Struggling with trauma, EMS staff have nowhere to turn

Plight of paramedics, nurses neglected, with few facilities to help them cope

KARACHI: After a powerful bomb ripped through Abbas Town during Ashura in 2013, Saleem Ahmed was one of those who carried bodies away from the site. For days afterwards, he skipped his meals, unable to eat.

An ambulance driver, Ahmed has spent 19 years contributing to what he calls a 'noble cause.' As a first responder, he has witnessed a myriad of tragedies in Pakistan's most populated city. At this point, he is no longer affected as he used to be.

"I think people in this profession get used to these incidents. Now, I don't feel anything when I witness a catastrophe," he confessed.

Syed Habibullah Zaidi, another rescue worker, claimed toughening yourself up was the only way to continue in this line of work. He too recalled his apprehension dealing with shocking injuries at Abbas Town. But now, he is used to it. "In the recent Pakistan International Airlines crash, bodies were completely charred. It is a difficult job. Those who don't harden their hearts can't do it."

This is a phenomenon experienced by many providing emergency care and services, including nurses. Yet it is no less a symptom of the trauma so many of them struggle with.

Emergency medical service (EMS) systems are usually the first point of contact people with acute conditions have with healthcare professionals, and the crucial role they play for the successful functioning of healthcare is increasingly recognised across the world.

But in Pakistan, EMS staff are often neglected, with few training facilities and little assistance in dealing with such trauma.

"No one ever cared about my mental health. And neither did I," stated Ahmed.

Overlooked

Paramedic Parveen Kausar's eyes widened when asked about work-related trauma. "Nobody has ever asked me this before," exclaimed the 30-year-old, who has worked in emergency wards at different hospitals for a decade.

"People think we are heartless and unfeeling, but it's not true," she insisted, adding that the physiological response to paramedical work has been overlooked.

Stressful, hazardous work environments can have deep impacts on the wellbeing of paramedics. Night duty, long shifts, the lack of support in a demanding profession, bullying and threats from patients' relatives and the need to remain alert at all times can cause anxiety, depression, sleeplessness and other mental health issues, taking a toll on even the most steadfast professionals.

"I used to get flashbacks of the emergency ward when I started working," disclosed Anila Asif, 29, who used to be a hospital nurse. Her struggle to cope with the daily trauma of her job forced her to switch to a private nursing agency for home-based patients.

Dr Fatima, a junior doctor at Jinnah Postgraduate Medical Centre, said paramedical staff had to learn to put their emotions aside so that their performance was not affected, especially when patients' families threaten or humiliate them. "They can develop burnout and severe anxiety."

No help in sight

Studies show it's common for EMS staff to struggle with depression and helplessness early in their career. In Pakistan, though, it appears that people think their only plight is that of low pay.

Pakistan has 230 registered nursing schools, but the Pakistan Nursing Council curriculum mentions no training, counselling or short courses to help nurses and paramedics cope with the trauma and stress most will inevitably encounter.

Speaking to The Express Tribune, Dr Maryam Tariq, a clinical psychologist at Jinnah Medical College, claimed there were no nursing institutions in the country offering any training in this regard. "They are prone to post-traumatic stress disorder," she pointed out. "Psychological trauma is also obvious in paramedics, but over time, they become resilient to cope and continue working."

However, St James School of Nursing director James Watt claimed nurses were trained for emergency situations and were thus well-equipped to deal with crises. "They study nursing psychology, which can help them deal with work-related stress," he insisted, adding, however, that research on occupational stress among paramedical staff was sidelined in Pakistan.

Published in The Express Tribune, June 22^nd, 2020.