Originally published 2020-04-10.
In the first weeks of the Covid-19 pandemic, staff on the coronavirus ward at HaSharon Hospital in Petah Tikva, Israel, found a simple way to reassure frightened patients: they pinned or taped printed photos of their own smiling faces to the front of their protective suits. Behind goggles, masks and hoods, every doctor and nurse looked the same. The photo told each patient exactly who was caring for them.
The pictures spread quickly on social media in early April 2020 and became one of the gentler images of that frightening spring. Below we look at what the staff did, why a face matters so much to someone who is ill and isolated, where the idea came from, and what it can and cannot do.
What the HaSharon staff did
HaSharon Hospital is part of the Rabin Medical Center in Petah Tikva, a city just east of Tel Aviv. Rabin is run by Clalit, Israel's largest health maintenance organisation, and HaSharon (also called Golda-HaSharon) has been part of the centre since a merger with Beilinson Hospital in 1996.
When Israel began treating its first serious Covid-19 cases, the hospital opened a dedicated coronavirus department. Staff there worked in full protective equipment: gowns or coveralls, gloves, N95-type respirators, eye protection and head covers. For safety, little of the person inside was visible. So members of the team printed portrait photos of themselves, sometimes with their names, and fixed them to their chests where a patient lying in bed would see them first.
On 6 April 2020 Israeli journalist Dan Poraz shared photos of the team on Twitter, and the post was picked up by news sites and pages around the world.
Doctors in the #CoronaVirus department at HaSharon Hospital in #Israel found a good way for patients to know who’s taking care of them. pic.twitter.com/D4s74qq3vW
— Dan Poraz (@PorazDan) April 6, 2020
Why seeing a face matters to a patient
Hospital care is built on trust, and a large part of trust is visual. We read faces constantly for reassurance: a smile, raised eyebrows, the look of someone who is paying attention. Full protective gear removes nearly all of those signals. A patient who is short of breath, feverish and separated from family may spend days surrounded by figures who are hard to tell apart and whose voices are muffled by masks.
Covid-19 wards in 2020 were especially isolating. Most hospitals banned or tightly restricted visitors, so the people in protective suits were often the only human contact a patient had. Being able to say "that is Dr Cohen" or "that is the nurse who brought my water yesterday" restores a small sense of control and continuity. It also makes it easier for patients to ask questions and to remember what they were told.
The effect is likely to be strongest for groups who already rely heavily on faces: young children, older people, those with hearing loss who lip-read or read expressions, and people with dementia or delirium, for whom unfamiliar masked figures can be genuinely alarming.
Where the idea came from
HaSharon was not the first to try it, and it was not the last. A similar approach is often credited to American artist Mary Beth Heffernan, who reportedly developed a "PPE portrait" project for Ebola treatment units in Liberia in 2015, where staff in sealed suits wore photo badges so patients could recognise them. During Covid-19, comparable portrait badges appeared in hospitals in the United States, Europe and elsewhere, often organised by nurses themselves with a printer and tape.
The gesture also fits a wider movement in medicine about simple introductions. In the UK, the "Hello, my name is" campaign was started in 2013 by Dr Kate Granger, a doctor who was herself a patient with terminal cancer. She noticed how many staff treating her never said who they were, and argued that a name is the first step in a caring relationship. A photo on a protective suit is the same principle adapted for a pandemic.
The pressure on health workers behind the photos
The smiling pictures hid real strain. Across the world, health workers in 2020 faced shortages of protective equipment, long shifts in hot, uncomfortable suits, and a real risk of infection. The World Health Organization reported that in some countries around one in ten health workers had been infected, and by May 2020 the International Council of Nurses counted at least 90,000 infections among health workers and more than 260 nurse deaths.
China, where the outbreak was first identified, reportedly saw more than 3,000 medical workers infected in the early weeks of the epidemic, many before the risks were understood. Surveys of front-line staff there found high levels of anxiety, depression and sleeplessness. Similar findings came later from Italy, Singapore and other countries. Prolonged wear of masks and goggles also caused skin damage for the vast majority of staff in some studies.
Seen in that light, the photos were also a reminder for the public: inside each suit was a person who chose to come to work during a frightening time.
What the gesture can and cannot do
It is worth being clear about the limits. There is no evidence that photo badges change survival or recovery from Covid-19, and the HaSharon staff never claimed they did. What they offer is comfort, clearer communication and a more human experience of care, which matter in their own right.
Just as importantly, the photos were added on top of full protection, not instead of it. The point was never that masks or gowns could be relaxed. Protective equipment protects staff and stops infections spreading between patients, and the badge simply puts a face back on the outside of it.
Practical lessons for hospitals, carers and families
The idea is cheap, quick and easy to copy, which is part of why it spread. A few lessons that apply well beyond a pandemic ward:
- Introduce yourself every time. Name, role and what you are about to do. It costs seconds and reduces confusion.
- Make identification visible. Large-print name badges or photo cards on gowns help patients with poor eyesight or memory problems.
- Use the voice and the eyes. When a mask is unavoidable, speaking slowly, facing the person and using expressive eyes and gestures all help.
- Bring familiar faces in other ways. When visitors cannot come, video calls and family photos at the bedside can ease isolation.
- Ask about worries. If you are a patient or relative and feel lost about who is who, it is reasonable to ask staff to introduce themselves or write their names down. For anything about treatment, talk to a doctor.
The HaSharon pictures were a small act, but they captured something lasting about good care: medicine works best when patients can see that they are being looked after by people, not by anonymous suits.
For more on that period, see our coverage of how the coronavirus spread across the globe, why experts warned of a long-lasting pandemic, photos of doctors fighting the coronavirus, the marks left on the faces of Chinese nurses after long shifts, and the toll the crisis took on health workers' lives.
Sources: Dan Poraz on Twitter (6 April 2020), photos of the HaSharon team; Wikipedia: Rabin Medical Center; Wikipedia: Impact of the COVID-19 pandemic on healthcare workers.
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