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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 3  |  Issue : 3  |  Page : 86-89

COVID-19 pandemic and its influence: Case study in North Bengal Medical College, Darjeeling district, West Bengal, India


Department of Community Medicine, North Bengal Medical College, Siliguri, West Bengal, India

Date of Submission13-Dec-2020
Date of Decision14-Nov-2021
Date of Acceptance20-May-2021
Date of Web Publication14-Sep-2022

Correspondence Address:
Dr. Nilanjana Ghosh
Qr.NO.A1O, North Bengal Medical College Campus, Sushrutanagar, Darjeeling - 734 012, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_24_20

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  Abstract 


COVID-19 pandemic will be the most dreaded public health challenge world has ever faced and health-care workers play a crucial role in combating it, risking their own lives. Health workers serving COVID faced discrimination. Many new set up like COVID-19 screening clinics with complete new set of rules and logistics were set up. In North Bengal Medical College (NBMCH), it was functional round the clock since its inception. Our case that was a chronic smoker, alcoholic, and had records of defiant behavior was posted as a guard here. The anguish and pan of the patients attending, an increased job responsibility thrust on him along with the dependence of patients on his behavior brought about a change. Witnessing able tireless fearless leaderships from major wards, supportive supervision, empathy, and regular counseling sessions are thought to herald the positive behavioral change in him. The role of self-actualization theories and adoption of behaviors with effective health communications and theories of ergonomics were reinstated. Using health belief models, a deep understanding of the preventive behaviors was tried.

Keywords: Addicted, behavior change, counseling, COVID-19, supportive supervision


How to cite this article:
Ghosh N. COVID-19 pandemic and its influence: Case study in North Bengal Medical College, Darjeeling district, West Bengal, India. J Public Health Prim Care 2022;3:86-9

How to cite this URL:
Ghosh N. COVID-19 pandemic and its influence: Case study in North Bengal Medical College, Darjeeling district, West Bengal, India. J Public Health Prim Care [serial online] 2022 [cited 2022 Oct 1];3:86-9. Available from: http://www.jphpc.org/text.asp?2022/3/3/86/354816




  Introduction Top


COVID-19 pandemic is the most dreaded public health challenge faced by the world irrespective of caste, creed, ethnicity, and geographical variations. Since March, entire world went into lockdowns in the phased manner to merely save lives. Infection fatality rate is 1.4%. Globally, among stated 220 countries, 68,567,526 cases were confirmed with reported 1,563,130 deaths reported. In India, 9.74 million cases were reported with 141,000 deaths as per the latest figures. Maharashtra tops the list with Bengal leading close by. However, widespread mortality and morbidity ensued till people realized meanings and implications of words such as quarantine, isolation, asymptomatic transmissions, and the basic fact that each one can infect or protect the other. Health-care workers (HCW) stood like a rock in face of the impending doom risking their lives and staying away from their families for months. Despite masks, sanitizers, social distancing, handwashing, protective gears becoming household names, and COVID-19 pandemic rampantly savaged the globe. To add to the mayhem was the associated stigma and discrimination, especially for the HCWs which took its toll on their mental health. Overall addictive behaviors, suicides became common as were unemployment, dwindling finances. Migrant workers issue also compounded the devastation and caused dissemination of infection further.[1],[2]

Preventive precautionary behaviors require belief for diffusion, acceptance, and adoption into daily grind of life. Various studies on health behavior models among general populations revealed perceived threat outweighed perceived benefits and people were more concerned with of risk of contracting disease rather than getting equipped to prevent it maintaining logical scientific discretion.[3],[4]

Notwithstanding limitations, HCWs across all layers strived to excel their performance in face of new infectious disease even without adequate protection and prophylaxis. Increased duty hours, added responsibilities, wearing stuffy personal protective equipment, facing stigma back home in neighborhood, risking COVID infections and staying away from home for quarantine they faced all. It took its toll on their physical and mental health, chronic fatigue syndromes, repeated testing, and resuming duty in COVID wards became a routine practice.[5],[6],[7] New COVID wards were opened in North Bengal Medical College which harbored severe acute respiratory illness (SARI) cases and also COVID-positive cases in dire consequences. Isolation wards, respiratory intensive care unit wards, virus research and diagnostic laboratories, Kiosks for sample collection, and a 24 h fully functional COVID-19 Screening clinic were opened. HCWs were recruited contractually and many nursing staffs, guards, and other support staff other from doctors were recruited from the existing wards to work in designated COVID wards.

The clinic is operating with six doctors since its inception and is monitored and supervised under NBMCH authority. The footfall is quite high averaging 80–100/day with at least 5–6 admissions/day in hospital and 4–5 COVID-positive cases in designated hospitals. MSVP Office and Head of Department, Department of Medicine and Department of Community Medicine extend full support and co-operation in its smooth functioning. The clinic is also manned by three guards, two drivers and two nursing staff. Its overall functioning is monitored by Screening Clinic in charge who is also a teaching faculty.

Site of the study

Screening clinic was a new set up started with logistics and new rules meant to ward off the pandemic in an organized and strategic manner. It is located just beside the emergency and is the first contact point of SARI patients attending NBMCH since its inception. As it caters all types of patients and operates 24 h, the foot fall is very high. Quarantine is advised from clinic apart from regular treatment, testing decisions, and home isolation. It also caters COVID-positive patients also when they come who are appropriately managed and sent to designated COVID hospitals. COVID team of all clinical disciplines admit patients in respective departments after the first screening at the clinic as and where required. Evening and night shift are manned by junior doctors who work under supervision of seniors.


  Case Reports Top


The case deals with a guard on contractual post who was 36-year of age, male, living close to North Bengal Medical College and commuted by a bike. He belonged to socioeconomic Class 3 and had a history of family member affected with COVID. He was married, educated till class Xth and resided in a nuclear family with one child.

Case

The guards play a role beyond the stipulated and look after the cleanliness and other technical issues for smooth functioning of the clinic. They not only handle patients but also the patient party, allay their fear, address their queries, accompany them for admissions, help in putting required signages, give feedback to nursing staff and clinic in charge regarding daily working apart from maintaining the logistics. They have been posted in clinic since beginning in March 2020.

However, one guard who joined at the beginning was posted earlier as a hostel guard and hence did not want to join this screening clinic duty anticipating the profound risks. He was irregular in the previous duty as well but was “well connected” to the local leaders and hence did not have to pay a price. Moreover, he was addicted to alcohol to the extent of being held guilty twice of binge drinking during duty hours. A domestic violence case was imminent as conveyed by his close aids. Hence, his posting was taken a bit of apprehension for the new set up.

He was a known absentee and a chronic smoker and an alcoholic. He had been booked once in case of alleged misconduct with his colleague. The stated person belonged to a broken family and had an abusive childhood. He suffered from chronic alcoholism and was under treatment earlier. He had multiple postings prior and was on contractual job. Critical supervision led to more defiant behaviors and constant complaints against him led him to be absent on his duties frequently. Lack of belief on him by hierarchy may have led to a low self-esteem and consequent behavioral issues.

He was posted in shift duties at clinic where he had to interact with on duty doctors and nursing staff and other guards regularly. Patient interaction was a regular feature as was dealing with their queries, allaying their anxiety and helping them with testing and admission procedures. Human resource constraints being an issue one guard were posted for almost 12 h a day and they looked after logistics, cleanliness, and timely dissemination of information to patients and feedback to in charge along with managing crowds of 200 in morning times.

Intervention

He was provided with supportive supervision from end of college administration whenever they required. Food and lodging were provided from college end. The onduty doctors and the consultants of major disciplines, especially medicine department displayed strong leadership qualities along with addressing and troubleshooting their each small obstacles. They felt equipped and confident to work in the “safe setting” where they knew seniors would not only listen to them but also help them in any crisis. The round the clock active intervention of few senior consultants motivated him and made him realize the importance and impact of his work.

Screening clinic in charge also striked a chord with him and with positive reinforcement and handholding he felt enthused. Iterative discussions and regular counseling sessions on his perceived severity, susceptibility and threats, and benefits to action in phased manner helped him pave way with lots of sociocultural issues and understand his own worth as HCW, especially in COVID times. He was explained and he further percolated the concept of Health Belief Model that preventive behaviors depended on the risk of perception of people [Figure 1]. Face to face discussions with in charge of the clinic on regular visit days led him realize that his precautionary behavior depended on the risk perception of the implications and dissatisfaction with the existing causes. This was as relevant in times of COVID pandemic as were with his defiant and disruptive behavior. The peer group of other guards posted in COVID clinic also helped him in the positive change and his earlier associations which made him indulge in addictive behaviors were waning. His new support system at the clinic helped him realize his worth and understand the implications of reckless and ruthless behavior.
Figure 1: Diagram of the health belief model

Click here to view


The behavior change in him occurred as he grew more responsible, more regular in his duties and was keen to be an integral part of the clinic. The motivation and desire to quit addictive behaviors got ingrained as he was now satisfied with the job responsibility thrust on him.

Observed change and plausible reasons

In depth interview revealed a well-functioning team and team spirit, supportive supervision, able leadership from senior teachers and round the clock tireless fearless efforts of junior and senior doctors, extreme dependence of patients, and their accompaniments and good behavior of clinic support staff had a huge impact on him. Generated feelings of empathy, reliance, and doing a meaningful work where his words and actions can positively impact life of so many in these difficult times of the pandemic apparently removed his frustration and de-motivation. He found a meaning to his life and felt his social responsibility HCW. Further he reiterated sense of belonging and integrity to the team in clinic brought him peace and a sense of belonging. He along with other support staff now also percolate preventive health behavior messages encrypted to the patient and aim for optimum service delivery and client's satisfaction.

Interestingly, much to surprise a sea change followed. The ruthless brat turned the most motivated and enthusiastic secure guard. On the day of white-washing of clinic, he singlehandedly rearranged the furniture's, mopped the floors for no remuneration. Each day he kept vigil on logistics and helped ward off any untoward problems from outsiders in the clinic. He slowly turned into the safest and most reliable asset for clinic. His regularity and dedication was exemplary. Interestingly, he quit drinking absolutely over the 10 months and even was on treatment for a withdrawal phenomenon yet did not indulge in the addictive behavior. His family came and praised the clinic posting for his seemingly behavior change which reflected at home as well. His presence left an impeccable print in the clinic functioning.


  Discussion Top


Health belief models reinforce preventive precautionary behavior among general population depend on diffusion and percolation of risk perception among them. The perceived susceptibility of a condition can be addressed with increasing belief on the corrective measures which in turn will lead to interest and adoption of the behavior.

The interplay of interactive discussions and regular counselling sessions along with nonjudgmental approach of hierarchy set foundation for the behavior change communication leading to sustainable and noticeable changes. Sustainable positive behavior change communications along with conductive circumstances have been seen to induce positive reforms in long run.

Ergonomics means fitting the right man to the right job. Performance appraisal has time and again found enhanced performance of employees with higher where job satisfaction. This case is a unique example where responsibility and sense of doing a meaningful job can change the very thought process of a person ushering plethora of change in his behavior. Pain and uncertainty of the pandemic, dependence of general public on COVID Screening clinic staff made him realize the impact of his work in society and importance of team spirit. Stigma is driven mainly by fear of unknown, risking life for sake of duty, staying away from family for work and facing stigma was unique challenges the noble profession faced yet seemed small and surpassable in combating the pandemic. Counselling sessions reiterated the uniqueness of the unprecedented situation world faced and emphasized that HCW today were facing a fight which no before or after ever did or will do. We are creating history. Applicability of Rogers model of health communication of Adoption, Interest and Evaluation followed. Prioritization of health communication in daily practice was noted.[5],[7],[8],[9]

The sense of need for recognition, achievement, and self-esteem as advocated Maslow's Hierarchy of needs Pyramid was observed. This job gave him an identity, a sense of self-worth and belonging and satisfaction. The lack of direction and able leadership in usual government sectors and demotivated him and he turned to addictive behavior. His integrity, sincerity, and honesty were proved beyond worth when he abided completely by direction of his hierarchy despite his odds. Hence, laws of ergonomics and fitting the right man to right job with appropriate and sensitive retention and recruitment strategies would go a long way in ensuring effective service utilization and favorable indicators.[2],[9],[10]

Addictive behaviors are multifactorial and hence job satisfaction along with extra remuneration for COVID duties and extra food and staying conditions led to the quitting of the addictive behavior. Deaddiction can be heralded with controlled modifications of external environments and addressing the imminent stressors. Circumstances have always been an important influencer of human behavior. Regular counseling sessions, interactive discussions, no punitive action strategy and hand holding paved way for a welcome change.[3],[4],[5],[6]

COVID-19 is a game changer of the era which taught man to respect nature and understand his limits. It also positively impacted many lives, especially the HCWs regarding deep understanding of their job beyond the usual stated responsibilities. Improvement of performance on fitting of right job to the right person was reinstated yet again for a healthier and better tomorrow.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The work needs to mention support of all staffs posted at clinic, interns along with Principal, MSVP, Other college hierarchy all departments serving there alongwith Department of Medicine and Community Medicine, NBMCH in particular.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kenrick DT, Neuberg SL, Griskevicius V, Becker DV, Schaller M. Goal-driven cognition and functional behavior: The fundamental-motives framework. Curr Dir Psychol Sci 2010;19:63-7.  Back to cited text no. 1
    
2.
Sadique MZ, Edmunds WJ, Smith RD, Meerding WJ, de Zwart O, Brug J, et al. Precautionary behavior in response to perceived threat of pandemic influenza. Emerg Infect Dis 2007;13:1307-13.  Back to cited text no. 2
    
3.
Bish A, Michie S. Demographic and attitudinal determinants of protective behaviours during a pandemic: A review. Br J Health Psychol 2010;15:797-824.  Back to cited text no. 3
    
4.
Briss PA, Rodewald LE, Hinman AR, Shefer AM, Strikas RA, Bernier RR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The task force on community preventive services. Am J Prev Med 2000;18:97-140.  Back to cited text no. 4
    
5.
World Health Organization Department of Communications. 2019. Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan. Available from: https://www.who.int/internal-publications-detail/updated-country-preparedness-and-response-status-for-covid-19-as-of-19-march-2020. [Last accessed on 2021 Mar 19].  Back to cited text no. 5
    
6.
CDC. Implementation of mitigation strategies for communities with local COVID-19 transmission. Atlanta, GA: US Department of Health and Human Services, CDC; 2020.  Back to cited text no. 6
    
7.
Rogers EM. Mass media and interpersonal communication. In: Pool ID, Frey FW, Schramm W, Maccoby N, Parker EB, editors. Handbook of Communication. Chicago, IL: Rand McNally; 1973. p. 290-310.  Back to cited text no. 7
    
8.
Rogers EM. Communication and development: The passing of the dominant paradigm. Commun Res 1976;3:213-40.  Back to cited text no. 8
    
9.
Maslow AH. A theory of human motivation. Psychol Rev 1943;50:370-96.  Back to cited text no. 9
    
10.
Maslow AH. Motivation and Personality. New York: Harper and Row; 1954.  Back to cited text no. 10
    


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