AYUSH and the hidden toll
When we think about pandemic heroes, we often envision allopathic doctors in full PPE who are overworked. However, there exists a quieter and less recognised first line: AYUSH doctors. During the COVID-19 crisis, practitioners of Ayurveda, Yoga, Unani, Siddha, and Homoeopathy stepped up across India, particularly in rural areas that lacked sufficient care, to help alleviate the burden on an already strained healthcare system.
A new study from Odisha, a state in eastern India, highlights the emotional and physical challenges these healthcare workers faced during the pandemic. Given the immense pressure exerted by the COVID-19 pandemic on the healthcare system globally, the stress and burnout experienced by this set of healthcare workers raises concerns about how we might help other less-recognised healthcare providers, not solely the hegemonic allopathic doctors.
The COVID-19 pandemic created a strong ripple and exposed the overwhelmed healthcare system around the globe. At the same time, it also provided a platform for AYUSH doctors, who suddenly had to shoulder newer responsibilities, often without proper training, support, or acknowledgement.
The study findings are critical as they not only demonstrate that these doctors experienced stress and burnout but also validate these feelings. It spoke for these unrecognised healthcare providers who quietly battled their emotional exhaustion, fear of illness, and social neglect while serving during both waves of the pandemic in the state of Odisha.
Burnout is not mere fatigue. It includes a persistent state of emotional and physical exhaustion, often accompanied by cynicism and a sense of helplessness. The researchers employed a validated psychological assessment tool known as the Copenhagen Burnout Inventory (CBI) to examine three types of burnout among 56 AYUSH doctors: personal, work-related, and COVID-19 patient-related burnout.
The results were striking. The highest score was for personal burnout (49.55), followed by patient-related burnout (43.22), and work-related burnout (41.45). However, numbers tell only part of the story. Qualitative interviews with 11 doctors unveiled considerable psychological distress, which they described as “frustration and irritation” or “giving so much and getting nothing in return.”
Many people assume that AYUSH doctors had an easier time during the pandemic due to their formal training and typically smaller clinical responsibilities. This study counters that misconception.
While some may believe these doctors worked in safe environments, they operated in high-risk settings, including screening travellers at train stations, running COVID care facilities, leading community awareness campaigns, and organising immunisation programmes. They frequently worked without breaks, away from their families, and did not always have adequate protective equipment or mental health care.
A doctor remarked: “In the initial phase, I worked for more than five months straight without taking a break. I was thinking, ‘How long will this last?’ I can’t stand it anymore.”
This issue extends beyond merely excessive workload; it involves feeling unappreciated and unnoticed.
The study offers healthcare systems, particularly in resource-constrained areas, urgent recommendations for preparing for future crises:
- Integrating AYUSH doctors holistically: It is essential to go beyond merely including AYUSH professionals in national health missions on a symbolic level. These practitioners should receive the same level of training, protection, and recognition as their allopathic counterparts.
- Prioritising mental health: Preventing burnout is not a luxury; it is a necessity. AYUSH doctors reported feeling exhausted, unable to sleep, and anxious due to fears of illness. Systems for mental health support, including counselling, peer networks, and helplines, should be embedded within healthcare practices.
- Enhanced administrative support: Many doctors felt they were giving more than they were receiving, both in terms of compensation and recognition. Targeted financial incentives, appropriate time off, and genuine recognition can significantly boost morale.
- Emergency training: AYUSH professionals should consistently engage in emergency response training and public health preparedness programmes alongside their routine responsibilities.
This study transcends an academic exercise; it illuminates flaws in our health workforce system. The burnout experienced by AYUSH doctors stems not solely from the pandemic but also from the devaluation of their labour within India’s diverse healthcare system.
The critical question remains: Are we listening?
As India progresses and learns from COVID-19, health policy must prioritise the mental health of all healthcare workers, irrespective of their medical background. Otherwise, we may find ourselves even less prepared for the next health crisis, not due to a lack of personnel but because we fail to value them.