THE EDITOR: Pre-pandemic, junior doctors were already facing high levels of burnout, with implications for psychological safety, wellness and error. Now over a year into the pandemic, significantly higher levels of stress, secondary trauma, anxiety and depression are expected.

Recently the medical fraternity was plunged into mourning with the tragic passing of one of our young doctors due to suicide. A budding surgeon from the class of 2015. His death is a great loss to the profession and our population. Suicide has been an ongoing silent battle amongst doctors, particularly junior doctors who hold the fort on the wards day and night, hence the reason they are called residents or house officers.

I recall my encounter as a junior in the neonatal ICU at Mt Hope with a nurse who returned to Trinidad from the UK frustrated that she was unable to provide the 'standard of care' because of a lack of resources. As a paediatric resident in Toronto, I can now relate to the disparity she experienced. The problem was a daily lack of resources surrounding essential medications, antibiotics, blood products, basic equipment, laboratory investigations and the absence of allied health professionals.

For junior doctors in Trinidad, the job runs the gamut of duties in a hospital. Despite the hour of the day or night, when a patient requires a blood test, a doctor will take the blood sample, walk with it to the lab, wait on the result and then file that result. In Toronto this process is done with one click of a mouse.

But these stories rarely make it to the public, simply because junior doctors don't call press conferences, neither do they issue press releases. They just trudge along and do their jobs to the best of their abilities while CEOs and politicians perform in a never-ending public relations circus.

Be that as it may, training in a low-resource setting has its benefits and UWI graduates have built a reputation for their clinical skills worldwide. This system, however, is untenable as it quickly leads to a significant degree of fatigue and mental distress very early in the careers of junior doctors, which can at times be irreparable.

As the third covid19 wave surges on, house officers and residents, who frequently work more than 24 hours straight, continue to face the brunt of the pandemic and consequently are at high risk of succumbing to mental health problems.

It is time governments and health authorities recognise and acknowledge the plight of junior doctors in our public health system. The choice each country makes with respect to health policy reflects the extent to which it is a just and caring society.

Post-pandemic, the ripple effects will be felt at every level of society for years. For junior doctors, would anything change? Would the Government finally invest in its young doctors rather than empty infrastructure? A good start may be offering proper contracts to junior doctors who remain on

locum so that they can be allowed vacation leave - after all, they will need it when this is over.

DR USA