Understanding the Mental, Emotional Toll that Natural Disasters Have on Physicians

Health care providers are truly in the “eye of the storm” when faced with the ravages of natural disaster due to the patient care they must administer with immediacy, and the obstacles that come with trying to provide that care. Therefore, it stands to reason natural disaster such as a hurricane can have an appreciable impact on the mental and emotional health of HCPs. But how significant is that toll? And how do HCPs maintain their mental wellbeing while tending to patients amid major storms? In part five of an eight-part interview, MarkAlain Déry, DO, answers those questions and more.

DWN: How big of a mental toll do natural disasters have on physicians, and how do you go about navigating and treating the mental and emotional needs of patients amid these disasters?

MD: I am going to start off by giving a general answer, then I’m going to give you very, very specific examples that I personally had because I think that’s going to really help drive it home. Of course, natural disasters have a significant mental toll on physicians and health care workers, while also presenting unique challenges in treating patients’ mental and emotional needs; burnout and exhaustion. Physicians often work long hours under stressful conditions during disasters, leading to physical and emotional exhaustion.

I will say this, the nurses had, both in Haiti and during Katrina, immediately established themselves into eight-hour shifts. Once they had enough folks to do so… Initially it was twelve-hour shifts and then eight-hour shifts. Whereas physicians, we don’t have that. We usually come to work in the morning and stay until the work is done. That said… Certainly in Haiti, the physicians were burning themselves out. They could only be there for a couple of days, whereas the nurses, again, were incredibly organized because that’s the way they work, and so they immediately organize themselves that way.

The second thing that we would see, really, is the physicians’ or the health care workers’ secondary traumatic stress. Exposure to patients’ trauma and suffering can cause vicarious traumatization in health care providers, which leads to moral distress. Physicians and health care workers may face difficult ethical decisions when resources are limited, potentially leading to feelings of guilt or helplessness, and this is certainly something that I have seen and experienced myself. Personal impact. Physicians may also be personally affected by the disaster, dealing with their own losses or concerns for family, as we mentioned a moment ago, and anxiety and depression. The high stress environment, and prolonged exposure to disaster aftermath can contribute to anxiety and depressive symptoms.

Now, I’m going to personalize this and tell you about my experience, both when I went to Haiti and my experience when I was working just behind the front lines in the Ukraine war when the Russian Federation first invaded Ukraine. I came back. For about three weeks was my tenure in the so-called American Hospital in Haiti. Like I mentioned, I was there a couple days after the earthquake occurred. I was the Haitian trifecta. French is my first language, I’m an infectious diseases physician, and I’m trauma trained. That was exactly what was needed at the time. What I didn’t expect to happen is that after my three weeks, and they were able to get in a very stable… A lot of the aftermath earthquakes, those had all settled down at that point, and they were able to start bringing in regular shifts of physicians and nurses, and I was cycled out.

I came back to New Orleans, I would say, a fairly broken person. I was not expecting that. I have been very fortunate in my life that mental health issues have not been something that have affected me personally. Certainly, I’ve seen it all around me. I’ve seen it in my family, but I’ve been very fortunate that it’s not something that affected me. That’s not true when I came back from Haiti. I was personally traumatized by what I saw. We saw something like 250,000 deaths in the Haitian earthquake, a majority of them in Port-au-Prince, which is where I was based.

When I went to Ukraine, the Ministry of Health asked us to rapidly put together a program that would teach non-trauma-based physicians, nurses, medical students, nursing students, through the use of Zoom, how to manage trauma. As we saw early on, civilian installations were targets of the Russian Federation. This is something that we all know now. Certainly then, that was not something that was well known because we were right at the very beginning of the invasion into Ukraine.

What we did was we immediately pulled together a program that was a little bit of ATLS, was a little bit of Stop the Bleed. It was basically teaching non-trauma health care workers how to stop trauma because you may be a psychiatrist, you may be a dentist, you could be a non-trauma-based person, a pediatrician, an internist, and then all of a sudden, the building next to you completely collapses as a result of being bombed, and now you are being called upon to go do something about that. It was those individuals that we trained, and it was extremely successful. We trained thousands of clinicians. It was very, very successful.

The thing that I want to mention was that built into that one-hour Zoom course over 16 of these courses was 15 minutes that was dedicated to psychological first aid, which was essentially teaching both the clinician to manage and how to manage the trauma they were seeing at that moment, how to manage it moving forward, and also how to transfer that to the patient that they were caring for, who has now experienced significant trauma. Perhaps they’ve been significantly wounded or have potentially traumatically lost a limb, what have you. It was building into all trauma courses, I think, moving forward, is this idea where we should have mental health acknowledgement, trauma first aid. This sort of stuff needs to be built into it, as well.

We built it into our program. We think that we’re the first people that have ever done that. But I’m very, very keen on addressing mental health issues when it comes to trauma, because there’s no question about it. Just like trauma and infectious diseases go hand in hand, trauma and mental health issues also go hand in hand. We talked about it a little earlier in this interview that after the recovery process and after people’s homes and the flooding waters reside and the mudslides reside or what have you, and as people start processing all that has happened around them, a large part of that is going to be the mental health toll that that takes, and I think addressing that early on is incredibly important.