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Route to resilience and recovery

By OLEEN FLORENDO, The Philippine Star Published Nov 26, 2020 4:00 pm Updated Nov 26, 2020 6:43 pm

The healthcare sector needs care and attention just as much as we do.

Eight months since the pandemic started, unwelcomed loss, anxiety and grief have settled in and found a spot in our lives.

For our healthcare workers, these emotions have been mirrored and magnified more in their everyday lives because of the nature of their profession. As they continue to bear the brunt of fighting this pandemic, they are no longer strangers to praise, hero narratives and the countless times where they’ve been put on a pedestal for their sacrifice. While they do deserve every bit of this — more than ever — the reality is, applause and words of approval won’t save them from the grim realities and effects of this virus. 

Anyone living in the year 2020 can attest that what we’re currently going through has not been forgiving to our mental health — and much more so for the healthcare sector. AHA!, a behavioral design organization, has partnered with the Department of Health (DOH) to address the needs of our hospital workers. They have spent the previous months extending help through the framework they know best: behavioral economics.

This time, their goal is to help 39,000 healthcare workers. We talked to Lei, Shairra, Jaime and Inna from AHA! to learn about their progress and why behavioral design is important.

YOUNG STAR: Can you introduce us to your company? How did it start?

AHA!: We started AHA! in 2017. Three of our partners were part of an organization back in college that focused on structured learning experiences. They started the company with the mindset that they want to pioneer behavioral design in the Philippines. (EDITOR’S NOTE: This is a way of combining design thinking with influence theory to alter behavior).

It’s common for development organizations to apply knowledge-based interventions to target behavioral change, but the impact of the approach is usually lacking. While information and education are important, we realized they don’t necessarily change behaviors. For example, we know sugar is addictive and bad, but we continue to overeat. There was an intention-action gap that we wanted to address. 

What sparked the initiative to direct your efforts towards frontliners’ mental health?

Initially, it jumpstarted from a WHO survey for healthcare workers. We saw that mental health was a specific area that we could help in. As early as March, we’d already been telling organizations that it’s good that they’re going out to help in terms of food and medical needs of their hospitals and communities, but they have to go back to their people. And to prepare, we studied the previous pandemic settings and looked at emerging research from China since they dealt with this first. It also wouldn’t be complete without the human-centered approach. Since people come from different contexts, it’s important to cater-fit the tools to them. We talked to the DOH, chosen representatives from DOH-retained hospitals, and consulted with emotion-based consultants in terms of which aspects should be considered.

What mental health challenges do our healthcare workers face with their daily battle in the frontlines? 

We have this process called journey mapping which is part of a four-step process. We see what happens in their day and learn when their stress spikes. Based on our current sample size, this can be divided into three contexts for our healthcare workers. For pre-duty, the first spike of stress starts as soon as they wake up and feel anxious over their duty for the day. Next is during duty when they start donning their PPE and think of colleagues who still caught the disease despite wearing the gear, and another spike is when they do their job-focused task where exposure is highest. And then during post-duty, when they start removing their PPE and anxiety kicks in, thinking if they might bring home the disease to their families. It’s very focused on moments and also why behavioral design is a powerful tool. We wish the Philippines would use it more extensively. There are so many external factors that could affect the problem we want to address that we usually fail to put into consideration.

How did healthcare workers deal with their spikes of stress before AHA reached out to them?

Many have their own respective coping strategies, such as talking to loved ones, praying, watching Netflix, and allotting time for hobbies. Most of them value having quality sleep or even just taking the time to rest, whether at home or in the hospital as a way to recharge. The height of the physical tiredness and mental burden is usually felt the most after their duty, so rest wherein they don’t have to think about work is highly valuable for them.

How do you think your program can improve and change the quality of life of our healthcare workers?

Our overall aspiration is for them to have long-term recovery and resilience. Because we don’t know when this pandemic will end, which further prolongs chronic stress, we aspire to apply interventions that could help them recover by focusing on resilience-building behaviors. It’s definitely not a silver bullet and it won’t solve all of their problems, so it’s still important to consult psychologists and psychiatrists for overall mental health assessment — but we definitely hope to make a dent and make a pocket of hope during this time.

Is there a particular behavioral design intervention that you think would work for most?

Initial data points towards breathing-control behaviors and instilling a sense of hope for doctors through intention-setting and mindfulness behaviors. But for everyone dealing with mental health, there are generally five resilience strategies that work. One focuses on hope, another is safety which pertains to your physical well-being, control, which is what empowers you to make your own decisions, calm thinking, and lastly generating social connection. 

Ultimately, our objective is to know which behaviors would make these strategies concrete, then eventually bring it out to allow them to be more mentally and emotionally resilient. Behavior is the basic unit of change. It’s very small, but when compounded, it can generate an effect.

Can you share your perspective on what working with frontliners has been like?

Honestly, it’s difficult not to be emotionally affected by their stories, especially their difficulties. But we want to be able to honor their sacrifices by providing them support and hope through this project. One of the most admirable things is that they really deliver on their mission to save lives despite the risks to their body and mind. They are hope personified in this pandemic.

How can we communicate empathy towards our frontliners? 

Healthcare workers look for decompression points or mental health breaks. And it’s important for us to honor and respect those breaks. But in general, the call for this time, and not just for healthcare workers, as clichéd as it may sound, is just to be kinder to people. 

Remembering that healthcare professionals are people, too, seems natural, but actually doesn’t come naturally to people. We have to recognize that what they’re going through is real. They’re also absorbing the compounding effect of the stories of their patients and loved ones. Add this to the reality of this pandemic that makes everything extreme; not just the risk but also the volume of the work. To always remember this perspective is very powerful when dealing with them. Let’s not just put ourselves in their shoes, but also walk with them in their lives. It’s one of the keys in creating a more empathetic space for them.