BOSIRE: Daily dangers in the line of duty

Alice* was a dedicated nursing student. She was very religious and walked the talk.

Every Friday evening, along with a few others of her faith, she visited with the sick in the wards, not as a nurse but as symbol of encouragement. Together, they sang the vespers and ushered in the Sabbath.

In her third year of school, she developed a persistent cough. She always took her diet very seriously, eating only wholesome foods, with a trim body to boot, but she was losing weight markedly.

At night, she couldn’t sleep well and woke up drenched in sweat several times.

After three weeks of trying to keep it together, she sought care and was diagnosed with tuberculosis. Her big heart had walked her right into the lair.

Tuberculosis is more easily transmitted at night. During the day, the sun’s naturally occurring ultra-violet light is protective. Alice’s Friday night interactions with her patients had made her one of them.

Alice’s experience happens to all health workers in the course of their career. My very first one came three months into my internship. I was two weeks away from finishing my first rotation, paediatrics.

In the crowded paediatric emergency department, a little girl was brought in by her parents. She had watery eyes and a dry cough.

As I leaned forward to examine her chest with my stethoscope, she coughed right in my face. I spotted the vesicular rash on her neck and knew my goose was cooked.

I spent a week in bed oscillating between chills and fever while my entire body broke out in the extremely itchy chicken pox. I even had it in my mouth.

Despite chickenpox being mostly a mild infection in children, it can get severe in adults and in extreme cases, can lead to death But one never truly appreciate what that means until it happens to them.

To add insult to injury, the question everyone asks is where you grew up where you did not come into contact with chicken pox as a child; as if it is a developmental milestone you missed!

This was the beginning of what I thought was going to be an illustrious career. Two episodes of needle prick injuries and having to take anti-retroviral drugs to protect myself from HIV and I was quickly turning into a veteran. We all quickly learn to wear our stripes with pride.

NEED FOR SAFETY NET

The experiences are vast, from physical assault from mentally ill patients, to respiratory tract infections, to rare cases such as a colleague who dislocated her wrist during a particularly difficult Caesarean section.

Outside of direct patient contact are health workers who work in high-risk areas such as laboratories. They are constantly exposed to dangerous organisms, infectious body fluids, chemicals and reagents. Laboratory accidents can be catastrophic.

But who is keeping tabs? Despite the daily dangers that health workers face as an occupational hazard, there is no safety net.

Take the case of Dr Stella Ameyo Adadevoh, the Nigerian doctor who put her life on the line to protect Nigeria from the Ebola epidemic. She diagnosed Nigeria’s patient zero, Patrick Sawyer, a Liberian national who had come into the country to seek faith healing.

The timely diagnosis and subsequent decisions taken to immediately institute quarantine, meant she put herself in immediate danger. Nigeria was not ready for Ebola and she had to make do with what they had, to protect the rest of the country.

Despite causing a diplomatic row between the two countries, being accused of restraining a foreigner against his will, she did not budge. Did she die a heroine? Absolutely. Was her sacrifice in vain? Not at all. She saved one of Africa’s most populous countries from sliding into the quagmire of a devastating epidemic.

In Nigeria, she will always be immortalised as the larger-than-life heroine. In the medical profession, we hold her in awe. She epitomised the very definition of selflessness.

This then begs the question: What do countries do to protect those who, by virtue of their calling, are expected to stand in the gap, not only for their patients, but the entire population at large when called upon to do so?

During the height of the Ebola epidemic, many health workers were in panic, especially those who worked in emergency departments. They knew they were the first contact with patients.

Few felt sufficiently trained to get into a hazmat (hazardous materials) suit and handle a patient with Ebola. Even fewer were ready and willing to be quarantined with a patient for the required duration. In Kenya, there is not even basic life insurance cover to cater for health workers who might die in the line of duty.

This is a clear indication of the disregard for the risk involved. Just like a soldier goes to war for his country, knowing his body may come home in a box, so do health workers. Every day they navigate spaces that put them at risk of physical harm. Ebola may not be an everyday occurrence, but tuberculosis and HIV are.

It is important to wake up to this realisation. Health workers, just like other people, have families that care for them and would be deeply pained to lose them in the line of duty. They have dependents who would be left destitute in their absence.

This is a gap we must aim to fill as a matter of urgency. We cannot continue to take our health workforce for granted in such a callous manner.