PHOTOS: How 9 Health Workers Stay Strong In A Pandemic Year

To be a health care worker in the best of times includes days of stress, sorrow, frustration, triumph, joy and reflection — not always in that order. This past year was all of that on warp speed, as the World Health Organization declared a global pandemic on March 11, 2020.

To mark the one year anniversary of that declaration, we've photographed and interviewed nine healthcare workers from around the globe, serving very different communities but all with the same goal: conquering COVID-19. We especially wanted to know: What has surprised them most over the past year? And how have they managed to cope with all the stress?

Diving For Solace

A colleague of Dr. Storm Bissict's was the first serious case of COVID her hospital had seen of one of their own staff. His health deteriorated to the point that he needed a tube inserted to help him breathe — intubation, often the last line of defense for COVID patients.

"We both knew full well what the chances of survival post intubation were at that point," she says. Before they started the intubation, her colleague — a husband and father of two — asked Bissict to pass along messages to his family. Then he turned to her and asked, "What if this is it?"

It's that single moment of intubation that Bissict finds the hardest to deal with — what she calls "those moments of breathlessness when there is no other alternative but to be sedated and connected to the ventilator."

Some of these patients are aware of what is happening but unable to communicate, she says. "They often just don't have the breath to form the words." Others, perhaps the luckier ones, says Bissict, are delirious from too little oxygen. Either way, she says, the moment of fear when they're not able to breathe is always there.

Bissict's colleague recovered and after three months in the hospital, they wheeled him out the door. He's now back at work.

Many who get that sick aren't as fortunate, says Bissict. And dealing with the amount of loss the staff sees every day is tough. She says the word "heroes" doesn't even begin to define the people she works with.

"From exhaustion (physical and mental), the fear of falling ill (or more so taking it home to loved ones), to the illness and sometimes death of colleagues. It's a day-to-day, shift-to-shift struggle. Relentless. We have all repeatedly cycled through the stages of grief — denial, anger, bargaining, depression and acceptance. At this stage a great deal [of medical workers] seems to be stuck on the anger phase.

"Yet, despite this, they still arrive."

Free diving is how Bissict escapes the stress, and she finds herself struggling if a few days pass without a dive. The ocean is "my solace, my therapy," she says, leaving her "centered, calmer, more at peace with myself and the chaos of the world above."

"It's the crackling of the kelp and seabed, the gentle pushing of the surge, the colors, the light. There's a rhythm to the ocean. And an order."

Bissict has also rediscovered yoga to "quiet the mind" and reconnect her with her breath.

"Funny how a disease that steals breath led me along a path of rediscovering it," she says.

-Photographs and interview by Charlie Shoemaker

An Ambulance Driver With An Unexpected Mission

What has shocked ambulance driver Jamil Ahmad Digoo about the past year was not the grim scenes he has often been faced with as part of his job. It's the "self-centered" way so many people have acted when asked to help others.

"I witnessed brothers running away from brothers and sons running away from fathers. Such was the fear of the pandemic."

He made a decision early on in the pandemic to do whatever needed to get people they help they needed. "I left all my fears and came to the forefront to help people — from carrying COVID positive patients and dead bodies [in his ambulance] to helping dig graves for the dead."

What has gotten him through? Digoo says the "single most important thing" was his family. "My kids would tell me that they were proud of me. My wife always said that God would always protect me because whatever I was doing was for His creation. This attitude of my family always gave me the courage to keep myself going through the toughest time of my life."

Despite it all, Digoo is positive about 2021. "I think humanity saw enough in the year 2020 and I am hopeful that God will end this difficult time for us. I am sure the year 2021 will be a year of prosperity and good health."

-Photographs and interview by Showkat Nanda

Pushing Through Chemo And COVID

To say the last year has been tough for Dr. Seemin Jamali, the executive director of Jinnah Postgraduate Medical Centre, would be a serious understatement.

First, her work: The hospital she runs is one of the largest in Pakistan, overseeing projects and teams in the hospital and working in the emergency room.

Attacks on doctors and nurses occur regularly — usually instigated by family members or acquaintances frustrated by a patient's diagnosis or death. It happened before the pandemic, and now it's happening as a result of the pandemic.

"That is what I saw in the ward – how they [family members] tried to drag the dead body out of the ward. They broke the ward, they beat people with sticks and bashed all the glass. And this is what happens in normal times also." She attributes it to the feeling among relatives of an injured or deceased person: "They need to put the blame on somebody."

As frustration and anger increased while COVID raged, so did the violence. One of the biggest issues, she says, is how the hospital should handle the dead from COVID while still respecting different communities' rituals. Some relatives of patients who had died became angry at not getting the body back by a certain time. Jamali says operating procedures have changed over how they handle the bodies, so things have improved.

"Every culture and religion has its own way of carrying out burials or death rituals, so certain communities were agitated by not being able to enter the ward before the person died or collect their bodies in a timely fashion afterward."

Add in her personal life: At one point last year, Dr. Seemin Jamali and her husband, an orthopedic surgeon, were both sick in different wards of the hospital: He had COVID, she had colon cancer. She also lost some family members and colleagues to COVID.

The hardships in both her personal and work life have made Jamali all the more determined to get up every day and do her job, even though she is at an extra high risk if infected because of her cancer treatments; although she does spend less time in the emergency room since her illness. "I didn't want to stay home. I didn't want to live a life that was useless. I wanted to make my life worthwhile. There are so many people who benefit from my being here so it's worth it."

She is very thankful for the help she received along the way. Jamali's sisters came from the U.S. to help and she is so grateful to them. "The last three months of chemotherapy were really bad. And I pushed myself to go to work. They left their work, their family, their kids and came here to help me. There are no words to repay them for anything for the rest of my life."

-Photographs and interview by Betsy Joles

A Midwife Delivers

As a midwife during a pandemic, Ofelia Pérez Ruiz has learned to listen to her conscience. And that's been a complicated matter. She not only supports her patients through the exceptional stresses of pregnancy in the COVID era, she's been worried about keeping her own two children safe and cared for family members ill with the coronavirus.

"[M]y conscience said that I have to attend births, regardless of the fact that it could put my family or myself at risk."

Her burdens would have been easier with proper protective equipment. She spent a great deal of time trying to get the government to recognize midwives as frontline workers and provide resources to keep them safe.

"We wanted them to support us with protection supplies and to give attention to the midwives and give recognition and respect to their work. Nobody responded, but midwifery continues, with or without support from anyone."

As the pandemic year progressed, Ruiz moved her appointments to virtual and lived in a haze of anxiety, stress and insomnia while family, friends and colleagues died around her.

Eventually, she came to the realization she would have to learn to live with COVID for her patients' sake: "We had to keep going, since the virus came to stay with us."

Ruiz's motto is to move forward. "I will keep taking care of the pregnant women and their births, since it's my job as a midwife," she says. "Midwifery continues, with or without support from anyone."

-Photographs and interview by Janet Jarman

A Psychiatrist Keeps His Virtual Door Open

Suicide has been a very real concern during the pandemic, says Dr. Maurizio Pompili, a psychiatrist who specializes in suicide prevention and treatment.

Among his concerns are a possible increase in people who take their lives, but it is still too early to know, he says. "No doubt, there is a growth [in 2020] of human misery related to unemployment, economic recession, uncertainty about the future, and a great disruption of daily activities both in terms of work and leisure and in terms of human connection."

Over the past year, Pompili found himself doing double duty – caring not only for his patients, but his colleagues and staff as well. "I tried to meet every single individual of my team and devote some time to reduce the pressure by listening and caring for them."

Pompili says that despite 2020 being "the most dreadful event that the world faced in recent history," there were some positive outcomes. "It was nevertheless a source of opportunities for revising policies, organizing our lives in terms of which values are fundamental and how we spend our time in daily activities. I think we will slowly return to our usual lives being more aware of the importance of inner and private values, sometimes forgotten in our routines."

And his simplest advice when trying to help others? Stay relaxed and keep your virtual door open. "Anybody was invited to my home digitally. We took advantage of the national motto 'Andrà tutto bene' – 'Everything will be ok.'"

-Photographs and interview by Lavinia Parlamenti

Learning Not To Be Afraid

An elderly man was admitted to the hospital where Dr. Henang Kwasau was working in the internal medicine department. He was a suspected COVID-19 case. He suffered from diabetes and alcoholism and, quite suddenly, had a difficult time breathing.

"I was the one going in to see the patient," she says. One day she went into his room and saw he was doing better. His breathing had improved. He looked calm. But later that day she was called back. "He was unresponsive," she says. "I felt I needed to do something, anything I could to save his life." She started CPR. A nurse came and helped.

It was to no avail. "We knew we had lost him. It was a sad Saturday morning. And we'll never know if he was infected with COVID-19."

This life-and-death work earned her no money. Kwasau had agreed to work at the hospital for no pay as a kind of internship. Then the pandemic hit.

Wrapped in her protective gear, she administered medicines and therapies, reassured frightened patients and sometimes felt as if she were swimming in a sea of disinformation.

"Every day there was different information on the mode of transmission, prevention. Scientists did not have all the facts. Also there was a lot of fake news in circulation so it was difficult to sieve out what was correct."

After hours, staying in a room at her church — a way to save money and reduce her commute — she was lonely. "My family and friends called regularly to check up on me. The virtual connections with them helped me cope with the sense of alienation I felt as a result of the very essential social distancing."

She's now completed her internship training and is enlisted for the compulsory National Youth Service Corps in Nigeria and plans to subsequently pursue a career in surgery.

And she's learned not to be afraid. Trusting her PPE and precautions, she says: "In a nutshell, I was not overcome with fear of death from COVID-19 infection."

-Photographs and interview by Nneka Ezemezue

Eager, Tired, Faithful

Carla Ayala is exhausted.

When she first heard about the pandemic, she didn't think it would be "this long or this hard."

In her job at the Acute Care Clinic, she knew she would be in contact with people who had contracted the coronavirus — registering them, checking their vitals, doing EKGs and blood work. She says that even with protective equipment, she and other health workers were "scared, nervous, seeing very sick people with a lot of shortness of breath" about the 100 patients who come each day.

Nonetheless, she was eager to do her job: "We are going to help people, sick people. I felt like I belonged there."

Ayala brings her Spanish language skills to the mix working with the immigrant population. She was born in Guatemala.

Not only has she tended to those with COVID, she has contracted the disease herself — as have 16 members of her immediate family, including her husband, one of her three children and her mother-in-law, who was hospitalized for 3 months.

"We were thankful to be in this country," she says, reflecting on the health-care system in the U.S. compared to Guatemala. "We don't know how lucky we are."

She is especially grateful for support from co-workers. After she tested positive, a colleague brought her bags of food — "and she wouldn't accept anything for it."

Now she's looking forward with hope: "At first I was scared and nervous about the vaccines, but I got my second vaccine and felt good after it." She hopes that life will go "back to normal" at the clinic where she works — and that she will find time to pursue dreams. "I love the health field. I'm been thinking of finding online classes for nursing."

Through it all, her faith has sustained her. "I'm Catholic. I pray. I love to pray."

-Photographs and interview by Jodi Hilton

'If Not Me, Then Who?'

Alejandro Evangelisa Ramilloza had no qualms about working in a COVID isolation unit.

"If not me, then who?" was his rationale: "I was called for this."

What he didn't expect was the discrimination he'd faced from the community in his village, relatives and acquaintances — comments like, "Get away from us. You got COVID."

And then he did get COVID. Ramilloza says even though he worked in a high risk hospital unit, he was still surprised when he fell ill. "Every day, for the past four months before being infected, I was battling with it, following all protocols, every step of wearing PPEs, every handwashing, all basic protocols. Good thing I was a survivor. I fought it hard and won it."

Now he's back at work — and finding ways to keep his spirits up when he has to isolate himself from the people he loves because of his job. "I love dancing, so when I get stressed out, I dance or play online games. It [helps] me get a grip on my sanity."

-Photographs and interview by Xyza Bacani

He Says Alaska Is One Of The Best Places To Be In A Pandemic

Michael Bakker bikes, skis, hunts, fishes and competes in the occasional triathlon. But his job as a physician assistant in some of the most rural parts of Alaska this year has likely been his greatest challenge.

Bakker is not a member of the tribal community (he moved to Alaska from Minnesota 10 years ago). But even as an outsider, he has garnered respect. The tribal hospital in Anchorage recommended Bakker be featured in this photo essay as a representative of strategies they've used to battle COVID from Alaska's relatively big cities to the state's many remote villages.

And remote they are. Some of the eight communities where Bakker serves as the primary advanced care provider are only accessible by single engine plane in winter. And it's been isolating as many residents haven't been making their usual trips to Anchorage to get supplies and visit family — mainly because most residents rely on a subsistence lifestyle and if they leave, they have to quarantine on return and can't participate in those activities that get food on the table, says Bakker.

"Since the communities have no stores but rely largely on a subsistence lifestyle, community members inevitably must make trips to Anchorage now and then, but when they return, they can't partake in their necessary subsistence activities if they're in quarantine. So the vaccine is a real turning point that should put a very welcome end to many of those challenges.

Alaska leads the U.S. in vaccination rates (currently at 23% fully vaccinated) and on Tuesday became the first state to expand the vaccine to people as young as 16. But it hasn't been easy. Bakker says he spent a good deal of this year trying to help Alaskans overcome vaccine hesitancy - especially after one of the biggest initial allergic reactions happened in the state.

"I think one of the hardest things was — right away, when the COVID-19 vaccine was distributed, there was a lot of information in the news. One of the two or three allergic reactions that happened in the whole country happened here in Alaska. And that got a lot of publicity."

Despite the difficulties Bakker has faced this year, he says Alaska is one of the best places to be in a pandemic, since the great outdoors is a part of his everyday life and that hasn't changed much.

And the words Bakker lives by? "I think it's by William Arthur Ward. 'The pessimist complains about the wind, the optimist expects it to change and the realist adjusts the sails."

-Photographs and interview by Acacia Johnson

Visuals edited by Ben de la Cruz, Xueying Chang, Michele Abercrombie and Nicole Werbeck. Text edited by Suzette Lohmeyer and Marc Silver. Special thanks to global health supervising editor Vikki Valentine; chief international editor Didrik Schanche; and Caroline Drees, senior director for field safety and security at NPR. This project was a collaboration between NPR and the The Everyday Projects.

Copyright 2021 NPR. To see more, visit https://www.npr.org.