The walking wounded: supporting physicians after the COVID-19 crisis

April 21, 2020

In this Joule COVID-19 Learning Series webinar, host Dr. Jillian Horton speaks to Lieutenant-General Roméo Dallaire (retd), Force Commander of the UN Assistance Mission for Rwanda, who witnessed the slaughter of more than 800,000 people during the 1994 genocide.   

General Dallaire considers the COVID-19 pandemic to be its own kind of war, with physicians on the front lines of the battle. He shares lessons from his own struggle with post-traumatic stress disorder (PTSD) in an effort to prevent health care workers from suffering the same fate once this crisis is over.

KEY TAKEAWAYS

For anyone who isn't familiar with what transpired in Rwanda, can you talk about the circumstances under which you served and the impact it had on you personally?

  • The UN mission that General Dallaire commanded was sent into Rwanda with the goal of helping resolve the civil war.
  • He alerted the UN about a planned massacre but was denied permission to intervene and the UN withdrew its peacekeeping forces.
  • Along with a small contingent of Ghanaian and Tunisian soldiers, General Dallaire remained in Rwanda to fulfill his ethical obligation to protect those who sought refuge with the UN forces.
  • He witnessed the slaughter of more than 800,000 people in less than 100 days.
  • In 1997, he revealed he suffered from PTSD as a direct result of the mission. Though it led to his medical release from the Canadian Army in 2000, he has become an outspoken advocate for veterans struggling with the disorder.

tweetable: “For many years after I came back from Rwanda, I was told ‘you did what you could, and nobody can expect more.’ That provided zero solace – zero – because you saw it, smelled it, touched it, you lived it, you heard them cry… so the fact you did everything you could not alleviate the potential sense of guilt.”

You were sent to Rwanda with inadequate supplies. Many physicians and other health care workers are worried about not having the resources they need to combat COVID-19. Based on your experience, what advice can you give them?

  • General Dallaire predicts some physicians will end up feeling enormous guilt over whether they “did enough” for their patients.
  • He says medical leaders need to reinforce the idea that everyone is part of a team and that individuals can’t hold themselves accountable for not having all the resources required.

tweetable: “You must communicate with colleagues constantly to sustain these pressures and these stresses, and not let both rage, and a sense of guilt, take hold.”

One of your colleagues on the Rwanda mission noted the concern and kindness you directed toward everyone on the mission, except for yourself. Medicine is also a profession not known for self-care. How can this be a liability during a pandemic?

  • General Dallaire says professions where people wear a uniform (including medicine) often punish people for not giving 100%.
  • He says medical leaders shouldn’t become martyrs or take risks that will put the entire team in jeopardy.
  • He says health professionals need to know their physical and mental limits and ensure they’re sustaining themselves for the entire “campaign”.

tweetable: “What you ultimately will be held accountable for is making decisions that put you in jeopardy and end up abandoning those who need you – the patients who still haven’t come to your door.”

You have expressed concerns about the mental health of physicians after this crisis is over. How can the medical profession begin to mitigate the risk of PTSD now?

  • General Dallaire says soldiers often don’t feel the effects of war in the moment because they are going flat out. The same may be true for physicians working through the pandemic.
  • He says peer support programs can give physicians a space to express their ongoing fears or concerns about COVID-19.
  • After the crisis, he says governments need to ensure there are professional resources to help health care workers deal with trauma and transition back to their regular life.

tweetable: “Where are the tools to bring the walking wounded back to a certain level of normality? They’ll never forget what they witnessed, but can they live with it and continue?”

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about this topic? Please connect with us at jouleinquiries@cma.ca.

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