COVID’s fifth wave has devastated its Israeli warriors emotionally, physically and financially

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It began with applause from balconies, citations of honor and endless deliveries of gifts and food to the hospitals during the first wave of the COVID-19 crisis – but since then almost everything has gone wrong for the medical professionals at the forefront of the battle against the pandemic.

The halo has faded, the terrible sights and traumatic experiences have hit them hard, their shifts have gotten longer, the waves of contagion haven’t ended, and the virus crisis has become a divisive subject that arouses frustration and social conflict. Thus the heroes of the first wave two years ago now find themselves bearing a large part of the burden of dealing with the pandemic, which is still far from over.

It’s no secret that COVID has had a powerful effect on the emotional resilience of medical staff all over the world and is causing serious burnout. In the United States, as of the end of 2021, the pandemic had led to mass resignations among these personnel: Estimates are that 18 percent have resigned, almost one out of every five. In Israel there are no official figures, but the burnout cries out during every random conversation with people in these professions, especially those who work in hospital COVID wards, internal medicine wards or in the community, which bears 98 percent of the burden of dealing with the virus.

But who is treating the medical staff? Those typically entrusted with those roles in Israel’s health system include medical psychologists, who specialize both in providing guidance and assistance to patients, and also in caring for health-care personnel who in the context of their jobs are grappling with difficult, complex situations. But the medical psychologists working in hospitals have had their hands full during the coronavirus period, and are having difficulty managing the illness in the public sector where they are so badly needed.

A COVID-19 ward at Hadassah University Hospital, Ein Karem, last year. “In the final analysis these are professionals, but they’re also human beings with children at home.” Ohad Zwigenberg

Some 400 medical and rehabilitation psychologists employed in very part-time positions in Israel’s public health system are supposed to be helping patients, their families and the medical teams during this crisis. But even this small number of work slots is not easily filled. The salary is tens of percentage points lower than that in the private sector, and the conditions are difficult.

Medical psychology is a relatively new specialty; it was recognized in Israel as a separate discipline only in 2000. Medical psychologists treat patients and their families, and help them cope with illnesses, medical interventions, healing processes and so on. As said, they also treat employees of the health-care system and the unique challenges those workers face – an issue that has become particularly acute during the COVID period, which has greatly exacerbated their predicament.

Over 80 percent of the 77 medical and rehabilitation psychologists questioned in a recent survey reported substantial or acute emotional damage among medical staffs treating coronavirus patients, but only 30 percent of the respondents saw themselves continuing in public service in the future, and over 50 percent testified to an inability to provide suitable solutions for the psychological needs of regular patients and health care workers alike. Some voices from the field:

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‘The medical staffs were terrified’

“You have to realize that all of us, but medical personnel even more, are simultaneously suffering from trauma and post-trauma,” says Yael Sharon, 44, a psychologist at the Sourasky Medical Center (Ichilov Hospital) in Tel Aviv. “If we, the public, are still traumatized by the first or second wave – these staff people were terrified. Some had no choice but to part from their children for a month, because they couldn’t return home for fear of contagion during the first waves.

“The hospital became a ghost town. If someone dared to hug someone else – that was really wild. The medical workers had to deal with the protective gear and the suffocation, during very demanding shifts, and were forced to see a lot of death. One of the tough things is that the deaths from COVID have been very immediate and unexpected. There are medical workers who found themselves grappling with the subject of death without ever experiencing that sort of intensity. Their feeling was: ‘I didn’t sign up for this’ when they entered the medical system. The protective gear, the endless shifts, the home-work balance that is upset, the children staying alone at home – the whole pressure cooker.

A ward for coronavirus patients at Beilinson Hospital. “At first there was adrenaline and a sense of a shared fate, and people maintained inner resilience. But these things became eroded.” Tomer Appelbaum

“Often the medical personnel constituted the patient’s closest and most intimate surroundings, because the family wasn’t there, and the staff found themselves dealing with tremendous distress. Suddenly it was hard to use the familiar defense mechanism of making a separation between themselves as caregivers and the patients. You had to fashion a whole new uniform.”

There are workers, Sharon continues, “who are almost invisible, who have suffered greatly. For example, respiratory technicians – that’s an example of people who don’t deal with death at such an intensity on an everyday basis, but during COVID, the proximity to the patients and the fact that the families weren’t in the wards turned them into the people closest to the patients. Likewise the lab workers who worked in shifts without a break, doing an incredible amount of work. The health care professions are not like an ordinary profession. Your actions are a matter of life and death, and that erodes your ability to maintain limits. The human capital that exists in this realm is amazing, but it’s not being sufficiently nurtured.

“Someone told me: ‘When the wave passes you think it’s behind you, and suddenly you enter a ward where there’s someone who may have COVID, and that triggers your memories and you’re drawn inside all that again.’ It’s like complex post-trauma – not a one-time event but more and more events that accumulate and change something inside you.”

What did you do in order to help?

Sharon: “The hospital mobilized to provide a psychological solution to staff members. We tried to enter the wards and focus on their needs, to figure out what could we could contribute to the personnel with our very limited resources. We have advisory discussions with the staffs, but it’s just too little and insufficient. It’s awful how insufficient it is, because after that you want to send the person for ongoing therapy in the community but there’s no place to send them. The Health Ministry takes limited responsibility for medical workers.

Medical psychologist Yael Sharon, this month. “The health care professions are not like an ordinary profession. Your actions are a matter of life and death.” Gili Getz

“Medical psychologists leave their jobs because they can’t deal with the low salary. Those who leave are very frustrated, because they like working in the hospital and it’s such important work. Our biggest battle is for more positions to be opened up, because the other health care workers are in such bad shape, and for there to be an improvement in our conditions so that good people will stay in the system. Finally, the service a patient gets is a function of the caregivers’ situation, and the focus should be on the caregiver – the doctors, the nurses and those in the invisible professions who suffer the most: unskilled support staff, people dealing with transport, technicians.

“One of the things that happens with burnout is depersonalization, a reduced ability to really see the patient. If you don’t have a place where you can talk about the pain and the memories and process traumatic events, to learn how to feel less guilt and stop blaming yourself – the distress will increase, and that will be reflected in the relationship between colleagues, with the patients, the families, and even with your own family.”

‘The consequences are profound’

“During COVID I went back to working in a half-time position at a hospital, in December 2020, after a break of several years when I switched to the private sector,” says Shir Reichert Ramot, 37, a specialist in medical psychology who works in a private clinic in Tel Aviv.

“I went back because I felt that this is a crucial time when there is a great need for us,” she says. “I returned to a job whose entire essence is work with the staff. I felt that something huge was happening that’s important to be a part of, and that this is an opportunity to perhaps create a major and significant change.”

Medical psychology expert Shir Reichert Ramot, this month. “I conducted a therapy session with a staff member on the stairwell.” Ofer Vaknin

And what did you discover?

Ramot: “I joined a COVID intensive care unit shortly before the third wave, at the stage when the team had just been formed. I discovered staff members who had suffered serious distress – people who worked for decades in other departments, and one day were recruited to a new one. Everything happens at once: getting to know the members of the new team and bonding with them, and all that on the backdrop of a great deal of trauma from the first two waves.

“Some of them have worked in the system for many years; they are people who have developed resilience despite the fact that some of them work in the most difficult places. But the virus really triggered and created traumas, shook the foundations. In the final analysis these are professionals, but they’re also human beings who have children at home. They worked 12-12 shifts (12 hours of work and 12 hours of rest), didn’t see their kids. During the first waves of the pandemic there was nobody to help them because nobody dared to go near the homes of people working in COVID wards.

“Someone told me that she had separated from a partner and had wanted to start dating, but nobody wanted to meet her because of her profession. The third wave was particularly hard.”

Why the third wave?

“It was a long and difficult wave. At the start the vaccinations began and there was tremendous optimism, but the wave continued and tragic cases started to arrive, involving many young people, pregnant women. These are very tough experiences. And the most difficult and upsetting thing was the conditions: Professionals who work in intensive care maintain professional conduct despite the chaos, but in the third wave they already felt that they didn’t know anything, that they didn’t have clear guidelines as they do for dealing with a heart attack or other familiar acute conditions, and that there were many people whom they just couldn’t help. They didn’t know how to assess who would survive and who would die. It was chaotic.

“In routine times, professionals know how to work and what they’re supposed to do, but here all that was taken away from them and they were expected to continue to function, although the usual and familiar method wasn’t working any more, and it was a matter of human life. It’s terribly upsetting and frightening, and at the same time their children were alone at home or sick.”

Why did you leave after six months?

“I felt that I didn’t have the tools to do even the minimum. I worked 15 to 16 hours a week, mostly doing therapy, but I was given a room for only three hours a week, because the hospital was so full that all the rooms were allocated to patients. I reached a situation where I conducted a therapy session with a staff member on the stairwell. That was the craziness of the hospital – you want to treat someone but you don’t have minimal conditions. The health care system is a slow, cumbersome, hierarchical system preoccupied with balancing the budget. In order to provide for the genuine welfare for the staff, there has to be a process. You have to understand its importance and then invest in it.

“Traumatized staff members are expensive – they’re burned out, they make more mistakes, they leave, they abuse the interns. In addition to their tremendous human suffering, they also cause harm to others. The system must undergo a profound change and realize how important it is to treat that, and how much distortion and damage are caused as a result of the entire array of pressures being brought to bear on an employee in the health care system.

Dr. Yuval Hirsch, among those leading a forum supporting psychology in the private sector, this month. “Burnout, post-trauma, an absence of support – all that makes it hard to serve the public.” Ofer Vaknin

“I have a family, and in the final analysis the salary I was getting was simply ridiculous. I worked six days a week, two of them in a hospital, for which I received less than 2,000 shekels ($643) a month, and that’s even considered a relatively well-paying hospital. The work is very tough, it drove the family crazy, and I had to explain to myself how it could be that I was working so hard and that was the bottom line in the bank. I’d be very happy to return to the public sector. I’m active in promoting psychology among the public and at the same time I work only privately, and that hurts. To my regret, I’m a big believer in the importance of public-sector psychology, but I have to feed my kids.

“The government hasn’t succeeded to create a more profound change in this realm, and in the end everyone loses. The doctor who had a traumatic experience and didn’t get help, the cancer patient who will get only six therapy sessions even if she’s been ill for two years – not to mention children who experience terrible and ongoing damage. The consequences are profound and long term, affecting generations, because a staff member who experienced trauma in a ward comes home as a different parent, and that also affects their children, who won’t receive therapy in the public sector either. And then the professional encounters his patients in that state.”

Ridiculous salaries for psychologists

“We’re in the fifth wave and the situation is becoming worse,” says Dr. Yuval Hirsch, 42, who heads the psychologists’ chapter of the Union of Graduates in Humanities and Social Sciences, and is among those leading a forum of groups supporting psychology in the private sector.

“The medical staff is in a catastrophic state: At first there was adrenaline and a sense of a shared fate, and people maintained inner resilience in order to be able to cope. But over time these things became eroded, and the ability to hold on for the long term was weakened. These people have suffered twice: both as citizens experiencing COVID and as those at the forefront against the pandemic. We’re really worried about the fact that these professionals do not have proper support,” he says.

Why is it that so many medical psychologists don’t see a future in the public sector?

Hirsch: “There is no shortage of psychologists in Israel but according to a rough estimate, there is a shortage of hundreds of medical psychologists in the health care system. In the hospitals there are no positions on offer, every hospital does its best, and in the community there aren’t any medical psychologists. It’s very hard to bring in expert psychologists and get them to stay in the public sector, because the salary and conditions are very poor.

“A psychologist with a doctorate and over 10 years of seniority will earn 4,200 shekels a month for a half-time position in a hospital (there are almost no full-time positions in the field). In the private sector, psychologists earn far more and are easily able to fill their clinics. That’s a result of many years of neglect, by all the governments. Public-sector psychology has been relegated to the backyard for many years, and during COVID-19 the situation has become much worse.

“In addition to the human suffering of the personnel – the public is going to be seriously harmed in the coming years. Burnout, post-trauma and an absence of support – all that makes it hard to continue to serve the public. The role of the medical psychologist is to provide support so that medical workers can continue to function, and presently this service is all but nonexistent.”