The last year has been another long one for health care workers.

As the coronavirus pandemic continues, so have the challenges medical providers have faced.

An influx of patients, mental health challenges, waning public awareness and support, and even variable internet access have made medical care more difficult and left health care workers fatigued. Yet even amid these obstacles, doctors and nurses, psychiatrists and therapists, community health and social workers remain committed to those they serve.

“Our caregivers are tired, especially during the holidays,” said Robert Underwood, chief medical officer of San Juan Regional Medical Center in Farmington.

“We’ve had two years that have been relatively difficult in the health care field,” Underwood said.

When the first wave of the coronavirus swept across the U.S., medical workers were heralded as heroes. Images of ICU nurses treating hospitalized COVID-19 patients featured on the nightly news and people opened their doors to applaud those swamped caring for the ill.

While the acuity of the first surge has faded, not much else has changed for many health care workers.

“Since the start of the pandemic, there haven’t been any slow times,” said Molly Rodriguez, a licensed professional counselor and clinical manager for Axis Health System. “There hasn’t been any opportunity to rest or take note of all of the experiences that we’re going through both personally and professionally.”

Across the health care spectrum, medical providers have continued to see an influx of patients seeking care.

The trend has been especially pronounced for those in primary care and behavioral health, two often overlook medical specialties whose patient visits rebounded faster than almost any other after an initial dip in 2020, according to a report by The Commonwealth Fund, a private foundation addressing the inequities and efficiency of health care.

“We’re just seeing more people needing support than we have in the past,” Rodriguez said. “In some ways, that’s encouraging that people are asking for help. In other ways, the volume is just incredible.”

The increase in patients has strained the capacities and resources of medical facilities, compounding the many stressors that health care workers face.

“We experience as providers and support staff all the same things that everybody else does,” said Luke Casias, chief medical officer of Axis Health System. “We go home to families, we have family members who have gotten ill, we have friends who have gotten ill, we ourselves have got ill. All those things weave into the fatigue that we are feeling both emotionally and physically.”

Almost two-thirds of front-line health care workers, which includes those in hospitals, outpatient clinics, assisted care facilities and home health care, said COVID-19-related stress was negatively affecting their mental health, according to a 2021 survey by the Kaiser Family Foundation and The Washington Post.

For those who work directly with COVID-19 patients, the emotional toll can be profound.

“This is a deadly disease and the more you see people who are in critical care and the more you see people die, the harder it is,” Underwood said. “It’s a very heavy emotional burden that many people in health care carry.”

For those who work in behavioral health, which includes mental health, rising substance use during the pandemic and new awareness about the importance of behavioral health has overwhelmed caregivers.

“Before the pandemic, there were already stresses and challenges related to behavioral health care, (including) staff shortages and stressed systems,” Rodriguez said.

Even something as simple as internet or cellular service has further fatigued medical providers.

Axis Health System adapted to the pandemic by expanding telehealth, but limited internet and cellular service in parts of Southwest Colorado created another barrier that has exhausted providers, Casias said.

2021 has been difficult not just for doctors and nurses, but everyone in the medical industry, from respiratory and radiology technicians to receptionists and cleaning crews.

“Anybody who works in the medical or behavioral health field is really touched by this,” Casias said.

To combat the fatigue and anxiety many health care workers are feeling, medical executives and operations have turned to a number of strategies to promote better self-care and build support.

Axis Health System purchased a behavioral health support app for all of its employees to help them alleviate some of the emotional stress, Casias said.

San Juan Regional Medical Center expanded counseling access from eight to unlimited sessions for all of its staff members, Underwood said. It has also hosted gingerbread house competitions, a Christmas tree lighting and other team-building efforts so caregivers would know they have support from those around them.

Medical organizations have also used financial benefits like bonuses to show medical workers their value.

“We’re doing a lot of things trying to help with resilience, but health care workers are often quite resilient already,” Underwood said.

Mercy Hospital declined to comment for this story.

Through the struggles, medical professionals in Southwest Colorado continue to place their communities before themselves.

“Even with all of the burnout, our staff still are so passionate that they’ll drive through 8 inches of snow to get in every day because they realize that they’re important to their patients,” Casias said.

The public’s appreciation for that commitment has waned in 2021 as the pandemic has dragged on and the divides surrounding COVID-19 guidance and information have grown deeper.

Health care workers have tried to take the ebb and flow of support in stride, acknowledging that almost two years into the pandemic many people are spent. But their frustration has grown as some people’s opposition to health care has become more entrenched and hostile, only worsening the many challenges health care workers must confront.

Casias has seen more patients question the guidance of their medical providers. While a healthy questioning is good, a noticeable shift in the last year has prevented doctors from helping their patients, he said.

“We’re starting to see individuals question the institutions that lay the framework which our providers are trained and respond on and I think that’s added to that fatigue,” he said.

It’s particularly difficult for health care workers who treat sick and dying patients to then see people spurn preventative measures, Underwood said.

“It becomes frustrating. The work that you're doing isn’t appreciated by others,” Underwood said.

Doing something as simple as showing appreciation and being respectful can make a difference and ease the fatigue, said Underwood and Casias.

“Just say thank you to somebody you know is in health care,” Underwood said.

“The greatest gift that we get from the people that we serve is grace,” Rodriguez said. “We too are humans who are working through a difficult time and really wanting to do the best we can to support the community.”

Heading into 2022, health care workers expect that the New Year will offer the same fatigue and anxieties.

“I’m expecting it to be similar in terms of volume,” Rodriguez said. “... There's just going to be some residual effects from this because it’s like a shared trauma and I think we’ll see the effects of the pandemic for a long time.”

“As the year ends, there is a sense of trepidation that (the fatigue) will continue or potentially get worse,” Underwood said. “At the same time, there’s the sense of hope that we’ll get into 2022 and not be in the same position that we’ve been for the last two years.”

“Regardless, we approach (our work) with a sense of duty knowing that we have to keep doing what we’re doing until we get through this,” he said.

ahannon@durangoherald.com