Overwork leading to burn-out among Kenya’s nurses

Anastacia Odhiambo, a nurse at the maternity wing of the Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu County, knows what it means to be overworked.

Before June 2013, when free maternity was rolled out, about 350 women used to deliver at her unit. The number has since risen by 34 per cent, to about 470.

Ideally, Ms Odhiambo says, the beds in her unit should accommodate 14 patients, but on the day this writer visited the hospital there were 29, more than double the limit.

According to the most recent national nurses’ census which was completed in 2012, Kenya’s nurses are overworked, short-staffed, underpaid, and doing jobs that are poorly matched to their specialised skills.

The lopsided, uneven geographical distribution of nurses also hinders their ability to provide adequate health care.

Nurses are an essential part of Kenya’s healthcare system, but public hospitals operate with far fewer than are necessary. Currently, Kenya has around 46,000 registered nurses and 27,500 enrolled nurses, according to the 2016 Economic Survey..

According to the nurses’ census which was conducted by the Nursing Council of Kenya, the country had about 50 for every 100,000 or 5 for for every 10,000 people, going by WHO units. The World Health Organisation (WHO) recommends that in order to sufficiently cover the population with essential health services, 23 nurses, doctors and midwives per 10,000 people should be available at a minimum.

NURSES ARE STRAINED

Countries that fall below this threshold struggle to provide skilled care at birth to significant numbers of pregnant women, as well as emergency and specialised services for newborn and young children, increasing the likelihood of deaths.

Available figures from 2010 show Kenya had 13 of all three kinds of health workers per 10,000 people, meaning the country still needed an increase of 10 doctors, nurses and midwives for every 10,000 people.

Back at the referral hospital in Kisumu, an entry in the department’s visitors’ book on December 16, 2014 by a Dr Jane Wakahe reads partly: “The staff are burnt out… consider having in-house medical officers and anaesthetists because of the many emergencies.”

The referral hospital attends to women from as far as Vihiga, Kakamega, Homa Bay, Busia and Bungoma counties, most of whom have complications such as high blood pressure and early rapturing of the membrane.

Kisumu County has 73 nurses for every 100,000 patients, ranking it seventh nationally. The County’s Chief Officer in the health department, Dr Ojwang' Lusi, says that the situation is not ideal. “We have employed more than 700 and there are interviews ongoing for more… we are trying,” he told Newsplex.

The situation is worse in Busia, where health county boss Dr Maurice Siminyu says only 405 nurses are serving nearly 600,000 people in about 96 hospitals. “The nurses are strained, they have been forced to work for as long as 22 hours with very few off days and you know their work…feed and clean patients, administer drugs,” he said.

Dr Siminyu says the issue has been raised with the Council of Governors several times, with very little results. “I have been given very little money for administration and expenses, there is little left for hiring nurses,” he said. Busia County has 67 nurses per 100,000 people and ranks tenth nationally.

OXYGEN DEPRIVATION

The Kenya National Union of Nurses (KNUN) has decried the pay nurses receive, saying that enrolled nurses who are certificate holders earn a basic salary of less than Sh14,000 at entry, while registered nurses with degrees and diplomas earn Sh16,000. Nation Newsplex found that these amounts are lower than the basic minimum wage in Nairobi, Mombasa and Kisumu, which was Sh17,200 in 2015.

KNUN Secretary General, Mr Seth Panyako, says that there are many specialisations in  nursing, which make it difficult for a nurse with a huge workload to cope. Take, for example, the paediatric nurses Caroline and her colleague Abigail Nyatogo, who work at Jaramogi Oginga Odinga Teaching and Referral hospital in Kisumu.

Medical students aside, Caroline and Abigail are the only qualified nurses looking after 31 babies with various birth-related medical complications in the unit. Most of the newborns suffer from birth asphyxia, a medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain.

Caroline’s job description reads like a constitution: check the babies’ vitals (respiratory rate and temperature); administer intravenous and intramuscular injections in some beds at certain intervals; ensure that the temperatures at all 12 incubators are at 31 degrees; observe feeding of the children; document every little activity and nursing care given to each baby.

GASPING FOR AIR

One of the four rooms is for Kangaroo mother care, a skin-to-skin childcare method where the baby relies on the warmth from its mother’s chest.

Caroline has to check on the mothers here regularly to ensure the baby’s head is slightly turned at an angle as it leans on its mother’s bosom. She also has to check that the socks and hat have not been removed, for that would deny the baby lifesaving warmth. She is supposed to repeat all these tasks every three hours.

The baby with the mother in question is fed through a tube called a nasogastric tube, a feeding process where the liquid fed to the baby relies on the force of gravity.

Should the mother force the liquid down the tube to speed up feeding, the baby would choke, sometimes with fatal consequences.

“When the baby starts choking [the mother] will rush and dump the baby violently on your laps and tell you she has given it to you, and that may be very late to save that child”, she says.

Here, a three-minute delay may cause the death of a newborn. One time, she recalls, two babies developed an apneic attack. The babies “forgot to breathe”, she says.

Suddenly, secretions were coming out from their mouths and noses and the babies started gasping for air. All by herself in the ward, she had to resuscitate the two babies urgently.

“You are stimulating them, inflating and deflating the bags that aid their breathing … all with two hands and you have little time, and here are two babies,” she said.

SYSTEMIC NEGLECT

Nakuru, the headquarters of the former Rift Valley province, has experienced its fair share of nurses’ strikes.

Isiolo, the best-nursed county in Kenya, has 128 nurses per 100,00 people. The county has more than 13 times more nurses per 100,000 people than Mandera, which with nine nurses per 100,000 is the lowest ranked county in the country.

Embu is in second place, with 15 nurses per 100,000 people followed by Nyeri with 10.

Despite the challenges in devolving healthcare, counties seem to be gradually improving the care of patients by hiring more nurses. Mr Panyako praised Kisii County, with 59 nurses per 100,000 people, and Murang’a with 47 nurses per 100,000 people, for making good progress.

However, counties that have historically suffered systemic neglect from the central government, such as those in North Eastern region, have not only had to struggle to lay basic foundations of healthcare but also to hire enough health workers.

Turkana, with 12 nurses per 100,000 people, and Wajir, with 20 nurses per 100,000 people, are ranked second and third from the bottom respectively.

Nurses' Week was celebrated from May 6 to 12 this year.