Detroit area social workers meet the pandemic head-on
When Amanda Stein heard the schools were shutting down as the coronavirus spread, she set up a food pantry in Madison Heights.
Three months later, it serves 1,000 people a week.
“When the schools closed, I had an idea of what might be coming,” said Stein, a licensed social worker who had taken time off from regular employment, only to answer the call, again, as the pandemic struck.
“The food, obviously, was a big one, with people not being able to leave their houses and go to grocery stores, people not working. I said, well somebody needs to start a food pantry in the city, because Madison Heights did not have a food pantry at the time.”
As COVID-19 sunk its indiscriminate teeth into Metro Detroit, Stein said her training instinctively led her.
Attentive to forces that create problems for living, especially on the fringes, she said she thought of the needy and vulnerable and realized the critical role schools play in food security.
Councilwoman Kymm Clark got the city to donate a recreation building, Stein said. Her landlord donated some industrial shelving. Restaurants and businesses, including Costco, Sysco and Dearborn Brand, made donations.
And Stein and a gathering retinue of volunteers raised funds.
"To be honest, this has totally changed my life," Stein said. "I was a stay-at-home mom for the most part."
All across Metro Detroit, in the unsettling, hectic days of the onset of COVID-19, social workers encountered similar opportunities and seized them.
Like doctors and nurses on the front lines of the coronavirus or those responding first in New York City on Sept. 11, 2001, social workers encountered a topsy-turvy world, especially for people who already live with considerable concerns.
Social workers who usually prepare patients for outpatient routines after surgery responded instead to the awesome tragedy of death in isolation, stricken patients barred from aching families.
“The social work background is really helpful to try to understand a predicament in a specific social context,” said Emily Fagre, a social worker for Michigan Medicine at University Hospital in Ann Arbor.
In a few short days, Fagre went from helping children and women with fairly standard health care to providing the only communication between patients stricken with COVID-19 and their often overwhelmed families.
“As the patient’s needs grew, I moved up to that unit full-time,” Fagre said. “I sought to be their voice, their presence, to see how the families were coping and then talk to them about their loved one’s care.
“The families were so resilient. It was such an unprecedented time,” she said.
“One of the things we are normally able to do is to have conversations face-to-face, to see the loved ones and help them prepare and to advocate for them. This really turned everything upside down in terms of the family understanding what is going on and our ideas about how to make that work.”
Fagre said the situation motivated her to do her work, to bring her training to bear and provide some remedy.
“Adaptability is important,” she said. “Flexibility.”
Brian Nickerson, a social worker from Ypsilanti, usually works with adults who have cystic fibrosis, as an inpatient social worker.
“That’s my bread and butter,” he said. “Suddenly, I was coping with death in isolation.”
With families unable to stand at bedsides to comfort dying loved ones, and many victims sedated and intubated, Nickerson struggled to make critical illness and death more normal.
“They are fighting for their lives and I am supporting the families,” said Nickerson, who works for Michigan Medicine at University Hospital.
“The families themselves are really isolated, given the security check, and most families members are also are quarantining because they’ve had contact with their loved one.
“So it is really a matter of coping with death in isolation,” he said. “Sometimes, I was the only outside voice they heard.
“Sometimes, when the patient is at the end of their lives, in the last 24 hours, I would invite family members to come to be at their bedside and support them, logistically, through the system.”
It means taking families from the outside world through a series of precautions, including special attire, walking through airlocks, all while trying to provide the usual direction, advice, counseling and meeting with doctors and clergy.
“As they are about to pass away, we support the visitors through the entire visit,” Nickerson said. “Our hope is to facilitate a good goodbye for them.
“We want to give them the space to process what is really going on.”
Social workers placed between families and dying loved ones said nothing in their training prepared them specifically for the task.
But as social workers, their training is to make life bearable for those in need.
Kristine Abuls, who also works for Michigan Medicine, said moving from moderate care into an intensive care unit and then into the COVID-19 intensive care unit at University Hospital, was a big change.
“It was difficult, at first, going from face-to-face contact to often just going over the phone,” said Abuls, a social worker.
“The patients were intubated and nonresponsive. Explaining to the families why they cannot come for a visit and listening to their reaction could be difficult.
“It was a great sense of responsibility,” she said. “Normally, we are in the background. But we play a vital role.
“Facilitating video calls and doing what I could do, I think it brought great comfort. There was lots of coordination that goes on with that.”
Coordination came at a premium, especially early on, social workers say.
“At first, things were changing hour-by-hour, day-by-day,” said Karissa Canfield, who helped create a manual for colleagues in social work who were suddenly providing hands-on services that were quite different from simply managing care.
“We needed a place to keep track of things, and to make the transition from one set of responsibilities to another as smooth as possible,” said Canfield, who works for Michigan Medicine.
“When you are pulling social workers from one department and putting them in another, the work is a little different than what was usually done.”
It also happened in an utterly different environment, in which social workers used to face-to-face contact suddenly had no expressions or body language to help them discern situations.
“We are always looking for cues, whether it be verbal or nonverbal,” Canfield said. “In many cases, our situations took all the nonverbal right out of it.
“And things were changing so rapidly, we were doing the best we could, while minute-by-minute changing what our focus was.”
Because so much of it was new, the emphasis was on improvisation.
Audrey Houttekier, a social work manager for Michigan Medicine, said that while disaster mental health is something in which social workers are widely trained, not all workers have the same abilities or preparation.
“But the challenge to us (at University Hospital) was that the entire institution was operating under crisis,” she said. “We had to focus on areas in which people were the most talented, and capable at the volume of care we were anticipating.
“We had to figure out where our strengths were, very quickly, and get our team organized where we could target them purposefully.”
Gariann Brock, also a social work administrator at Michigan Medicine, said the response to the pandemic has been a challenge and involved a lot of hard work.
“I’m not sure excitement is a proper word,” Brock said.
“Your main goal was to make sure we were delivering services to everyone consistent with the goals of institution and to have the right skill sets where they needed to be, while also connecting families and patients to the right services in the community.”