Medical Social Work Practice In India

Amidst the COVID-19 Pandemic

5th Chinese Regional Medical Social Work Conference, Taiwan
19 November 2021
Keynote Speech

Dr. VISHAL M. V., M.Phil., PhD

Medical Social Worker
Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST)
Thiruvananthapuram, Kerala, India
An Institution of National Importance, Department of Science and Technology, Govt. of India

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Content
1. The Covid-19 pandemic in India

2. Medical Social Work in India – before

the Covid-19 pandemic

3. Medical Social Work after the

emergence of the Covid-19 pandemic

4. The Covid-19 appropriate Medical

Social
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India and Covid-19
• The first case of the Covid-19 was identified on
January 27, 2020
• India became a hub of the Covid-19 eventually.
• The Covid-19 pandemic spread from Urban Centers
to Rural centers. Lockdown
• India adopted National lockdown in four phases Phase 1:
25 March 2020 – 14 April 2020 (21 days)
Phase 2:
15 April 2020 – 3 May 2020 (19 days)
Phase 3:
4 May 2020 – 17 May 2020 (14 days)
Phase 4:
18 May 2020 – 31 May 2020 (14 days)
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How did the Covid-19 pandemic impact to the society ?
Primary Problem Mass spread of Covid- 19 (Urban and Rural)
Covid-19 -related Unprecedented Public Health Emergency Loss of life
Weakening of the health care delivery system
The Impact of  
Social System
the Covid- 19 on
Collapse
the Community
Health Challenges of the Non-Covid- 19 patients Accumulation of
Hospital hesitancy Unmet Needs in
Health Vaccine Hesitancy the Community
Failure of social networks
Secondary

Transformation in education system

Social &
Problems

Breakdown of economic systems An overall reduction of

Economic  Return – migration-unemployment Quality of community
Loss of job poverty among poor socio-economic life
groups
Fear, generalized anxiety, depression, suicide etc.
Psychological 5th Increasing domestic violence ( physical and
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emotional) on women
Social Fear
Covid-19- General Picture of the society after the Emergence of the
Covid-19 pandemic
Infected: 3.45 Million (as on 16/11/21)
Exact number: 3,44,56,401
Death: 0.46million

• All most all sections of the population has

come under vulnerable category
Vulnerable
Infected • India, being an ageing country – Older adults
Affected are more vulnerable (nearly 104 million
elderly persons, Census,2011)

• Poor socio-economic population

• Daily wage workers, migrants, temporary workers etc.
• Older adults, women and children…
• Chronic patients, regular patients, acute illness
patients etc..
• Health workers
• Kin of the diseased due to the Covid-19
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• Common man…
Medical social work Practice- Before the Covid-19
pandemic
OPDs MSW Practice IPDs
1. Crisis-intervention 1. Crisis-intervention
2. Socio-economic assessment 2. Socio-economic assessment ( At each level of
3. Psychosocial assessment and intervention treatment , Resource mapping and linking)
(Basic counseling ) 3. Psychosocial assessment and intervention
4. Psychosocial education, individual and (Case work, Group work )
group 4. Part of multidisciplinary team
5. Resource mapping and linking 5. Discharge planning
6. Social - Rehabilitation
Generic  

1. Resource mapping and linking

2. Community Health Social Work
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Covid-19 and it's Impacts on Hospitals
• Patients and family were the most affected category…
• Many hospitals closed due to the Covid-19 infection
among health professional… Covid-19
• The phenomena of a sudden reduction in patients
turned out at hospitals (Hospital hesitancy) was visible… patients
• Shortage of fund and financial aid to the patient
• But an abrupt increase of the Covid-19 patients
submerged many hospitals…
• Hospitals were strained without beds and ventilators…
• Many hospitals were converted as the Covid-19
Non-
dedicated hospitals…
• Health workers became the most vulnerable, many lost
Covid-19
life… patients
• Confusion on implementing the Covid-19 protocol was
present at the initial stage… 5th Chinese Regional Medical Social Work Conference, Taiwan_
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The Covid-19 & MSW practice
• The emerging of the Covid-19 was dreadful to MSWs as they became the
frontline worker in many hospitals.
• As confusion on prevention and treatment of the Covid-19 pandemic was
persistent at the beginning.
• But efforts from health department and self –updating helped fight against
it…
It paved the way for new work culture among the
MSWs
“the Covid-19 appropriate Medical Social Work
Practice”
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The Covid-19 appropriate MSW practice
• It is the outcome of adopting the Covid-19 appropriate
behaviors and the measures implemented by the
hospitals (or agencies) to avert the occurrence of the
Covid-19 pandemic.
• It aims to protect both patients and MSWs from getting
infected by the Covid-19 infection.
• It also brought new role to MSWs and modified their
work culture… lot of ethical problems as well..
• The Covid-19 appropriate behaviors were really a
challenging task for the MSWs to observe during
practice.
• It reduced the efficiency of the MSW practice.
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The Covid-19 appropriate Medical Social Work Practice

Reduced the
Covid-19
Efficiency of
appropriate
policies
the MSW
(hospital
level)
Covid-19 practice and
appropriate
Behavior ethical
(Individual level)
Patients and
MSWs

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What did it bring? Changes !
Introduced new policy (Hospital level);
• Reduced the intake of Outpatients and Inpatients – Only
most- needed patients were allowed to visit hospitals.
• Telemedicine and Online Medical Social Work
Introduced new physical barriers between MSWs and Clients
;
• Every patient and MSWs places were separated with
transparent glass.
• Installed loudspeaker systems.
Covid-19 appropriate behavior ( Individual level)
• Encouraged self –protection practice among patients and
the MSWs.
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How does the Covid-19 appropriate behavior affect MSW
practice? The Communication Gap!
• Physical distancing: reduced the interaction
with the client and health professionals.
• Hesitancy from client (patient) to interact
with the MSWs.
• Personal Protective Equipment's (PPE):
reduced the quality of the interaction
1. Verbal Communication
2. Non-verbal Communication
3. Expression of emotions etc.
These are very important tool of MSW
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How did the Covid-19 pandemic change MSW practice?
• At the initial stage, MSWs are pooled to from a
frontline work from their actual work at different Ethical
departments.
• It brought a partial or complete premature
How it
impact
Dilemma?
termination of MSW practice. MSW
profession
• It resulted panic situation among the patients… Is premature
• As mid-way stopping and discharging of patients termination of
Whether it
MSW practice
would have negative impact on patient recovery. okay?
brings
overburden to
• Therefore, the Covid-19 related discharge counseling How would it
the patients?
was started to overcome these situations. impact the
patients and What is
• Patients and their caregivers were not at all ready to their families? MSWs
accept the sudden implementations of the hospital Is Patient’s
Position to
regulations related to the Covid-19. Address
Human right
these
• This also
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brought ethical dilemma among
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Medical Social MSWs.
Work Conference, Taiwan_
violated ?
challenges?
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Frontline Medical Social Work ? New Role !
• The pooled strengths of MSWs are mostly
used for the Covid-19 prevention Screening
• It includes patients screening, limiting the
intake of the patients…
• Started the Covid-19 counselling to Front line
patients ( if needed) and family Education Social Prevention
Work
members.
• Educating the Covid-19 appropriate
behaviour to the non-Covid-19 patients
and family members. Counselling

• Ensuring physical distancing in and out

side the Hospitals premises.
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Unknown and Known Patients -Occupational Hazard
• During the intake process majority of the patients Known Patients Unknown Patients
Very Less Huge Number
are unaware of their Covid-19 status.
• Though the patients are being screened for Covid-19
before the intake process, the actual status of Covid- Patients
Patients
Not Aware
19 is not at all possible to determine. (Because the Aware
about
Covid-19 test is not mandatory for OPD patients) about
their
their
Covid-19
• This paved the way for the MSWs to getting infected Covid-19
status
status
by the virus.
• These circumstances lead the Medical Social Worker
to minimize the normal Medical Social Work Practice
and resort to providing only very essential services to Both Cases are Risky
the patients. As no mandatory testing is
needed to visit the hospitals
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Part of Vaccine Team
• The introduction of the Covid- 19 vaccine seems to
be an elixir for all health workers and laypersons
• Many Hospitals formed vaccine team including
Medial Social Workers to roll out vaccination drives.
• The appointed Medial Social Workers are assigned
to perform Pre- Vaccine Counselling (PVC) to
beneficiaries.
• The Pre Vaccine Counselling (PVC) aims to reduce
the vaccine hesitancy among the beneficiaries and
provides confidence to receive the jab.
• Approximately two hundred pre-vaccine
counselling sessions were rendered per day…
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Scope of Online Medical Social Work Practice
• The applicability of the online mode of Medical
Social Work services is tested along with
Telemedicine services.
• The project started as a pilot activity to reach out
to the patients and family members in need of
psychosocial supports.
• A team of Medical Social Workers are appointed
for this purpose.
• This mode is being widely used by patients who
need regular psychosocial supports
• It nullified the problem of social and physical
distancing while doing the MSW practice.
• Digital divide and physical problems of the
patients are the main hurdles to Online medical
social work
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Challenges
Stoppage of Academic and Career Development
• Many planned programs were cancelled, postponed or
converted of online mode over the last.1.5 year
• Seminars, conferences, workshops, training programs,
postgraduate and graduate internships are some of them.
• Suspension of regular academic class and related activities
were lost for the Medical Social Work trainees forever.
• The implementation of the online class comes in handy for
theoretical teaching purposes, but being a practice-oriented
profession, the loss of practical exposure would result in
negativity in their academic and professional development.
• Probably those who have opted for Health Social Worker as
specialization might be the highest suffers due to the lack of
internship opportunities due to the Covid-19 regulations at
Hospital Settings. 5th Chinese Regional Medical Social Work Conference, Taiwan_
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Challenges
Complexities in Work-Life –Balance
• Although the Covid- 19 pandemics decreased the regular
Medical Social Work practice but increased the workload of
the Medical Social Workers in many ways.
• The overloaded telephonic consultation (Online Medical
Social Work) with patients and caregivers are being a
stressful job for the medical social workers.
• On the other hand, the personal life of Medical Social
Workers went deserted or compromised many times by
Covid- 19.
• Mental health Challenges: Quarantine and isolation
became part and parcel of MSWs these days. It results in a
reduction in social engagement and leading to loneliness. It
greatly affected family relationships leading to emotional
strain.
• Social –stigma and stereotyped view from patients and
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family also present..
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Expecting high patients turn out in the coming days!
• As the presence of the Covid-19 in the society is
now subsiding day by day in India.
• Vaccination coverage is touching new high in
every day…
• Patients rush to the hospitals in the coming
days is expected..
• But, dealing with such rush is still need more
clarity from the health workers
• MSWs needed to device new strategies to
render their services to the patients amidst..
• Work load of the MSWs is expected to reach its
zenith…
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What’s next? Promote Inclusive Health Care Delivery
• The Covid-19 pandemic has changed the global perspective of health.
• It brought out inequalities in all sectors, especially health sectors…
• Health care purchasing power has reduced among the poor socio-economic
groups.. Addressing
• Need to develop more inclusive health care delivery in the coming days… Socio-economic
Status of the
benefiting all sections of the society… Patients
• Health infrastructure is being updated to “digital health/ telemedicine”
• These technological advancement is also providing opportunities as well as Addressing Social
Addressing Equal
challenges to both health professionals and patients Accesses to Health
justice and
Patient’s Rights
Care Delivery
• Digital divide is the hard nut to break ( especially to older adults and
vulnerable sections of the society.)
• Social work should also needed to updates their arsenal to discharges their
services with the help of modern technologies (Tele-medical social work-
TSW)
• MSW practice should focus to reduce the digital divide and
to promote inclusive health care delivery to all…
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Conclusion-Need new strategies
• Medical Social Work practice has made significant contribution to the
patients in many ways…
• Patients and family need more support from Social Workers as the presence
of the Covid-19 pandemic induced stress is every where in the society.
• Poor (socio-economically disadvantaged) patients are the main victim of the
Covid-19 pandemic. They need socio-economic support to continue their
treatments.
• So that while planning new strategies, MSWs should look at the human rights
of all sections of the patient and the society for ensuring accessibility to
health care facilities during the Covid-19 times.
• Welfare – Administration: MSWs should promote an inclusive treatment
modalities in the coming days viewing the devastating impacts of the Covid-
19 pandemic in the society.
• Need Social Work Research on the impact of the Covid-19 pandemic on
patients
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