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February 23, 2019

Is that haggard look making health workers sick?

A section of nurses during the ruling of their case in 2012. Many of them suffer burnouts at work. File Picture
A section of nurses during the ruling of their case in 2012. Many of them suffer burnouts at work. File Picture

We say that Kenya is a beautiful country. We talk of our stunning beaches, wildlife and culture of the different people who live in Kenya. To see all that makes Kenya beautiful requires you to travel and unfortunately for many of us, traveling around this country is not a pleasant thing unless you are lucky enough to afford a private helicopter and hop from place to place. Any other form of travel requires you to meet the face of public service.

Apart from a few newly constructed roads, the typical road that connects town to town is often inadequately maintained, with local communities in many places allowed the democracy to erect structures on the road itself, trade, collect taxes and generally prevent the smooth flow of traffic.

Relatively short distances take hours; require very alert drivers and a trip to the garage immediately before and after any major trip. Then there is meeting the face of public service, the police or becoming more common, members of National Transport and Safety Authority who in their zeal to reduce road accidents assume that any means necessary justifies the end.

So it is not unusual to be stopped every 50 kilometres along the highway for a ‘check’. Combine this with the ‘checks’ at malls and offices every day and images of a totalitarian state, where freedom of movement is severely restricted are not hard to imagine. It is easy under such circumstances to miss seeing how beautiful the country is and also how stressful the job these people are performing really is.

It is rare to meet a happy police officer. More often they have this scowling look that suggests you are being warned not to dare challenge their authority. Mostof the time the police officer will come across as rude and uncaring about the welfare of the motorist. To get away from such an encounter as quickly as possible, most motorists will adopt a subservient approach; others become belligerent, hoping a ‘do you know who I am?’ can get them moving; while others believe that money is the king of everything and look to talk as little as possible.

The problem with an authoritarian approach by police is that it often associated negatively with a loss of personal freedom and with dictators. Behaviour change is then temporary. For the police trying to change behaviour, it looks like motorists deliberately avoid doing the right thing and so they have to be ‘caught’. Starting from a premise of mutual distrust is stressful, more so for the person who is in such an interaction repeatedly all day long, every day.

Almost the same situation occurs in the health sector, where the primary job of the health worker is to persuade the patient and the population at large to change their behaviour in order to become healthier. Unlike the police, whose primary weapon is the law, health workers have to persuade using knowledge, explaining to the patient the problem, what they have to do to improve and then hoping that the patient takes the necessary medicine or preventive measures to ensure they become healthy. Just like in the police force, we have persistent reports of poor attitude of health workers when interacting with patients.

Clearly there is a problem that needs addressing. Research shows that factors that contribute to occupational stress such a high workload, poor organisational set up including such simple things as providing proper toilets and meals for health workers working 24 hours a day lead to stress.

In addition, health workers have some unique stressors, such as having to watch patients die, having patients and relatives express dissatisfaction about low quality service, situations of which they have little power to change individually. ‘Burnout’ especially among nurses is a common problem. The challenge is that burnout leads to reduced quality of care and further patient dissatisfaction.

You might meet a health worker or police officer who has that sour look of an unhappy person who just does not care.

A common thought might be to imagine that they look so unhappy that one day they will make themselves sick from the stress they bring onto themselves and others.

But do looks kill? Psychological stress, especially repeatedly over a period of time have long been associated with biological changes in the functioning of the cardiovascular and immune systems. Stressed people fall ill more often. But unfortunately there is no direct causality that the mean nurse or unpleasant police will eventually develop high blood pressure and die. A better way to deal with the situation is to change the behaviour of those working under them to be in line with expectations of a beautiful and modern Kenya.

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