have utilized virtual platforms to minimize physical
distance, build international collaborations in medical education, policy, and research, and
offer valuable contributions to our local and global communities. These activities highlight
the strong leadership of junior doctors across the globe.
This issue of the JDN Newsletter focuses on personal reflections, scientific perspectives,
and community activities on the health and well-being of junior doctors. Personally, I feel
that my clinical responsibilities have been worthwhile and fulfilling, especially when patients
show their appreciation and satisfaction. Through this positive feedback from patients, I feel
that my dedicated efforts in clinical care were rewarding. By prioritizing career satisfaction
and mental well-being, we can develop international collaborations that support pressing
health issues, energize our networks, and provide professional and personal growth.
I hope that you enjoy reading the articles in this biannual issue of the JDN Newsletter,
where you will be inspired by global leadership and collaborations. As we broaden our
horizons, the world actually becomes more connected!
Sending love from Berlin,
Maki Okamoto
Junior Doctors Network Newsletter
Issue 22
June 2021
Words from the Communications Director
Maki Okamoto, MD
Communications Director (2020−2021)
Junior Doctors Network
World Medical Association
Dear colleagues,
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 7
On behalf of the Medical Exchange, Education, and International Mobility Working Group, I
am pleased to present the Junior Doctors’ Network (JDN) Newsletter Special Edition on
Doctors’ Well-being.
The novel coronavirus disease 2019 (COVID-19) pandemic held the world at a standstill.
Along with significant morbidity and mortality to COVID-19, the resulting havoc included
economic challenges, isolation, mental health stressors, and disruption of academic
programs, especially to low-income countries. Since doctors’ mental health and well-being
have been overlooked early in the pandemic, hardships experienced by this frontline
workforce have encouraged global dialogue to protect their mental health and well-being
moving ahead.
There is need for continued support to ensure optimal healthcare workers’ well-being, since
a healthy workforce ultimately translates to better patient experiences and high-quality
healthcare delivery. As part of the World Health Organization (WHO)’s efforts to promote
the well-being of healthcare workers and recognize their unwavering dedication during
COVID-19 response efforts, the year 2021 was designated as the International Year of
Health and Care Workers. Notably, the WHO launched the “Protect. Invest. Together”
campaign as a global call for action to ensure that the health workforce is supported,
protected, motivated, and equipped to always deliver safe health care services, during and
after the COVID-19 pandemic.
Over the past year, we have learned that prioritizing doctors’ well-being continues to be a
challenge, especially during an extremely rigorous and demanding postgraduate medical
training. Junior doctors bear the brunt of overwhelming workloads, high expectations from
trainers, pressure of passing examinations, risk of placing patients in harm, and fear of
severe health consequences as a result of COVID-19. All these factors invariably have an
untoward effect on doctors’ well-being.
Junior Doctors Network Newsletter
Issue 22
June 2021
Words from the Medical Exchange, Education, and
International Mobility Working Group Chair
TEAM OF OFFICIALS’ CONTRIBUTIONS
Uchechukwu Arum, MD
Education Director (2020−2021)
Chair, Medical Exchange, Education, and International Mobility
Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Page 8
The Special Edition of the JDN Newsletter – with the theme of Doctors’ Well-being – is one
of the collaborative efforts of JDN members in facilitating an open dialogue about global
events and activities that are relevant to their postgraduate training. This project would not
have been successful without the dedication of the project lead (Dr Maymona Choudry)
and members of the Medical Exchange, Education, and International Mobility Working
Group as well as the JDN Publications Team. Articles include, but are not limited to, topics
on doctors’ mental and physical well-being, work-life balance, psychosocial stressors,
coping measures and resilience, fatigue, and the emotional toll experienced as a
healthcare worker.
Please enjoy the knowledge-laden JDN Newsletter!
Thank you,
Uchechukwu Arum
Junior Doctors Network Newsletter
Issue 22
June 2021
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 9
It is my pleasure to welcome you to the Special Edition on Doctors’ Well-Being of the Junior
Doctors Network (JDN) Newsletter.
Over the past year, the healthcare system has changed in numerous ways – including
different approaches for provider-patient interactions in the clinic and the emergence of
various telehealth strategies that deliver holistic care to patients across the globe. Due to
the sudden and rapid transition in the healthcare delivery system, the JDN community
would like to share the experiences of JDN members from all around the globe, with
regards to the challenges as well as personal and social issues that they have faced with
their mental health and well-being. There have numerous stressors that have affected
junior doctors, such as social isolation, limited access to personal protective equipment,
transitions in schedules and extended work hours, fear and anxiety of disease
transmission, and living away from loved ones to decrease risk of exposure.
On behalf of the JDN Management Team, JDN Publications Team, and the Medical
Exchange, Education, and International Mobility Working Group, I would like to thank each
JDN member who contributed to this Special Edition. Their personal anecdotes, stories,
and experiences will serve as an inspiration and motivation to other JDN members.
Junior Doctors Network Newsletter
Issue 22
June 2021
Words from the Medical Exchange, Education, and International
Mobility Working Group Project Lead
TEAM OF OFFICIALS’ CONTRIBUTIONS
Maymona Choudry, MD MPH
Project Lead, Medical Exchange, Education and International
Mobility Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Dear colleagues from around the world,
Page 10
Personally, by reading their stories, it has made me feel that we
are not alone in our journey to seek approaches that can improve
our mental health well-being during this pandemic.
As humans, we are vulnerable to experience fear, anxiety, stress, and mental health
challenges, especially when we become overwhelmed with new changes and transitions in
our daily routine. However, as junior doctors, we must strive to protect our own well-being,
for the sake of our patients, communities, and countries. We can promote the highest
standards of holistic care, including a focus on mental health and well-being, for ourselves
and our patients.
We hope that this JDN Newsletter will inspire more junior doctors globally to continue
sharing and supporting the JDN community! As junior doctors, our network aims to
strengthen the bonds among members from different continents in order to create
strategies and projects that advance our medical and public health expertise.
Sincerely,
Maymona Choudry
Junior Doctors Network Newsletter
Issue 22
June 2021
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 11
Dear JDN colleagues,
On behalf of the Publications Team (2020-2021) of the Junior Doctors Network (JDN), we
are honored to present and share the Doctors’ Well-being Special Edition of the JDN
Newsletter with junior doctors across the world.
This 22nd issue of the JDN Newsletter marks the first collaborative effort between the JDN
Publications Team and the JDN Medical Exchange, Education, and International Mobility
Working Group to develop a joint Special Edition issue. This collaboration represents a
symbol of the leadership and passion of junior doctors who encourage their colleagues to
share their clinical and community health experiences and perspectives on topics related to
doctors’ well-being.
The JDN Newsletter offers an international platform for junior doctors across the globe to
share their medical and public health leadership activities in local and national health
initiatives. These articles disseminate updates on JDN activities, scientific perspectives on
pressing global health issues, and reflections on community experiences. Their leadership
can encourage and empower other junior doctors to develop health promotion activities and
enhance communication between World Medical Association (WMA) and JDN members.
We recognize the dedicated efforts of all leaders of the Medical Exchange, Education, and
International Mobility Working Group and editors of the JDN Publications Team 2020-2021
as we finalized this 22nd issue. We appreciate the continued support of the JDN
management team and WMA leadership as we prepared this high-quality resource for
junior doctors. We hope that you enjoy reading about junior doctors’ experiences in this
22nd issue!
Together in health,
Helena Chapman
Junior Doctors Network Newsletter
Issue 22
June 2021
Words from the Publications Director
Helena Chapman, MD MPH PhD
Publications Director (2020−2021)
Junior Doctors Network
World Medical Association
TEAM OF OFFICIALS’ CONTRIBUTIONS Page 12
Junior Doctors Network Newsletter
Issue 22
June 2021
Reflections on Promoting Doctors’ Well-being
by the JDN Publications Team (2020−2021)
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Helena Chapman (Dominican Republic)
As junior doctors, our physical and mental health and well-being
provide a framework for our significant contributions to clinical care,
community health, medical education, and research. Although
challenging, we must always strive to establish a positive work-life
balance by spending quality time with family and friends, finding
enjoyment in hobbies and other personal activities, establishing a
physical fitness routine, and taking time to rest! Time is precious,
and we must care for our own heath, so that we can care for the
health of our family and patients!
Dr Victor Animasahun (Nigeria)
Doctors should have a conversation about their personal well-being
and the well-being of their colleagues. We need to look after
ourselves so that we can care for others. The first step to looking
after one another is to create a safe space to talk about sensitive
topics, without judging others or fear of being judged.
Dr Nishwa Azeem (Pakistan)
I believe that promoting doctors’ well-being means having an open
feedback system, standing against valorisation of overworking, and
creating an atmosphere where doctors can ask for help. I have
mindfully taken days off and discussed topics with colleagues – that
even if no tangible solution was reached – I have been able to
alleviate any negative feelings of alienation.
Page 13
Junior Doctors Network Newsletter
Issue 22
June 2021
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Ricardo Correa (Panama/United States).
Well-being is a major topic that includes resilience, burnout, and
wellness. As junior doctors, we can find trainings on resilience and
stress management, evaluate our well-being on burnout self-tests,
seek personal coaching or professional help, and identify the
wellness mentor in our department. It is important to remember the
work-life balance and spend time with our family and friends.
Dr Suleiman Ahmad Idris (Nigeria)
As the nature of our profession compels us to embrace stress as a
norm, we must remember the importance of the work-life balance.
We should schedule regular breaks to participate in personal
activities and hobbies, sleep for at least eight hours, eat healthy
foods, and exercise regularly. Even with a busy clinical schedule, I
take time to connect with family and friends as well as work on my
hobbies and fun side projects!
Dr Mashkur Abdulhamid Isa (Nigeria/United Kingdom)
Self-reflection, exercise, social connection, positivity, meditation,
and deep breathing are some vital techniques and strategies to
promote doctors’ well-being. Although there have been significant
stressors during the pandemic, there are many positive things that
we can acknowledge and be grateful for. As our friends, family, and
colleagues are invaluable connections who encourage us, we can
schedule weekly chats. This support system is paramount,
particularly in these trying times. Furthermore, exercise, meditation,
and deep breathing are techniques that are instrumental in
reducing stress and anxiety as well as promoting overall well-being.
Page 14
Junior Doctors Network Newsletter
Issue 22
June 2021
PUBLICATIONS TEAM’S CONTRIBUTIONS
Dr Jooyoung Moon (Republic of Korea)
Under high pressure and expectations, doctors are often pushed to
their limits. I have personally found it effective to always be aware
of my own mind and body and to understand the limits. It has also
been helpful to have a positive mindset that can reduce anxiety and
foster self regard. Remember, we are all great in our own ways!
Dr Vandrome Nakundi Kakonga
(Democratic Republic of the Congo)
Last year, my clinical responsibilities in primary care were stressful,
where I managed adult patients with chronic diseases like diabetes
mellitus and hypertension in the eastern region of the Democratic
Republic of the Congo. As these high-risk patients faced significant
morbidity and mortality due to COVID-19, I experienced feelings of
being overwhelmed. To promote my physical and mental well-being,
I decided to integrate physical exercise (jogging) in my morning
routine.
Dr Jeazul Ponce Hernández (Mexico)
To promote a positive work-life balance, we should try to separate
our work activities from our personal lives. We should take care of
our physical and mental health, consume healthy foods, sleep
sufficient hours, and participate in social activities. As health care
workers, if we do not take care of ourselves, then we cannot
effectively take care of our patients!
Page 15
Junior Doctors Network Newsletter
Issue 22
June 2021
WORKING GROUP MEMBERS’ CONTRIBUTIONS
Uchechukwu Arum (Nigeria/United Kingdom)
Patient safety and experience remain at the heart of providing high-
quality clinical practice. One of the best ways to emphasize patient
safety and experience is to promote doctors’ complete state of
physical, mental, and social well-being in the daily workplace.
Dr Dabota Buowari (Nigeria)
As healthy physicians care for the sick, the commandment of
physician self-care should be strictly followed. When a physician is
sick, patients will inevitably seek care from another physician. We
must always aim to prevent physician burnout and exhaustion to
optimize patient care, reduce medical errors, and avoid potential
litigations.
Dr Maymona Choudry (Philippines)
Doctors’ well-being can be promoted by spending time with family
and friends. With their support, we can develop coping
mechanisms, engage in healthier behaviours, improve self-esteem,
and build self-confidence. These efforts can lead to better overall
physical, psychological, and emotional health and well-being.
Page 16
Reflections on Promoting Doctors’ Well-being
by the JDN Members
Junior Doctors Network Newsletter
Issue 22
June 2021
WORKING GROUP MEMBERS’ CONTRIBUTIONS
Dr Samuel d’Almeida (France)
Well-being has a mix of sources – ranging from ethics, personal life,
and labour conditions – which may lead to burnout, bore-out or
brown-out. If you feel overwhelmed, it is time to pause, reflect, and
look upstream.
Dr Lisanul Hasan (Bangladesh)
Take good care of your physical and mental health so that you can
take good care of others!
Dr Christopher Mathew (India)
We march through grey fields, in blue scrubs and an amber heart.
We must defend ourselves as defenders. Non omnis moriar (Not all
of me will die)!
Page 17
The Medical Exchange, Education, and International Mobility Working Group of the Junior
Doctors Network (JDN) supported an international webinar on Doctors’ Well-being on
March 20, 2021. At the beginning of the event, three JDN members – Dr Mehrdad Heravi
(Iran), Dr Lisanul Hasan (Bangladesh), and Dr Wunna Tun (Myanmar) – shared how they
have managed their well-being during the coronavirus disease 2019 (COVID-19) pandemic.
They offered their personal experiences in the clinical workplace and shared encountered
challenges (Photo 1).
The keynote speaker, Dr Stuart Slavin (United States), is a renowned Accreditation Council
for Graduate Medical Education (ACGME) Senior Scholar on Well-being. In his
presentation, he recognized the hardships that doctors across the globe have faced before
and during the COVID-19 pandemic (Photo 2). Notably, he classified “satisfaction” for
optimal well-being into three categories – school and work, general life, and self – and
offered individual strategies to cope with the stressors of the workplace environment (1).
He opined that satisfaction is not a binary construct, but rather exists on a longer
continuum. No matter where individuals are on this continuum scale, he suggested that
they aim for greater satisfaction over time. For example, if they express “extreme
dissatisfaction”, then they can take appropriate actions to move to “moderate
dissatisfaction”.
Junior Doctors Network Newsletter
Issue 22
June 2021
Echoes from the JDN Doctors’ Well-being Webinar
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA
Uchechukwu Arum, MD
Education Director (2020−2021)
Chair, Medical Exchange, Education, and International Mobility
Working Group (2020−2021)
Junior Doctors Network
World Medical Association
Page 18
Some of these challenges included burnout, psychological
stress, shortage of personal protective equipment, and
physical assault on healthcare workers.
Furthermore, Dr Slavin identified automatic thoughts and cognitive distortions – such as
performance as identity, personalization and self-blame, magnification, tunnel vision
focusing on negative events, fortune telling, mind reading, ‘should have’, over
generalization, maladaptive perfections, and impostor phenomenon (2). These thoughts
generate feelings of inadequacy, embarrassment, shame, and guilt.
Dr Slavin recommended that these thoughts can be modified using the cognitive toolbox –
called Metacognition – defined as the ability to evaluate an individual’s analytical processes
and change any negative pattern to a more positive form (3). He emphasized the value of
cognitive behavioural therapy – with or without a mental health diagnosis – which is
effective for modifying negative thoughts, depression, and anxiety. He further explained
that individuals tend to erroneously believe that adverse events are similar to outcomes,
when in reality, adverse effects coupled with the cognitive emotional reaction actually result
in the outcome.
He highlighted that the only way to influence the outcome is to best manage the cognitive
emotional reaction. For example, the aim is not to be happy when something bad happens,
but rather to have a more proportionate and functional reaction to the adverse event.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 19
Adverse effect + Cognitive emotional reaction = Outcome
He elucidated three steps to mitigate the effects of these
automatic thoughts: 1) notice your thoughts; 2) label your
thoughts with self-compassion; and 3) dispute any distortion
and create a different narrative.
He stated that the overall goal is to recognize these negative
emotions and manage them in a more functional way.
After the keynote presentation, Dr Elizabeth Gitau (Kenya), the Chief Executive Officer of
the Kenya Medical Association (KMA), summarised KMA’s efforts towards maintaining
optimal mental health and well-being of Kenyan doctors. Such KMA programmes, which
include physician health programs and call centres staffed by psychologists, provide mental
health support and services for doctors.
Overall, this international webinar was interactive for all attendees, offering insightful
reflections on promoting doctors’ well-being. Many JDN members expressed their
appreciation for learning novel approaches to mitigate the effects of cognitive distortions. In
the upcoming months, the Medical Exchange, Education, and International Mobility
Working Group will continue to support JDN activities that will help advance medical
education, including understanding career opportunities with international organizations,
developing a global postgraduate medical directory, and seeking avenues to partner with
health institutions that encourage medical exchange and international mobility.
References
1) Slavin S. Reimagining well-being initiatives in medical education: shifting from promoting wellness
to increasing satisfaction. Acad Med. 2021;96:632-634.
2) Slavin S. ACGME AWARE Well-being podcast: Cognitive skill – building for well being. 2019 [cited
24 May 2021].
3) Cognitive Learning Systems, Inc. Metacognition: the cognitive toolbox. 2021 [cited 24 May 2021].
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 20
Photo 1. JDN members participated in the JDN
Doctors’ Well-being Webinar. Credit: JDN
Photo 2. Dr Stuart Slavin presented the keynote
presentation at the JDN Doctors’ Well-being
Webinar. Credit: JDN
Within a few months, the coronavirus disease 2019 (COVID-19) pandemic drastically
changed the numerous facets of our lives. The medical education sector was not spared,
and the impact of COVID-19 has not yet been fully quantified. The rapid transition of global
medical developments already poses a challenge to medical professionals in terms of their
career development and progression.
Malawi, a landlocked, southern African nation, has also been knocked with this uncertainty.
With only one medical school in the country that offers medical, pharmaceutical, dental,
physiotherapy, lab sciences undergraduate programs, and clinical and global public health
postgraduate programs, more than 3,000 students were aground with classes postponed,
hospital clerkships and electives cancelled, and exam schedules and graduation timelines
rendered unknown.
Junior Doctors Network Newsletter
Issue 22
June 2021
Impact of COVID-19 on Medical Education in Malawi
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA
Parth Patel, MBBS
Atlas Medical Center,
Blantyre, Malawi
Steven Munharo, MBBS
Chikwawa Diocese Montfort Hospital
Chikwawa, Malawi
Robert Mkweu, MBBS
College of Medicine, University of Malawi,
Blantyre, Malawi
Elias Rejoice Maynard Phiri, MBBS
Policy Unit, Malawi-Liverpool-Wellcome Trust
Clinical Research Programme
Blantyre, Malawi
Page 21
The COVID-19 pandemic, therefore, exacerbates the
situation resulting in drastic setbacks for medical careers
by the distortion of learning and training schedules in
hospitals and universities around the world (1).
Challenges
Following the declaration of a state of disaster by the President of the Republic of Malawi
on March 23, 2020, all public and private universities were shut down indefinitely. Medical
education and training were affected in four specific ways.
First, medical students were unable to gain practical exposures as their medical clerkships
were interrupted. Medical students, who had their required clinical rotations from third year
to final year, were now denied the opportunity to learn hands-on skills in medical practice
(3). Second, with the reduction in traditional face-to-face learning, a significant amount of
learning and studying time was lost. Third, the COVID-19 pandemic has the potential to
negatively impact the mental health of medical students. With the closure of schools,
medical students may have found themselves isolated and distressed due to the lack of
uncertainty as to when schools would open (4).
Fourth, attempts at migrating to online learning were limited by its inability to address other
important aspects of university life, including personal development, exposure to diversity,
self-care skills, and friendships (2).
Recommendations
First, the training curriculum should adopt innovative assessment methods. Medical
students should incorporate the evaluation of COVID-19 infection prevention strategies as
well as established teaching and learning outcomes. Exams in medical and allied health
professional training are largely dependent on the assessment of clinical performance to
ensure practical competency. Hence, rubrics should be adjusted to reflect COVID-19
ramifications by focusing on primary assessment methods, which can strengthen training of
future physicians (5).
Second, virtual education should be prioritized. Universities are being encouraged to
familiarize themselves with high-impact distance learning tools that have been
recommended by the United Nations Educational Scientific and Cultural Organization
(UNESCO), especially in resource-constrained countries (6). The Malawi education system
has widely used distance learning in secondary school education. However, only one
institution – Unicaf University – has adopted virtual education in its curriculum (7).
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 22
Medical students have proven to be a substantially more
vulnerable group than the general population, with an
estimated global prevalence of anxiety and depression of
33.8% and 33%, respectively (4).
The current COVID-19 situation offers education policymakers an opportunity to implement
a paradigm shift and harness the technology of virtual education in higher education
centres (7). Adapting to online teaching modalities in medical education will craft the 21st
century graduates to be well versed with traditional clinical education as well as up-to-date
information on the latest technologies, thus increasing efficiency in workplaces.
Third, the government should disburse funds to support digital innovation in medical
education. The government of Malawi will do well if they encourage digital education by
setting aside funding for medical and allied health colleges. They can offer virtual education
programs, set transparent and accountability systems to manage these funds, and ensure
that education financing is responsive to the prevailing needs and crises such as the
COVID-19 pandemic.
Fourth, adequate preventative measures should be implemented to limit infection risk
among medical students before physical clinical rotations re-commence. Medical schools
must emphasize the protection of students by prioritizing online theoretical pedagogy and
reconsider shifting clinical rotations to the future. Clinical rotations should only be
recommended with the guaranteed provision of appropriate infection preventive equipment
to limit exposure to COVID-19. This will provide physical safety to medical students as
faculty deliver their clinical teaching and learning methodologies.
Conclusion
The global COVID-19 pandemic has compelled medical institutions and fraternities to re-
examine the delivery of medical education. We stand at crossroads to re-align with the
developing needs of the current generation of medical students, while nurturing them with
improved teaching and learning methodologies and ensuring equitable access and safety
from COVID-19.
References
1) Barberio B, Massimi D, Dipace A, Zingone F, Farinati F, Savarino EV. Medical and gastroenterological
education during the COVID-19 outbreak. Nat Rev Gastroenterol Hepatol. 2020:1-3.
2) Torda AJ, Velan G, Perkovic V. The impact of COVID-19 pandemic on medical education. Med J Aust.
2020;213:334-334.e1.
3) Liaison Committee on Medical Education. LCME update on medical students, patients, and COVID-19:
approaches to the clinical curriculum. 2020 [cited 2021 Mar 23].
4) Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, Ho RC. The global prevalence of anxiety
among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16:2735.
5) GEM Reports. Could coronavirus shape the way assessments work forever? World Education Blog. 2020
[cited 2020 Aug 26].
6) UNESCO. Distance learning solutions. UNESCO. 2020 [cited 2020 Aug 26].
7) Zhao Y. COVID-19 as a catalyst for educational change. Prospects. 2020 [cited 2020 Aug 28].
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 23
In early 2020, national health systems experienced a dramatic increase in acute infections,
hospitalizations, and mortality due to the coronavirus disease 2019 (COVID-19) pandemic.
These stressors directly affected the health and well-being of healthcare workers –
including junior doctors – who were placed at the frontline of medical care services (1). In
Nigeria, junior doctors were cautious yet scared about community transmission of this
novel coronavirus, experienced burnout due to long work schedules, and were at risk of
physical assaults by the general community (2). Many Nigerians speculated that COVID-19
was a disease created by the Nigerian government to extort money, while others believed
that it was a disease of the rich and hence disregarded precautionary measures. These
stressors hindered junior doctors from thinking beyond the present crisis.
Coping Mechanisms during the Pandemic
As the nationwide lockdown restrictions due to the COVID-19 pandemic were implemented
across Nigeria, public life came to a standstill. With the rising surge in COVID-19 cases,
junior doctors were overwhelmed with their clinical responsibilities and were not motivated
to participate in activities that aimed to improve general health and well-being.
Junior Doctors Network Newsletter
Issue 22
June 2021
Improving Junior Doctors’ Well-being
during the COVID-19 Pandemic in Nigeria
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA
Chioma Audrey Amugo, MBChB
Director, Queens Clinic Ltd.
Abuja, Nigeria
MPH student, University of South Wales
South Wales, Wales, United Kingdom
Page 24
As a result, their desire to pursue continued personal
and professional development – including taking
international licensing exams – were temporarily halted.
To address this challenge, I dedicated my efforts to promote a
healthy work-life balance through physical health, intellectual
preparedness, social balancing, and spiritual attainment.
Physical Health
As I focused on my nutritional intake, I prepared meals for the week using appropriate
portion sizes and high nutritional value from locally available ingredients. Although we could
not visit gyms, I completed regular workouts on YouTube and wellness apps (e.g.
WayBetter) and recorded my physical fitness routines. Also, brief walks each day provided
an opportunity to meditate and reflect on life.
Intellectual Preparedness
In order to continue my academic training, I began my online Master of Public Health
degree at the University of South Wales. This program consists of 10 modules, and each
module has a duration of eight weeks with two writing assignments of 3,000 words each.
An estimated 8-12 hours of dedicated study time per week was recommended.
Furthermore, although my foreign medical licensing exam was canceled for the initial date,
I continued to prepare and study with group members on virtual meetings. As these efforts
enabled me to stay up-to-date with the exam content and interact with colleagues, I was
equipped to pass this exam when it was finally rescheduled in late 2020.
Since will power can only take one so far, looking for opportunities to strengthen motivation
was key. In my case, leading the study group and organizing study sessions kept me
motivated, as I did not want to let my group down. I also used this period to review updates
on professional organizations, read motivational books, and learn a few additional skills.
Social Balancing
To maintain my personal connections in the socially distanced world, I joined a local video
gaming group online. These weekly games offered opportunities to gain new friendships
and acquaintances outside the medical community.
Spiritual Attainment
With the uncertain future, I aimed to strengthen my spiritual life. As I attended online church
services and read daily devotionals, I reflected on my mental health and well-being during
these stressful moments. As I pondered about the meaning of life, I concluded that finding
one’s purpose on Earth is more significant than material possessions and career
achievements.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 25
I resolved to value my loved ones, appreciate each day,
enjoy life, and be actively present in each moment.
Although the COVID-19 pandemic is not yet over, healthcare workers continue to face a
significant burden on their physical and mental health and well-being. As junior doctors, we
contribute significantly to the COVID-19 response efforts in clinical and community practice.
As the revised Physician oath states: “I will attend to my own health, well-being and abilities
in order to provide care of the highest standard.”
References
1) Elhadi M, Msherghi A, Elgzairi M, et al. Burnout syndrome among hospital healthcare workers during the
COVID-19 pandemic and civil war: a cross-sectional study. Front Psychiatry. 2020;11:579563.
2) Adegoke Y. Coronavirus in Nigeria: inside a Lagos coronavirus ward. 2020 [cited 2021 Mar 24].
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 26
As junior doctors, we must promote the importance of a
healthy work-life balance and optimal health and well-being
for all healthcare workers.
This countdown officially ended on March 12, 2020, when the first COVID-19 case was
reported in Kenya. The Government of Kenya instituted several public health measures
that were well established, including epidemiological surveillance, promotion of hand
hygiene, and physical distancing in public places. As clinicians, these measures reassured
us that the government was committed to combating the pandemic locally. In the clinical
setting, on account of observing the number of COVID-19 cases increase, we wanted to be
ready to combat this crisis. However, the reality on the ground was a little different,
considering we were ill-prepared with limited resources and knowledge to combat this novel
coronavirus.
Junior Doctors Network Newsletter
Issue 22
June 2021
Reflections from the COVID-19 Frontline One Year Later:
A Kenyan Perspective
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 27
Abdullahi Kassim, MD
Medical Officer
Nairobi, Kenya
Amal Rashid, MD
Medical Officer
Nairobi, Kenya
Mellany Murgor, MD
Medical Officer
Nairobi, Kenya
As we watched the news reports of the coronavirus disease 2019
(COVID-19) wreaking havoc overseas, we knew that it was only a
matter of time before this novel coronavirus would be in our midst.
Doubt and Anxiety
Nuances of fear and anxiety, albeit rarely spoken about, were easily palpable. As junior
doctors, we soldiered on, taking care of suspected patients, although we did not feel well
equipped in our clinical practice. Each time, we reflected on our own safety: Was I
protected enough? Were we really prepared to handle one COVID-19 case? Were we
prepared to handle 100 cases in our emergency department? All this time, our institution
worked tirelessly, seeking innovative ways of managing patient flow and ensuring adequate
staffing and continuous training.
During the first wave, attending to suspected COVID-19 patients involved rapid
communication of updates to senior management and Ministry of Health officials.
Polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) were in limited supplies. Clinicians faced these stressful tasks while
managing the increased volume of patients and limited available training. However, during
the second wave, training was conducted, nationwide resources availed for PCR testing,
and patient flow was better streamlined. Continued medical education on COVID-19
equipped junior doctors with courage and competence to manage the cases.
Health System Barriers and Strengths
With the increased number of confirmed COVID-19 cases, we faced multiple challenges.
Personal protective equipment (PPE) brought a sense of safety that was yearned for, but
within a short period of time, PPE was declared scarce across the country, and we had to
reuse some N-95 masks. With a health workforce shortage, staff on leave were recalled to
provide additional time to hire new healthcare workers. Over time, we received institutional
support to boost staff morale, including better working hours, short-term allowances, and
supportive mental health services. Institutions provided additional isolation units and
staffing, offered training on PPE use, and established continuous medical education
courses.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 28
Early on in the pandemic, the lack of adequate testing
resources and isolation facilities crippled care and brought
confusion and anxiety.
By gaining a better understanding of this novel coronavirus,
we worked in solidarity with our national and international
colleagues – a little comfort that we were not alone.
Adapting to the Situation
During the COVID-19 pandemic, our institution stressed the adherence to public health
measures, including availing of adequate PPE and promoting hand hygiene practices.
Working shifts were rearranged to offer staff periods of brief quarantine periods in order to
observe for possible symptoms. Staff who developed symptoms were tested, and if
positive, they were required to complete a 14-day isolation, returning to work only after
receiving a negative test. However, these new administrative policies meant that staff had
to complete longer and more consecutive clinical shifts. Added to other factors – such as
an increased medical surge and staff recovering from COVID-19 – we feared that the
overall effect would lead to fatigued staff and increased vulnerability to COVID-19.
The brutal reality is that healthcare workers have become a daily social pillar for patients,
offering a source of support and inspiration during their stay. As patients were admitted for
long periods of time, without physical touch or family visits, doctors smiled, celebrated, and
mourned together with them.
Particularly, early in the pandemic, national leaders of the Government of Kenya took
immediate action to implement public health response efforts including contact tracing,
promotion of hand hygiene practices, social distancing measures, partial lockdowns across
cities, and dusk-to-dawn curfews. However, the government’s lethargy in preparation for
the worst-case scenario became apparent later in the pandemic. These issues included the
lack of sufficient inpatient isolation wards and critical care units, shortage of the healthcare
workforce, and limited training for staff. Kenya is currently experiencing a third wave of the
COVID-19 pandemic, just one year since the first case was confirmed, and these
challenges are still present in clinical practice.
As we care for COVID-19 patients, we reflect on our resilience in contributing significantly
to clinical and public health response efforts. As junior doctors, we must continue to
support national efforts to advance science and advocate for our patients each day.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 29
The compassion in our voices and our eyes reminds our
patients of humanity and gives them strength to carry on.
To fellow frontlines, we are in this together − for our colleagues,
our patients, our society, our country, and our world.
In 2012, I was a young medical graduate working in a mission hospital in Nigeria, equipped
with basic surgical and medical skills to promptly diagnose and treat patients. Notably,
hospital capacity was frequently at a maximum level because many community members
were unable to afford medical care costs. One challenge was that many patients remained
hospitalized for long periods of time, until their relatives were able to pay their hospital bills.
The hospital, therefore, depended heavily on charity in order to offset expenditure due to
low-income patients. At the same time, some low-income patients, who were fearful to seek
healthcare services, often resorted to self-help approaches or unorthodox scammers,
which led to significantly poorer outcomes.
The Nigerian National Health Insurance Scheme (NHIS), under the NHIS Act of 2004, was
launched on June 6, 2005, to address this potentially catastrophic out-of-pocket
expenditure (1). Notably, similar schemes have been implemented in other low-income
countries. Now, 16 years later, Nigerian leaders have reported that the original objectives
have not been achieved, and the anticipated benefits have remained a mirage. As I worked
in primary care, I observed the challenges faced by some NHIS beneficiaries as they
accessed healthcare services, including limited access to specialists and limited range of
available prescription medications.
There is an undeniable need for good and affordable access to healthcare for all. However,
the current strategy across middle- and low-income countries is failing to achieve universal
health coverage (UHC). In the United Kingdom (UK), the National Health Service
exemplifies an enviable definition of UHC, a direction where every national health plan
should be headed.
Junior Doctors Network Newsletter
Issue 22
June 2021
A Call to Invest in Doctors
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA
Chukwuma Oraegbunam, MWACP MRCPSYCH
Chair (2018−2019)
Junior Doctors Network
World Medical Association
Page 30
The extensive and wide-reaching primary healthcare system,
manned by doctors and other experienced staff, can result in an
efficient approach to promote optimal health and well-being for
all citizens, irrespective of socioeconomic status.
Impact of the COVID-19 Pandemic
The coronavirus disease 2019 (COVID-19) pandemic has impacted all health systems and
patients. As countries battled an overstretched health system, leaders led the development
of new hospitals and clinics and requested that retired health professionals return to help in
the response efforts. Many patients, however, became defiant to recommended
precautions, struggling with circulating conspiracy theories and refusing to seek medical
care.
During the COVID-19 pandemic, healthcare workers have experienced significant stressors
during the increased clinical responsibilities and management of work-life balance (3). In
particular, they have experienced anxiety related to their own safety, struggled with burnout
due to the increased workload, and managed caregiving due to illness and death of family
members.
There have been few incentives for doctors to accept clinical positions in rural settings. The
quest for a better lifestyle with access to high-quality healthcare has inspired mass
movements of young doctors away from middle- and low-income countries to seek
employment in high-income countries. This has resulted in negative impacts on the UHC
goals of donor countries and has further reduced their capacity to fight the ongoing COVID-
19 pandemic.
Global Call to Action
The World Medical Association (WMA) and Junior Doctors Network (JDN) advocate that
true UHC will provide access to primary health services with doctors and appropriately
trained team of valued and diverse health professionals. Temporary and probably cheaper
measures may seem achievable in the short-term; however, not incorporating the
intermediate- and long-term goals of ensuring access to doctors at primary care levels may
actually be breeding catastrophe rather than achieving UHC.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 31
This was particularly evident in low-income countries as
conspiracy theories thrived, challenging adherence to social
distancing and exacerbating mistrust in the government (2).
Recent research has shown that poor quality of health care services was a major driver of
excess mortality from different disease conditions (4). As doctors are integrated in primary
health care services, attention must be placed to ensure appropriate physicians’ training
and provision of incentives in their clinical practice.
References
1) Nnamuchi O, Nwatu S, Anozie M, Onyeabor E. Nigeria’s national health act, national health insurance
scheme act and national health policy: A recipe for universal health coverage or what? Medicine and Law.
2018;37:645-682.
2) Bernard FO, Akaito JA, Joseph I, David KB. COVID-19: the trends of conspiracy theories vs facts. Pan Afr
Med J. 2020;35:147.
3) Shreffler J, Petrey J, Huecker M. The impact of COVID-19 on healthcare worker wellness: a scoping
review. West J Emerg Med. 2020;21:1059-1066.
4) Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA. Mortality due to low-quality
health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137
countries. Lancet. 2018;392:2203-2212.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 32
As a call to action, the COVID-19 pandemic has emphasized
that healthcare collaborations are key to promote UHC.
The time to act is now!
Work-life balance is a social construct with diverse definitions, as how an individual strikes
a balance between work and non-work activities (1). Although it is important for physical
and mental health and well-being, healthcare workers may struggle to achieve a healthy
work-life balance with their intense clinical responsibilities.
To address this challenge, the Medical Women’s International Association (MWIA) has
recently strengthened the organizational framework and formed the Work-Life Balance
working group to prioritize the role of female doctors in the workplace. Founded in 1919,
this international association of female medical practitioners and medical students is
comprised of five committees (Ethics and Resolutions; Scientific and Research; Finance;
Communication and Social Media; Strategy and Advocacy), two working groups (World
Health Organization; Governance), and other special interest groups (Mentoring and
Leadership; Child Health; Violence against Women and Girls).
Work-Life Balance Webinar
On February 27, 2020, MWIA members of the Work-Life Balance Special Interest Group
sponsored the International Webinar on Work-Life Balance (Figure 1). Attendees included
female and male doctors as well as other healthcare workers and students. This event
aimed to share techniques to help develop a positive work-life balance and prevent Zoom
fatigue during the numerous virtual teleconferences and events held during the COVID-19
pandemic.
Junior Doctors Network Newsletter
Issue 22
June 2021
Work-Life Balance Webinar
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA
Dabota Yvonne Buowari, MD
Department of Accident and Emergency
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers State, Nigeria
Page 33
Now, as the world adapts to the ‘new normal’ after the
coronavirus disease 2019 (COVID-19) pandemic, global focus
should highlight techniques to build a healthy work-life balance.
The COVID-19 pandemic has caused significant stress to achieve a healthy work-life
balance, especially when junior doctors have extensive clinical responsibilities and minimal
leisure time. To address this challenge, the Medical Exchange, Education, and
International Mobility Working Group of the Junior Doctors Network (JDN), led by Dr
Uchechukwu Arum, organized the Doctors’ Well-being webinar in March 2021. Moving
forward, additional JDN activities and webinars – together with medical and community
associations – can continue to promote work-life balance in the clinical and community
workplace and advocate for optimal health and well-being for all.
Reference
1) Gragnano A, Simbula S, Miglioretti M. Work-life balance: weighing the importance of work-family and
work-health balance. Int J Environ Res Public Health. 2020;17:907.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 34
The agenda included high-quality presentations by
six doctors from Australia, Germany, Nigeria, the
United Kingdom, and the United States. They shared
their expertise on six topics: 1) relevance of work-life
balance; 2) doctors’ well-being; 3) burnout in female
doctors; 4) balancing work and leisure time; 5)
achieving work-life balance during the COVID-19
pandemic; and 6) fatigue experienced with virtual
meetings. After panelists spoke on the respective
topics, there was a panel discussion followed by an
open discussion. Webinar attendees expressed their
appreciation to the organizers and panelists of this
timely event and sent supportive message to the
organizers. They commented on the engaging
discussions that encouraged them to take immediate
action to develop a healthy work-life balance.
Figure 1. Promotional flyer for the MWIA
International Webinar on Work-life Balance.
Credit: MWIA
As junior doctors, we should advocate for increased attention for
healthcare workers’ physical and mental health and well-being
through a positive work-life balance.
During the coronavirus disease-2019 (COVID-19) pandemic, the delivery of continued
medical education has transitioned from in-person to virtual conferences and meetings.
These virtual events have allowed knowledge sharing to continue through an array of
software technology applications such as Zoom, WebEx, BlueJeans, Slido, and Google
Meet. Zoom is a video conferencing platform that offers physicians the opportunity to
conduct virtual meetings, attend academic webinars, and communicate with colleagues,
regardless of their geographical locations (1). This technology has various functions,
including video recording to the Cloud for asynchronous viewing, chat messaging for real-
time communication, and the breakout room feature for small group meetings (2).
Zoom Fatigue
Despite their increased clinical responsibilities for COVID-19 management, physicians are
expected to attend virtual webinars and conferences for continued medical education on
COVID-19 and other pressing health topics. The rapid publication of scientific articles and
Zoom webinars on COVID-19 has resulted in an information overload for physicians.
Junior Doctors Network Newsletter
Issue 22
June 2021
Zoom Fatigue: A Pandemic within a Pandemic
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA
Dabota Yvonne Buowari, MD
Department of Accident and Emergency
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers State, Nigeria
Page 35
Healthcare workers should remain up-to-date on the evidence-based
scientific research published by global researchers and consensus
statements by international organizations, which highlight best
practices for the clinical management of COVID-19 cases.
This information overload can cause physicians to experience
physical and mental exhaustion – recognized as ‘Zoom fatigue’ (3).
Zoom fatigue can result from a combination of physical behaviors, including sedentarism
and digital eye strain from staring at a computer screen for long hours. It can even increase
the risk of obesity and deep venous thrombosis (4). However, mental health concerns may
arise as a result of excess stress from balancing clinical responsibilities and virtual medical
education as well as feeling self-conscious when viewing personal video images on Zoom
meetings (3).
Recommendations to Prevent Zoom Fatigue
To maintain high focus and productivity as well as an optimal work-life balance, healthcare
workers can take initiative to manage their work and leisure schedules. Some
recommendations to help reduce Zoom fatigue include (5-7):
Conclusion
Zoom fatigue can increase stress levels, hinder focus and concentration, and cause
burnout among healthcare workers. At the same time, it can result in poor patient
outcomes, communication challenges between co-workers, patients, and family members,
and increase risk of medical errors in the workplace. With lockdown and travel restrictions
due to the COVID-19 pandemic, physicians have been able to attend daily webinars in the
comfort of their office or home. However, physicians have been challenged to maintain a
healthy work-life balance with an increased clinical workload coupled with the need for up-
to-date evidence-based information on COVID-19 clinical management. Hence, national
health systems and professional medical associations should prioritise fostering harmony
between work responsibilities and leisure activities for all healthcare workers.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 36
Moving forward, junior doctors can lead the global dialogue that
stresses the importance of optimal physical and mental health
and well-being of healthcare workers during the COVID-19
pandemic and beyond.
❑ Take breaks in between and during each Zoom meeting
❑ Avoid scheduling back-to-back Zoom meetings
❑ Follow the 20-20-20 rule, where you schedule 20-minute intervals of looking
away from the screen to an object 20 feet away for 20 seconds
❑ Use the Stop Video feature to reduce anxiety related to self-consciousness of
the video image
❑ Avoid multitasking activities (e.g. email, phone calls) while on a Zoom meeting
❑ Prioritize rest and a healthy work-life balance through meditation
References
1) Aston B. When Zoom is the workplace: facts about remote work & mental health. 2020 [cited 2021 Mar
10].
2) Rucker J, Steele S, Zumwalt J. Bray N. Utilizing Zoom breakout rooms to expose preclerkship medical
students to telemedicine encounters. Med Sci Educ. 2020;30:1359-1360.
3) Dixon-Saxon S. Safety, productivity and stress: managing work, self and family in a pandemic. Presented
for the North Carolina State University’s Office of Institutional Equity and Diversity. 2020 [cited 2021 Mar
10].
4) Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic
Physiol Opt. 2011;31:502-515.
5) Maheu M, Wright S. Trouble-shooting “Zoom fatigue” in the era of telehealth. Presented for the American
Psychological Association. 2020 [cited 2021 Mar 10].
6) Wiederhold BK. Connecting through technology during the coronavirus disease 2019 pandemic: avoiding
‘‘Zoom fatigue’’. Cyberpsychology, Behavior, and Social Networking. 2020;23:437-438.
7) Fosshien L, Duffy MW. How to combat Zoom fatigue. Harvard Business Review. 2020 [2021 Mar 10].
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AFRICA Page 37
It can be daunting to create a practice of well-being or to maintain a well-rounded lifestyle.
As physicians and surgeons, we strive to provide the best care and be available for our
patients. Our work often comes at the cost of personal time, which can take a toll on our
mental health. Many of the health system challenges in medicine, however, are ubiquitous
to any specialty.
My inspiration to practice in the field of obstetrics and gynaecology (ob-gyn) came from my
experience as a medical assistant at Planned Parenthood, where I worked prior to medical
school. This organization is recognized globally for providing preventive care, sexually
transmitted infection (STI) testing, contraception, and abortion care. As I quickly learned
the stigma that came with abortion care, I was frustrated by all the negativity towards what I
viewed as a necessary and routine procedure. The lack of access, shortage of health care
providers, and many unnecessary barriers to care inspired me to advocate for the right to
access safe, legal abortions. As I entered medical school, I considered a few specialty
options, including family medicine, psychiatry, and general surgery.
Prior to ob-gyn residency, I spent two years at the American Medical Student Association
(AMSA) working on medical education and health policy topics. I began residency training
still excited for those opportunities, but I struggled to incorporate my interests in advocacy
and research, while maintaining my well-being. The 80-hour weeks only made work-life
balance more difficult. It was hard to find time and energy for my regular practice of yoga
and meditation, or for the people and activities which sustained my passion and motivation.
Junior Doctors Network Newsletter
Issue 22
June 2021
Perspective on Well-being as an Obstetrician-Gynecologist
JUNIOR DOCTORS’ PERSPECTIVES: AMERICAS
Aliye Runyan, MD
Westchester Medical Center
Valhalla, New York, USA
Page 38
I ultimately realized that ob-gyn would expose me to the continuity
of care throughout a woman’s life, offer the ability to perform life-
improving procedures and surgery, and provide skills to help
individuals choose if, when, and how they become pregnant.
Our residency program was not well equipped to handle mental health support for
residents. I was fortunate to have access to mental health resources, which helped me
navigate difficult situations.
After residency training, I wanted to focus on work that would sustain my passion for
medical education as well as reproductive health and justice issues. Currently, I am
focusing my clinical practice on abortion care and gynaecology. I recently re-joined AMSA
as a Reproductive Health Strategist, through a grant-funded project to improve the quality
of medical education in family planning, abortion care, and reproductive justice. In
collaboration with global medical student organizations, I work with the ScholarRx
educational company to create student-led curricular modules that address gaps in
traditional medical school curricula.
Through self-education and my lived experiences as a medical resident, I better
understand the crises of well-being and mental health among physicians as a health
system problem. To reduce physician burnout, we need a humane system of working
conditions for medical residents to maintain their full lives and passion for their work.
The culture of medicine has included a system of hierarchies, characterized by the ‘hazing’
experienced by medical students and residents as well as the non-clinical, repetitive,
administrative tasks that residents are expected to complete. This can lead to a threshold
of exhaustion where trainees are no longer learning, but rather simply performing tasks. If
these working conditions are repeated over multiple years, burnout, loss of creativity, and
new or worsening mental health issues can result. In the United States, physicians have
the highest suicide rate of any profession. The suicide rate among male and female
physicians is 1.41 and 2.27 times higher, when compared to the general male and female
population, respectively (1). Often, the burden of ‘keeping balance’ falls upon the trainee,
who has minimal control over hospital policies, negative cultures of training, and little
autonomy over clinical schedules.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AMERICAS Page 39
The system should prioritize physicians’ needs to control
their schedules and maintain autonomy, to an
appropriate degree that it does not sacrifice patient care.
By considering these elements and removing these stressors,
the training environment can become more humane.
Teaching cognitive-based therapy and promoting meditation practices are appropriate
measures, but they are insufficient to address this challenge. These practices focus on the
individual, while the root of the problem lies with the system itself. Significant improvement
in training conditions requires that administrators of academic departments, hospital
systems, and graduate medical education entities provide: 1) a fair salary; 2) adequate time
away from the hospital; 3) time off for mental health concerns (which should not be
separate from or subject to different requirements as physical health concerns); and 4)
advocacy within licensing and accreditation boards to not penalize physicians for seeking
out or reporting access to mental health care.
Bullying or harassment within training programs – whether related to gender, race,
ethnicity, or simply the ‘culture of the program’ – should never be normalized. Teaching
faculty can perpetuate this culture, and this is often because those individuals were subject
to similar abuse when they were trainees. A sustainable solution requires cooperation
among trainees, faculty members, and administrative leaders to maintain accountability,
such as an anonymous reporting system that is then taken seriously. The need for
autonomy and work-life balance goes beyond training, as many early- and mid-career
physicians face similar struggles.
The practice of medicine and surgery can be rewarding and inspiring, but it can also be
frustrating and exhausting. Faculty members and supervisors must prioritize the creation of
systems that promote wellness and work-life balance.
Reference
1) Copelan R. Physician suicide needs assessment − Analysis-based prevention is key. MedPage Today.
2020 [cited 2021 Mar 15].
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: AMERICAS Page 40
This healthy workplace environment is beneficial to all,
including patients, who are better cared for by personally
and professionally fulfilled physicians.
The coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges to the
healthcare workforce. As a result of COVID-19 response efforts, there have been
significant changes in daily medical practice, social lives have been reshaped, and
healthcare workers (HCWs) have been deployed to frontline roles. This transition has
impacted the physical and mental health and well-being of HCWs.
The prevalence of mental health problems, like depression and anxiety, is well known to be
higher among doctors, when compared to the general population and other professional
groups (1). Several studies have highlighted a prevalence of depressive symptoms
between 8.9% and 50.4%, and anxiety rates ranging from 14.5% to 44.6% among HCWs,
especially during public health emergencies (2). Therefore, tackling the mental health
breakdown among HCWs becomes an urgent matter, and one of the more effective ways
to do this is to build resilience among HCWs.
What is Resilience?
Resilience can be defined as one’s ability to cope with crisis, trauma, or other sources of
stressors (4). Stressors can take many forms, such as problems within the family, personal
relationships, physical or mental health, and the workplace. As resilience involves
“bouncing back” from difficult experiences, it can stimulate profound personal growth. With
four core components to building resilience – connection, wellness, healthy thinking, and
meaning – specific strategies can be employed to empower one to learn from difficult and
traumatic experiences.
Junior Doctors Network Newsletter
Issue 22
June 2021
A Junior Doctor’s Journey to Well-Being:
Building Resilience to Prevent Mental Health Breakdown
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 41
Maymona Choudry, MD MPH
General Surgery Resident
Vicente Sotto Memorial Medical Center
Cebu City, Philippines
“Resilience is defined as the ability to recover from setbacks,
adapt well to change, and keep going in the face of adversity”
− Constance Scharff, Psychology Today (3)
Tips on Developing Resilience
The American Psychological Association has provided some tips for developing resilience,
counteracting burnout syndrome, and preventing mental health breakdown among
physicians (4). This article aims to summarize these recommended strategies.
Building Connections
❑ Prioritize relationships: It is important to connect with your colleagues and peers who can
remind you that you are not alone amidst the difficulties. There are various ways to
connect with others, such as weekly lunch meetings with colleagues and friends or
sports activities such as volleyball or badminton.
❑ Join a special interest group: Meaningful connections can be fostered by joining local,
national or international organizations. These groups can include local youth chapters,
religious organizations or professional organizations such as the Junior Doctors’
Network.
Fostering Wellness
❑ Prioritize self-care: Self-care can be promoted through healthy lifestyle practices such as
eating proper food, obtaining an appropriate amount of sleep, and engaging in physical
exercise. These practices can strengthen the body and the mind, allow adaptations to
stress, and reduce any feelings of anxiety or depression.
❑ Practice mindfulness: Mindfulness simply means being in the present and focusing your
energy on doing one task at a time. There are many ways to practice mindfulness
including mindful journaling, yoga, and other spiritual practices like prayer or meditation.
All of these practices can help build connections and restore hope.
Finding Purpose
❑ Help others: By participating in volunteer work or supporting colleagues in their
presentations or academic tasks, we can promote a sense of purpose for our work,
foster feelings of validation and self-confidence, and build connections with other people.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 42
When you journal, meditate or pray, focus on the positive
aspects of your life and try to recall the people, activities,
and things for which you are most grateful.
❑ Be proactive: In taking a proactive approach, we should always go back to asking
fundamental questions: Why did I want to complete residency in the first place? What
are my goals? These reflections can help you find purpose in your activities. By
simplifying your problems into manageable tasks, you can take the initiative and muster
motivation and purpose even during stressful periods. These actions will increase the
likelihood that you will rise during difficult times in the future.
❑ Move toward your goals: Creating realistic goals can foster a sense of accomplishment
and self-fulfillment. For example, I find it helpful to create to-do lists based on daily,
weekly, and monthly goals.
❑ Look for opportunities for self-discovery: As human beings, we experience personal and
professional growth as a result of a significant struggle. For instance, challenging
residency rotations can improve your clinical skills.
Embracing Healthy Thoughts
❑ Keep things in perspective: Coping with stressful events can be challenging, but how you
interpret and react to these events is vital.
❑ Accept change: Since change is an inevitable element of life, you should be realistic in
setting your goals and be willing to revise your goals as needed. As you do not have
control over all situations, you should focus your attention on those where you have
control.
❑ Maintain a hopeful outlook: As you visualize what you want to accomplish in the near
future, slowly alter your mindset as you prepare to deal with any potential difficult
situations.
❑ Learn from your past: It is essential to always reflect and learn from your experiences,
treasure each lesson learned, and understand how these experiences have
strengthened you as an individual.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 43
These moments of self-discovery can increase self-confidence
and heighten appreciation for continued perseverance.
A healthy perspective can lead you to develop resilience when
you face adversities.
Seeking Help
One of the most important tips is to know when to ask for help, as it is crucial in building
resilience. At times, the described strategies are enough for most people to develop
resilience. However, some people may find themselves unable to make progress on the
road to stability. In these cases, a licensed mental health professional can assist people in
developing an appropriate strategy for moving forward. It is crucial to seek professional
help if you feel like you are unable to “function” as you would like or perform basic daily
activities, as a result of a traumatic or other stressful life experience. This community
resource can help you build resilience and promote well-being.
In conclusion, it is important to remember that we can all experience mental health
exhaustion at one point in our lives. Learning to recognize these difficult moments and
develop appropriate coping mechanisms can help us in our journey to optimal health and
well-being. As individuals, although we may not have the power to control every aspect of
our lives, we can prioritize the four core components to building resilience – connection,
wellness, healthy thinking, and meaning – in our journey to well-being.
References
1) Gerada C. Doctors, suicide and mental illness. BJPsych Bulletin. 2018;42(4):165–168.
2) De Kock JH, Latham HA, Leslie SJ, et al. A rapid review of the impact of COVID-19 on the mental health
of healthcare workers: implications for supporting psychological well-being. BMC Public Health.
2021;21:104.
3) Scharff C. Recovery and resilience connection. 2015 [cited 2021 Mar 14].
4) Palmiter D, Alvord M, Dorlen R, Comas-Diaz L, Luthar, S. Building your resilience. American
Psychological Association. 2012 [cited 2021 Mar 14].
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 44
Moving forward, we can focus our energy and minds on the
aspects of life that we can control and manage with the help of
our family, friends, and loved ones.
As junior doctors, we are responsible for the clinical management of our patients –
ensuring their nutritional intake, recording their sleeping patterns and bowel movements,
and observing their mental and emotional health status. We can relate our clinical
responsibilities to parenting, where we understand that another life is placed in our hands,
and that small decisions can have a large impact on lives. During these routine duties, we
prepare for any unexpected health events with our patients.
As I reflect upon my clinical training as an intern, I remember two examples that marked my
personal and professional training. Notably, my carefree attitude had disappeared when I
encountered the reality of clinical medicine. First, as the only physician in the emergency
room, nursing staff relied on my clinical recommendations and actions for acute patient
care. One day, when a male patient had no further management options left, his grieving
wife blamed me for his death. Second, when a man refused to donate blood to his pregnant
wife, who was experiencing physiological stress during labour, I donated blood and realized
that not all love is selfless. When I suffered a needlestick injury while treating a high-risk
patient, I understood that good deeds can sometimes cost you everything you cherish.
Our role as junior doctors can be described in a similar fashion to a one-side romantic
relationship. Our patients can act indifferently toward us, patients’ families can behave in
confrontational manners and the natural course of disease can be unstoppable. As
healthcare workers, it is our job to care for our patients but not become emotional; to fight
for life although we may lose; and to be assertive messengers of bad news yet timid
Junior Doctors Network Newsletter
Issue 22
June 2021
The Emotional Toll of a Junior Doctor
JUNIOR DOCTORS’ PERSPECTIVES: ASIA
Vyom Agarwal, MBBS
Junior Medical Resident, Department of Medicine
Pt. JNM Medical College
Raipur, India
Page 45
Since these workplace stressors have the potential to
impact physical and mental health and well-being, junior
doctors should prioritize a healthy work-life balance.
harbingers of good news. We must always rise up to the call of need, whether we want to
or not, whether we can or cannot, whether it is urgent or non-urgent, whether it is for an
acquaintance or a stranger. When I decided to pursue my medical education, I knew that it
was a profession that required high technical expertise for medical evaluations and patient
care. Now, I am wiser, and I have realized that it is more about treating individual patients,
not diseases. Since diseases are more similar to each other than individual patients, we
are faced with new dilemmas every day. Not all of these dilemmas are answered in medical
literature, and not all of them can probably be resolved by mankind.
However, as junior doctors, we have an exhilarating career contributing significantly to the
delivery of medical care to our patients. Therefore, we must remain optimistic and continue
to strive in our commitment. This sentiment was expressed by Dr Tinsley Harrison, creator
and editor of Harrison’s Principles of Internal Medicine (1): “No greater opportunity,
responsibility, or obligation can fall to the lot of a human being than to become a physician.
In the care of the suffering he needs technical skill, scientific knowledge, and human
understanding. He who uses these with courage, with humility, and with wisdom will
provide a unique service for his fellow man, and will build an enduring edifice of character
within himself. The physician should ask of his destiny no more than this; he should be
content with no less”.
Reference
1) Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper SL, Longo DL. Harrison’s
Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 46
Such is the emotional toll of being a junior doctor….
Junior doctors in Myanmar are dedicated to restoring democracy in the best interests of
patients while also supplying vital medical care and services to Myanmar residents during
the military coup. Despite these commitments to humanity, junior doctors have faced
unprecedented challenges in the military coup. For instance, the military would harass,
arrest, beat, and even kill junior doctors serving in clinics and private hospitals who were
providing routine and emergency care to patients (1). At times, the military sought these
life-saving medical services, forcing doctors to flee from one place to the next. Each day,
the military has announced a new list of names to the “charge list against doctors as
criminals.” Some penalties have included a forfeit of medical licenses, jail terms of up to
three years, and closure of private clinics and hospitals (2).
Doctors, like the rest of Myanmar citizens, have family and personal responsibilities, enjoy
activities outside of their professional lives, and are at risk of physical and mental health
concerns. Junior doctors have experienced burnout, felt anxious or depressed, and
struggle with productivity and overall focus, as a result of the protracted military crackdown
and deep sense of insecurity. All these factors affect physician well-being: “Physician well-
being refers to the optimization of all factors affecting biological, psychological and social
health and preventing or treating acute or chronic diseases experienced by physicians
including mental illness, disabilities and injuries resulting from work hazards, occupational
stress and burnout” (3).
Junior Doctors Network Newsletter
Issue 22
June 2021
The Well-being of Myanmar Junior Doctors during the Military Coup
JUNIOR DOCTORS’ PERSPECTIVES: ASIA
Wunna Tun, MBBS MD
Fellow in Medical Education
Founder, Myanmar Medical Association
Young Doctor Society
Yangon, Myanmar
Page 47
Junior doctors continue to be in grave trouble merely for doing
their job of providing essential care to the Myanmar people.
The health effects of war and military conflict include physical and emotional trauma, non-
communicable diseases, maternal and infant health, sexual and reproductive health, and
infectious diseases. War and military conflict can negatively influence well-being based on
the broader socioeconomic consequences (4). The history of sustained war and
oppression, exacerbated by prolonged circumstances of hardship and migration, is likely to
intensify the susceptibility of people in armed conflict areas to a wide range of mental
health issues, including posttraumatic stress disorder, anxiety, depression, and suicidal
ideation. High prevalence of sexual harassment, a lack of privacy and safe environments,
and insufficient access to integrated psychosocial and mental health support are all factors
that lead to poor well-being. Every day, Myanmar doctors are up at night, fearful that they –
as well as their families – will be kidnapped, sexually abused, killed, or otherwise harmed
by the military. There is no protected spot in Myanmar for Myanmar doctors and civilians
(5).
To address this challenge, the World Medical Association (WMA) urged the Myanmar
military to ensure the physical and psychological integrity of demonstrators, including
medical staff, under all situations. In the WMA Council Resolution in Seoul, WMA called for
the immediate and unconditional release of demonstrators and health care professionals,
as well as the dismissal of all charges against them. This resolution stated that their
imprisonment was not only illegal, but also hindered freedom of speech and human rights
activities. It further emphasized the need to bring an end to assaults on health personnel
and hospitals, as well as to ensure their safety for the provision of safe health care for all
Myanmar citizens (6). These WMA statements demonstrate solidarity and encourage
Myanmar doctors to stay afloat and prioritize their own mental well-being.
Myanmar doctors have vowed to risk their lives to continue delivering critical treatment, and
the Civil Disobedience Movement (CDM) – in the face of a military crackdown – will
continue until freedom is restored. There is one clear solution for resuscitating the well-
being of Myanmar junior doctors and people: to restore democracy and hold the military
accountable for their terrorist acts.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 48
Although society has symbolically referred to Myanmar junior
doctors and citizens being on “life support” measures, we are
encouraged that better days are ahead (7).
References
1) World Medical Association. Harassment and arrest of doctors in Myanmar condemned by physician
leaders. 2021 [cited 2021 May 6].
2) Physicians for Human Rights. Wave of new warrants, arrests, and attacks on Myanmar health workers
must stop: PHR. 2021 cited 2021 May 6].
3) World Medical Association. WMA statement on physicians well-being. 2021 [cited 2021 May 6].
4) Garry S, Checchi F. Armed conflict and public health: into the 21st century. Journal of Public Health.
2019;42:e287-e298.
5) Tay A, Riley A, Islam R, Welton-Mitchell C, Duchesne B, Waters V, et al. The culture, mental health and
psychosocial wellbeing of Rohingya refugees: a systematic review. Epidemiol Psychiatr Sci. 2019;28:489-
494.
6) World Medical Association. WMA council resolution in support of medical personnel and citizens of
Myanmar. 2021 [cited 2021 May 6].
7) The Lancet. Myanmar’s democracy and health on life support. Lancet. 2021;397:1035.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: ASIA Page 49
On February 23, 2021, the British Royal College of Physicians published a comment in the
Lancet that emphasised the role of doctors’ well-being in professionalism (1). The authors
concluded that well-being is key for the quality of care and requested ‘organisational
interventions including flexible working arrangements, enhanced teamwork, reductions in
administrative burdens, and an optimal use of technology’ (1).
One particular aspect, however, becomes apparent: the nexus between public deference to
authority in crisis-mode and concerns about the commoditization of medical
professionalism. This is inherent if authorities are left without scrutiny, and merely
compensate professionals for their efforts ‘with a pat on the back’, instead of listening to
them, especially when it comes to moral injuries.
Junior Doctors Network Newsletter
Issue 22
June 2021
Well-being Helps Examine Hospital Governance during Health Crisis
JUNIOR DOCTORS’ PERSPECTIVES: EUROPE
Samuel d’Almeida, MD MPH
London School of Economics and Political Science
London School of Hygiene and Tropical Medicine
Fort-de-France, France
Page 50
While exceptional circumstances are calling for exceptional
measures, hare-brained ideas may supersede the warranted
management of a health crisis.
This paper outlines the nexus between the moral aspects of doctors’
well-being and the sense of ownership in complying with best
medical practices during the coronavirus disease 2019 (COVID-19)
crisis (1).
Recent examples in Western Europe exposed how skimping on social dialogue between
the government, hospitals, and health practitioners is a high risk for leading health policy
astray.
Example 1: Germany
In October 2020, the Handelsbatt national business newspaper revealed that the important
church-led private hospital group, Marienhaus-Gruppe (2), gained the system of special
COVID-19 regulations lowering the minimum staff by advancing its own staff reduction
framework. Even though the surge of patients never materialised, staff members were
asked to complete shifts in work overload or keep on the furlough scheme. Since the
special regulation allowed the hospital group to evade normal social dialogue, trade
unionists had no choice but to leak cases of moral injuries faced by workers to the press.
Naming and shaming the charity group, hereupon, allowed remedial measures to take
place.
Example 2: France
In early April 2020, the director of the regional health agency of Grand-Est expressed that
its bed reduction plan would be maintained for the university hospital centre of Nancy. This
was a result of persuasion by the Interministerial Committee for the Performance and
Modernization of the Hospital Care Offer (COPERMO), whose charge was to bailout the
most indebted hospitals in return of structural reforms, such as cost-containment
measures. At the time, however, Nancy became one of the key referral hospitals to fight
COVID-19 in France. The press leak of the grievances expressed by the medical director
and hospital manager was pivotal in defusing the situation. Genuinely speaking, it led to a
‘palace revolution’ at the regional level and a temporary suspension of the ‘feared and
respected’ hospital bailouter at the national level (3). In February 2021, the hospital
bailouter was rebranded the ‘health investment board’, accounting for the local electorate,
albeit no seat for trade unionists.
Example 3: United Kingdom
Among the numerous factors associated with the failed launch of the seven temporary sites
of the Nightingale Hospital London (NHL)’s 4,000-bed field hospital’s intensive care unit,
the lack of accountability for local medical practices and staff competence appears
essential (4). Staffing occurred as an afterthought, and subsequently pre-existing hospitals
were reluctant to sublease employees. Among National Health Service (NHS) staff, one in
three sick days is currently linked to mental illness or burnout (5). The temporary intensive
care units closed rapidly after seeing only a few patients.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: EUROPE Page 51
Take-away Message
Health reforms are political, and authorities have tended to depoliticize health policies with
appeals to scientific committees to support cost-containment as well as crisis measures
and reforms (6). The previous three examples outlined how social dialogue is inherently
seeking expression in hospital governance during crisis. The opposite would be a harbinger
of the commoditisation of medical professionalism.
At the time of uncertainty, frontline actors have invaluable insight and innovative analyses.
Their well-being is an inescapable moral compass to offset political obduracy.
References
1) Goddard AF, Patel M. The changing face of medical professionalism and the impact of COVID-19.
Lancet. 2021;0.
2) Keuchel J, Stiens T. Marienhaus-Gruppe: Wie ein katholischer Krankenhausbetreiber seine Kliniken
kaputtspart. Handelsblatt. 2020 [cited 2021 Mar 15]. German.
3) Herszkowicz A. Le scandale de l’hôpital de Nancy: mobilisation générale. Club de Mediapart. 2020 [cited
2021 Mar 15]. French.
4) Day M. Covid-19: Nightingale hospitals set to shut down after seeing few patients. BMJ. 2020;369:m1860.
5) Pressure on hospitals ‘at a really dangerous point’. BBC News. 2020 [cited 2021 Mar 15].
6) Parkhurst J. The politics of evidence: from evidence-based policy to the good governance of evidence.
London: Routledge; 2016.
Junior Doctors Network Newsletter
Issue 22
June 2021
JUNIOR DOCTORS’ PERSPECTIVES: EUROPE Page 52
Now, it is time to rethink the issue of hospital governance
presented during the COVID-19 pandemic, and junior doctors
have an indispensable role to play.