Women COVID Warriors Given PPEs Designed For 6 Ft Tall Men; And No Thought For Periods

Many doctors, nurses, etc. fighting COVID are women, and have to wear ill fitting PPEs not designed to be women friendly, especially during periods.

COVID and related frontline workers are very much in the news these days, but how many of us realize that a very large proportion of this workforce are women?

Menstrual Hygiene Day which is today, 28^th May, is a good time to look at the practical as well as menstrual issues faced by this huge and very important workforce.

So isn’t it rather ironical that these very ill fitting PPE (Personal Protective Equipment) designed for a “6’2” male rugby player” as one of the respondents in a study so succinctly put it, are given out to these women!

Irony or not, that is the truth and it’s the same in India too. A major spinoff of this fact is that the need to design “period-friendly” PPE has been completely overlooked.

I did a survey among my own medical staff – I started at home and asked Medical Officers, Nursing officers and other HCW (Health care Workers) in my own hospital for inputs. I then tapped other hospitals which were dealing with the unfolding pandemic crisis.

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Here is what I found.

Ill fitting PPEs with practical issues

The practical issues were echoed by everyone across the board. These issues were many, starting from the Size and Fit of the PPE suits.

Ill fitting PPEs for women

Many of the female HCW were unsettled by ill-fitting N 95 masks which are the lifeline in protection of the workers on the forefront. Even doing a ‘fit test’ doesn’t help.

Firstly, because most of the masks are designed for a larger male face and needs to be pulled tightly across the face for a woman. This can result in skin injuries on tightening the mask or trying to seal the nose bridge, as well as area over the chin.

Secondly, even if one does find a comfortable fit, it is not necessary that the same brand or size would be available always.

In fact, even the smallest size of the critical PPE like goggles, shields, coveralls, and masks are too big for some of the smaller built female HCWs.

This results in ill fitting PPEs with sleeves and trousers being too long and too loose. This hampers the movements as well causing the PPEs liable to be torn, thereby exposing the HCW to infection and defeating the very purpose of the PPE.

Skin issues due to sweat accumulation in long shifts

The high cost of the PPE means that the woman has to use it throughout the shift, which can vary from 6 to 8 hours and in some low risk areas even 10 to 12 hours. This is decidedly uncomfortable given the climatic conditions in a country like India especially during the hot humid Indian summers. Increased sweating for longer duration of time increases chances of skin damage due to sweat accumulation, again increasing the discomfort as well as the chance of even serious pelvic infection.

It is imperative that this glaring gap in PPE manufacturing and distribution is addressed at the earliest, at least in our country if not globally. Competent, relevant authorities should make it a point to redress it. It is a disgrace that this pertinent problem has to be highlighted at all.

Issues during periods

This now brings me to a very important aim of writing this article, which is to highlight the plight of female healthcare workers who have to deal with the decidedly ‘period-unfriendly’ as well as uncomfortable, ill fitting PPEs being used.

Most of the older staff has been excused duties in high risk areas and so it is the younger ladies in the so called “reproductive age group” who are holding the fort on the frontline. So there’s the additional factor of the woman health care worker having her periods for a few days a month, and it can be a nightmarish situation. ~ Being unable to change pads or even use the toilet during this duration can obviously make life extremely uncomfortable.

~ If a frontline worker has heavy periods, she is also more likely to stain the PPE adding embarrassment to the long list of woes of female HCW.
~ Most women also restrict their water intake to prevent bathroom breaks and this further aggravates the difficulty during periods.
~ Rashes caused by constant chafing of pads worn over long periods are a huge source of worry and misery.
~ Good menstrual hygiene advised by doctors includes changing of pads or tampons even if not fully soaked, after every 3 to 4 hours to maintain the cleanliness and hygiene of the intimate areas. If we cannot provide this basic necessity to female frontline workers, isn’t that denying them basic sanitation rights? Is that really too much to ask for?

What my health care workers said

I interviewed approximately 70 to 80 lady health workers across the spectrum of doctors, nurses, ward helpers and other frontliners during the course of my background research for this study and almost 90% of them had complaints regarding the ill fitting PPEs from the mask to the coveralls. Some of them had learnt to cut off the sleeves and trouser lengths of the coverall but this generally interferes with the sealing at the extremities and compromises protection.

The problems during periods were echoed across the range of female field workers. Many of them had devised their own methods of dealing with the issues.

~ A common refrain among doctors was the use of oral contraceptive pills to postpone their periods. But this is a temporary measure as well as one that interferes with normal rhythm and cyclicity. It would be acceptable for 1 or 2 months but with the COVID virus and duties appearing to be here to stay for a while, this is not likely to work nor is it advisable.

~ One of the workers said she resorted to using adult diapers and she had other friends using them as well. Another resorted to the use of the menstrual cup along with a pad which can help against staining and hygiene but is still uncomfortable for long duties.

Heavy periods are often accompanied by dysmenorrhea (painful periods) and other exhausting symptoms. The constant worry of staining one’s gown while on duty plagues the mind of many a female health worker even during regular duties. Doing COVID duty has its own stress and longer duty spells. This means an added risk of embarrassment of staining, and worse, being unable to do anything about it.

These worries can also distract and even result in mistakes in high stress environments like the ICU and labor room.

This in turn would invite guilt and disciplinary actions, too, thereby demotivating the female staff and causing further attrition of the precious work force.

Post menopausal women

A word about the postmenopausal women here.

Though they are not troubled by menstrual problems, the heat trapping PPE are even less accepted by these women who already have a higher level of heat intolerance than the regular populace. So even if PPE is available, they may be hesitant to wear them thereby compromising on their safety.

Pregnant women

There is another group of young women who undergo a lot of worry and uneasiness. Pregnant ladies and lactating young mothers.

Pregnant women have the need to go more frequently to the bathroom, and can cause a lot of discomfort and embarrassment.

Not breastfeeding the baby for long hours can cause breast engorgement, and stagnation of milk can even lead to abscess formation and such complications. Stopping feeding cannot be advised as an option, either.

How do we deal with these very valid issues?

Correct sizes need to be manufactured

An obvious suggestion is to have the manufacturers make different sizes in all kinds of PPE to obviate the discomfort caused by the ill fitting PPEs. Hospitals can then buy the required sizes which are also gender appropriate, for their staff.

This change has to be made at the manufacturing levels, and hence would necessitate Govt or suitable competent monitoring authorities to intervene on the behalf of the female HCW.

Design changes to make them period friendly

The root cause of problem in the coverall is that the tapes and zips do not allow for any change of innerwear or pads for a female or even use of a washroom, for that matter.

PPE could also be in the form of a two-piece suit consisting of a gown and a lower or a trouser under the gown rather than a coverall, as this would be more comfortable.

Need based rotation of female health care workers

Female HCW workers could be rotated or be posted to non-COVID areas of the hospital during periods where PPEs could be gowns and less stringent restrictions on bathroom visits.

Extra PPEs to be made available during periods

The female HCW should be allowed a change of PPE at least once during her duty allowing her to use the restroom especially when she has periods.

The female health worker shoulders a huge chunk of health care provision.  We, the public, the Governments, as well as the lawmaking authorities owe it to her, morally, ethically, and lawfully to ensure that she is kept in mind while designing, manufacturing, procuring and distributing PPE kits which she needs to use, with special attention to comfort during periods.

Charity begins at home and I promise to do my bit in my area of influence. I hope all of us will make that pledge today after reading this.

Images credit: Dr Aruna Menon

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