When Dr Otieno Omollo graduated from medical school, he was impatient with life and was looking forward to the day he would be posted in a hospital to begin his internship programme.
He was eventually posted in a hospital in rural Siaya County. Though he was earning Sh35,000, which to him was a lot of money, he was never prepared for what lay ahead of him. Having to watch his patients die because he did not have the equipment to save their lives and having to see a patient die while lining up for treatment due to inadequate staffing.
“I was never prepared for such reality. I had no idea what I was going to meet in the wards,” he says.
He was first attached to surgical wards, where he took care of accident patients and made rounds in wards many times in a 24-hour shift. At times, he came across undressed wounds because there was no cotton wool or drugs to clean the wound.
His frustrations got worse when a child he was treating died because there was no oxygen and the patient had a breathing problem.
“The distance between the hospital where I am to a well-equipped hospital is like two kilometers and had I transferred the child he would have died on the way. I did all I could but I lost the child,” he says.
Dr Omollo’s case is not isolated, but rather just an example of how extreme pressure and situations at work can wear out doctors beyond limits.
Kenyatta National Hospital recommended a programme for the Kenyan medical workers to manage burnout.
Burnout is a major issue among physicians, according to the National Physicians Burnout, Depression and Suicide Survey 2019 published recently on Medscape, an American website that provides access to medical information.
The study, which established that 44 percent of physicians in the US were burnt out, used a popular definition of burnout – “Long-term, unresolved job stress that leads to exhaustion and feeling overwhelmed, cynical, and detached from the job and lacking a sense of personal commitment.”
In Kenya, a 2014 Kenyatta National Hospital study published in the Journal of Psychiatry found burnout to be high among medical workers at the top public hospital in Nairobi at a prevalence rate of 95 percent, rising to 97 percent among practitioners under 30 years old. The burnout prevalence at KNH then was higher than the average of 60 percent found in studies in other countries worldwide and more than double what the US study found.
From the study, slightly more male medical staff (97 percent) than female workers (95 percent) experienced high levels of burnout syndrome and nurses suffered slightly lower levels of burnout syndrome (95 percent) compared with the medical practitioners (97 percent).
The Medscape study, however, shows that women had a higher burnout prevalence of 50 percent, compared with men’s 39 percent.
Work environment was the leading contributing factor (56 percent) to burnout among medical workers in the KNH study. This affected more medical practitioners (53 percent) than nurses (41 percent).
Not much has changed five years later as the world marked World Health Day yesterday and the country gears up for Universal Healthcare Coverage. Poor staffing, which translates into very long working hours for medical staff, remains a challenge. The country has 120 medical practitioners (doctors, clinical officers and nurses/midwives) per 100,000 people, which is about a quarter of the 450 recommended by the World Health Organization (WHO). As few as they are, a majority of the practitioners shy away from serving in the public sector as they are prone to higher stress levels and poor remuneration relative to the conditions in the private sector.
Alongside better remuneration, improving working conditions has been a key demand by medical staff in recent strikes. "Kenya produces 600 doctors a year but many do not get employed by counties because of the system instead they get employed elsewhere. In the last two years, the country has lost more than 2,000 doctors, most of whom were in the public sector," said the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) secretary-general, Dr Ouma Oluga.
The Kenya Institute for Public Policy Research and Analysis (KIPPRA) noted in a report last year that “shortfalls have been observable despite an increase in registered medical personnel, which increased by an annual average of eight percent between 2013 and 2016.”
Long hours are the norm for physicians. According to the US study, the percentage of physicians who are burnt out rises with the number of hours they work each week.
A third of physicians in the US blame spending too many hours at work on burnout.
Some of the symptoms of burnout are conflicts at home and work, substance abuse and boredom. In extreme cases, it can lead to suicide. According to the 2019 study, one in seven physicians who experienced burnout reported having thoughts of suicide but have not attempted it. Just recently, a Kenyan doctor working in Cuba committed suicide as a result of depression, which could have been partly caused by burnout.
About half of the people experiencing burnout have exercising as a copying mechanism. Chatting with family and friends, isolation, sleeping and listening to music are the other preferred ways out.
The KNH study recommended a programme for the Kenyan medical workers to manage burnout. It painted burnout among medical practitioners as a ticking time bomb by posing the question: “For how long would the medical workers in Kenya stand the test of time with such high levels of burnout syndrome…?”