Table 5

Social and structural sources of burn-out and embitterment and illustrative quotes

SubthemesIllustrative quotes
Politicisation of COVID-19‘COVID-19 has become a battleground for politicians. One side is applauding the system, while the other side is saying that their opponents are hiding the number of cases, and recently they fight about the vaccines. All I did was my work, but suddenly it became a political battleground… I started having strong doubts and cynicism about society.’ – FHW1, female
‘After Cluster Z*, I had to prepare reports for a politician for a month, even until now… They were trying to gather evidence to prove the governor’s decisions had flaws, and I had to write reports three times to meet their requirements… When I was involved in the political fight putting aside my epidemiological investigation over a month, I felt extremely embittered.’ – FHW9, female
Lack of social recognition‘I just did my job, analyzing CCTV, classifying people, and stopping transmission, but I was blamed. I heard unfair criticisms. I heard ‘You are a government stooge’, and it’s so unfair. I felt embittered… The foremost important value for me is justice, but for them, it’s politically interpreted. I collapsed emotionally… I just want them to know our work is neutral. This work is about responding to the pandemic.’ – FHW1, female
‘There was a campaign that people cheer for medical professionals, but even though we are working at the forefront of the pandemic, there is no such campaign for us… I think it is unfair that there is no such encouragement or emotional support for us.’ – FHW6, female
Employment instability‘We are not on a permanent term but on a temporary-based contract so our employment status is not stable because we have to renew it every year. After the pandemic is over, can we [still work]? The recent amendment requires cities and towns to hire an FHW, but even this position is temporary… Who will protect our position when the pandemic is over? Being in the circumstance that the future is not stable, I felt it’s unfair and unjust.’ – FHW6, female
‘When cities and towns hire an FHW, existing public officers will be overburdened with additional work. Even I am under so much pressure, but would they be able to handle different tasks simultaneously? This is also an employment instability issue.’ – FHW7, male
  • *Cluster Z occurred at a distribution centre in May 2020. Over 4000 individuals, including day labourers, were classified as close contacts to be quarantined. The governor limited social gatherings in the distribution centre for 2 weeks.

  • CCTV, closed-circuit television.