It has been more than six months since South Korea declared the de facto end of the Middle East respiratory syndrome outbreak -- which infected 186 and claimed 38 lives here -- but nurses like Kim who cared for MERS patients are still feeling its impact.

A number of her colleagues have been diagnosed with post-traumatic stress disorder. A colleague, Hyun Jin-ah (not her real name), has had to take antidepressants and her condition has even led to her sending her eldest child to therapy sessions.

The nurses plan to file industrial accident claims for the emotional damages they suffered during and after the outbreak.

“There were no detailed guidelines. We were all new to the whole situation and I did not feel like I was being protected.” Hyun told The Korea Herald.

“We were not given any safety training before caring for MERS patients. Throughout the outbreak I barely slept and ate -- I constantly worried about what would happen to me if something went wrong, or if the situation got worse. Not knowing what to do and not having any guidelines to rely on made me incredibly anxious the whole time.”

In the early stages of the outbreak, Kim, Hyun and their colleague Choi Eun-young were asked to care for MERS patients without proper protective gear, even when the patients were receiving aerosol-generating procedures.

The procedures are known to expose health care workers to respiratory pathogens, thereby increasing the risk of contracting the associated infectious diseases. However, the nurses were told that wearing a facial mask would be enough.

Kim found out a month later that when using nebulizers -- a drug delivery device used to administer medication in the form of a mist inhaled into the lungs -- on MERS patients, medical staff are actually required to use power air purifying respirators with a hood or helmet according to the Center for Infectious Disease Research and Policy in the U.S.

“No one told us anything,” Kim said. “Often I felt I could get infected at any minute and end up dying.”

There were many situations in which the nurses did not feel safe. The nurses claim that the hospital did not do enough to protect its own staff.

For instance, there was an incident in which a MERS patient threatened to kill the patient whom he had contracted the virus from. He would violently throw things when he was quarantined and felt frustrated about his condition.

In another case, a stressed patient experienced a violent stroke. As it was crucial that he had to keep his intubation tube in -- he could have died if it fell out -- Hyun went into his room and tried to hold on to the tube until someone else came in to calm him down. She was kicked by the patient several times and was badly bruised. When she told her superior about this, she was told in return, “You knew (something like that would happen). So why did you go in (the room) in the first place?”

“I did not know what to say to that,” she said. “Was I supposed to leave the patient alone knowing he could die if the tube fell out?”

During the outbreak, the nurses had to be separated from their families. As the hospital had seemingly made no plans to ensure their safety, the nurses had volunteered to stay away from their children and spouses. For two and a half months starting from June, they stayed in nonresidential rooms that had previously been used for research in the hospital. They were only given dehumidifiers and had no access to washing machines.

“We would hand wash our clothes and cry before going to bed,” Kim said.

MERS patients had to be quarantined and nurses even had to take on responsibilities that were usually performed by other caregivers.

On top of their usual daily duties, nurses had to perform extra tasks, such as cleaning rooms and washing patients’ hair. They had to maintain reports of patients’ medical histories, carry out treatments, administer medications and provide emotional support to patients.

And as if this was not hard enough, fighting MERS literally made the nurses break into a sweat because of the protective gear they were required to wear.

“You sweat a lot in the protective suit. You would be soaked in sweat after wearing it for 30 minutes,” Kim said. “Once you wear the goggles, you can barely breathe. We would spend more than an hour in each patient’s room. When you get out, you are completely dehydrated and extremely dizzy. When I tried to take a shower to maintain my personal hygiene (after taking the gear off), my superior said showers were not necessary.”

Being cut off from their families was also not easy, and the nurses had to deal with social stigma against their family members. One nurse was contacted by her child’s school teacher who suggested the child stay at home as his mother works at a hospital with MERS patients.

“We were already separated from our families, and getting such text messages were hurtful,” said Hyun.

Upon returning home after two and a half months of staying in the hospital, Hyun found herself unable to control her emotions. She could not sleep either.

“I was always angry,” she said. “Even when my children were just being children -- running and laughing -- I would scream at them to be quiet.”

Hyun’s youngest child, who suffered stress from being separated from her mother, would cry every morning when she tried to leave home for work. This lasted for two months. Her eldest son, 9, started to develop unusual habits, such as constantly rubbing his palms against one another.

Hyun sought professional help and was diagnosed with PTSD. Her 9-year-old was diagnosed with a stress disorder. She was treated by a psychiatrist at the hospital where she worked, but her employer did not offer to pay for her or her son’s treatment.

Hyun’s colleague, Choi, has had to deal with another kind of trauma. She felt that the MERS patient who was the 80th confirmed case in Korea had been unfairly treated.

This patient had been suffering from cancerous lymphoma prior to contracting the virus. He was diagnosed with the virus on June 7 and was released from a quarantine facility on Oct. 3. Prior to this, he had tested negative for the virus twice consecutively.

However, he was hospitalized on Oct. 11 at Seoul National University Hospital after experiencing symptoms once again. There, he was tested again for MERS.

Choi claims that the Korea Centers for Disease Control and Prevention had held a press conference about the patient’s positive test results on Oct. 12 before even informing the patient and his family. The KCDC told The Korea Herald that they are unable to confirm whether or not Choi’s claims are true.

“It was such a disrespectful thing to do,” Choi said. “The patient learned about his test results on TV.”

On Oct. 13, Choi went into the patient’s room to check on him. He told her he had found out about his results by watching the news.

He also mentioned that acquaintances who had met him in person before his hospitalization had called him to ask what they should do about their safety after finding out about his condition via the TV news.

Choi remembers that the patient had looked visibly hurt. “And then he told me it was his birthday,” she said.

As the patient was in quarantine, Choi was the only person who could visit him. She left the room and returned again with a birthday cake and a lit candle. Clad in protective gear, with the cake in her hands, Choi sang “Happy Birthday” to the patient. He died about a month later on Nov. 25. He had wanted to see his 4-year-old son before his death, but his wish was never fulfilled.

The South Korean government declared a formal end to the MERS outbreak on Dec. 23.

“The memory of the patient’s birthday pains me. I keep getting flashbacks. I still vividly remember his facial expressions that day,” said Choi.

By Claire Lee (dyc@heraldcorp.com)