Pandemic Created Combat Like Trauma for Pharmacists

When I was the state executive in South Carolina, I would visit about 20 pharmacies a week. As I was waiting to meet with the team at each community pharmacy, I watched each member of team run back and forth to answer phones that did not stop ringing with calls from patients and providers, service the drive-thru customers, arrange for minute clinics as well as patient counseling, and take care of dozens of patients waiting in line for COVID-19 vaccines and/or testing.

Similar to other health care providers, pharmacists and their team members are under an immense amount of stress, pressure, and demand to serve the needs of their patients. I watched them work selflessly to meet the needs of their patients.

Throughout the pandemic, overrun hospitals were often referred to as combat zones and health care workers as frontline soldiers. Research shows that those comparisons were probably warranted. As they faced fatigue, death, fear of infection, burnout, and watched as people ignored public health recommendations, health care workers have been experiencing record levels of mental health distress.

What health care workers faced early in the pandemic is a type of post-traumatic stress disorder (PTSD) called “moral injury,” a feeling of guilt or shame after having participated in an extraordinary high-stress situation that required immediate and often life-or-death decision-making.

The impact of the pandemic on the mental health of health care workers, including pharmacists, has been well documented. Every day, we hear about rising reports of exhaustion, burnout, and staff turnover in our community.

A recent survey reveals that more than 60% of pharmacists report experiencing a high level of burnout in practice. This is one of the highest rates among other health care professionals, even higher than those found among surgeons, oncologists, and emergency and trauma unit practitioners.

Research shows that members of the health care team, pharmacists included, are more prone to making errors when under a lot of pressure. This is particularly concerning when considering that medical errors are the third leading cause of death in the United States behind cardiovascular disease and cancer.

Because of the demand and stress they are under, pharmacists are more likely to suffer more from PTSD than the general population and it’s easy to understand why. Pharmacists bear witness to their patients’ suffering, and many lack complete control over their work conditions and ability to maintain personal safety. New demands created by COVID-19 are fueling these stress responses—further raising the risk of PTSD.

It has been said that frontline health care workers are experiencing a level of mental health distress comparable to what is seen in soldiers who serve in combat. As a trauma-informed pharmacist who has personally served at the frontline in combat zones, I believe this comparison is accurate.

The human brain is not designed for uncertainty, it’s designed for survival. In times of extreme distress and uncertainty, the neocortex—where higher level thinking takes place—is overtaken by the parts of the brain that govern emotion and survival, the amygdala, also known as the body’s alarm system.

We become more self-centered and less collaborative, giving, and empathetic. It’s a self-defense mechanism that can negatively impact our work and our relationships.

Health care leaders face a different kind of trauma brought about by fear of the unknown. One of the classic symptoms of PTSD is flashbacks. Leaders may have flash-forwards—attacks of panic and anxiety about what might happen in the future.

Leaders are supposed to have the answers, so they don’t feel as though they have anyone they can turn to for advice. We are seeing a 300% increase in reports of loneliness among leaders. As a health threat, loneliness can be more harmful than smoking or obesity.

We enter this profession to help, but often don’t know how to help ourselves. Fortunately, there are techniques that can help prevent our emotional brain from sending false alarms.

• Mindfulness is about bringing ourselves to a full awareness of the present moment, to keep us calm and focused when exposed to images, thoughts or sounds that are reminiscent of our past or that are causing distress, and to restore a full ownership of our body, mind, and soul.
• Yoga includes practices specifically designed for people with trauma. Yoga is about looking inward and listening to the things our body is telling us.
• Pranayama technique teaches us to slowly breathe in, hold, and slowly release the breath when accessing painful memories or thinking about stressful situations can be helpful too.
• Build a healthy, supportive network. It is extremely hard for a trauma survivor to feel safe in an environment that often judges them for their feelings. Finding a professional, non-judgmental support group can provide a health network of people who have similar experiences and are finding health ways to deal with them.
• Get moving: movement is medicine. Decades of research has confirmed that exercise is one of the most powerful tools to help with stress. Movement helps with flexibility, balance, and good health. Movement of any sort can help release tension, deepen our breathing, and boost our memory and mood.Moving your body an include anything you like to do, such as kickboxing, running, swimming, and dancing.
• Break your silence through journaling. Use your writing to pour out all of your anger and sadness. You can use a journal to record events and feelings or write a letter to yourself about the ways people made you feel. No one will see those letters so do not worry about polishing your writing. Express yourself freely and let the energy flow out of you. We usually feel better after we let negative energy out of our system.
• Find a furry friend. We all need a dose of companionship and unconditional love from our pets. Our pets help us reconnect with our community and serve as our companion when no one is around to give us support. Having a pet that needs to be cared for can provide you with a sense of purpose and a reason to get out of bed on those less than good days.
• Heal your trauma through creativity. Art, music, and dancing are used around the world to treat trauma, especially to help people express their suffering. Those who struggle with not being able to articulate their trauma and feelings may be able to express themselves through a creative process, such as art or music.

As leaders in the profession, it is time for us to wake up to the unbearable work conditions that our fellow pharmacists are under. Long working hours, a lack of resources, the inability to take needed breaks, and the added responsibilities of meeting the demand created by the pandemic are among the challenges that community pharmacists live with on a daily basis.

While I am excited to see associations pay attention to pharmacists’ wellbeing, I feel that most initiatives have been pharmacist-centered and very few have been system-centered. When you put pharmacists in a system that induces stress, there is little room for pharmacist wellbeing.

We can’t solve the problem if we can’t prove the problem exists. Telling your stories can help bring about positive change and what are some of the changes needed to address the wellbeing of pharmacists? Increasing the number of technicians, reducing the number of working hours, and hiring more pharmacists to meet the patients’ demands. I recommend that thought leaders meet and agree on what specific changes can be made so pharmacists are better equipped to care for their patients.

About the Author

Helen Sairany holds extensive knowledge, skills, and experiences in executive leadership, administrative management, regulatory, practice, and accreditation systems gained through her 12 years of work as a trauma informed pharmacist, State Executive and CEO for the South Carolina Pharmacy Association (SCPhA), Director of Content Development and Partnership at the American Pharmacists Association (APhA), Director of Quality Assurance at the University of Duhok College of Pharmacy, and as a field provider for Doctors Without Borders in Iraq and Western Syria.

Dr. Sairany holds a Bachelor of Art from Agnes Scott College, an MBA from the University of Maryland, and a PharmD from Northeastern University.

She was recognized by the Washington Business Journal “40 Under 40” for her work on combating opioid abuse nationwide through pharmacist patient care services and trauma informed care.

She has keynoted nationally on a wide range of topics including but not limited to mental health fitness and wellbeing, racial and developmental trauma, addiction, diversity, equity, inclusion and belonging. She is a proud author of two books; “Trading Grenades for Candy: A Kurdish Refugee's American Journey” and “Post Traumatic Wisdom: Finding Belonging in Wake of Racial Trauma.” Her love for writing started when she blogged about her experiences living as a single woman in a male-dominated field in the Middle East. In her free time, she served as a faculty adviser for the All-Women Blogger’s Club, where she teaches young women from the minority communities how to voice their opinions through writing. She also serves as a mentor for countless number of students, residents, and fellows across the country.