Health staff need a dose of phone text messages

Nancy, a nurse for over 20 years, recalls a traumatic incident that she encountered while on night duty at a hospital in the coastal region.

On the fateful day, Nancy had just stepped out of the consultation room when she came face-to-face with the bodies of their hospital security guards who had been killed by robbers, and their eyes gouged out.

"This incident shocked me and it was so painful. These guards were our friends, people we talked to every day and relied on for our safety. And now they were gone, after such a brutal death," recalls Nancy.

The stress and mental trauma linked to the ordeal was unbearable to Nancy, who kept crying and breaking down as she relieved - over and over again - the gory images of the dead guards in her mind. Eventually, she opted to go home and did not report to work for many days.

"During this period, I was going through so much stress and suffering. But no one bothered to find out how I was doing. All I got after staying home for many days, was a warning letter that I would be fired if I did not resume work immediately," says Nancy.

Her experience mirrors the mental health challenges that health workers face due to stressful situations encountered in the course of their work such as losing patients to death, watching sick people suffer from immense pain and dealing with deadly conditions that put their lives at risk.

Findings of a recent study conducted by the Aga Khan University in partnership with the Johnson and Johnson Foundation revealed that one in every four healthcare workers in Kenya exhibits signs of depression.

The study, which interviewed nearly 4,000 nurses, midwives and community health volunteers (CHVs) across Kenya's 47 counties further revealed that two in every five healthcare workers show symptoms of post-traumatic stress disorder due to numerous painful experiences they are exposed to at work.

Some of the key drivers of mental health challenges highlighted by the study included lack of a social support system, heavy workload, lack of resources, poor working environment and irregular salary payments among nurses and midwives, as well as the lack of salaries for CHVs.

It was clear from the study that despite the mental health burden they face, a majority of health workers are ill-equipped to tackle the challenges and therefore end up suffering in silence.

"We can all agree that we want quality healthcare services. But to achieve this, we have to protect the well-being of our health workers," said Professor Amina Abubakar, the Director of the Institute for Human Development at Aga Khan University.

She noted that it is important for health workers to be trained on stress management and how they can tap on peer support for each other, to help tackle the challenges they face.

Aside from just highlighting the mental health burden experienced by healthcare workers, the findings of the new study also showed that mobile health (M-Health) technologies can go a long way in helping addressing the problem.

During the study, the researchers piloted the use of a mobile-based text message intervention that was designed to provide direct psychosocial support to health workers.

"Preliminary results show that these kinds of mobile health interventions could be feasible, acceptable and used to alleviate mental health challenges faced by health workers," stated Professor Abubakar.

Nancy, who was among the beneficiaries of the innovative mobile-based intervention, notes that the messages made her feel like she had a friend that was continuously checking on her, while at the same time offering effective stress prevention and management tips at no cost.

Most importantly, Nancy is grateful that the knowledge gained through the messages, enabled her to come to terms with the traumatic experience she had experienced following the death of the security guards.

Even though she changed hospitals after the ordeal, the experience still haunted her. Due to the fear of losing her job, she had been forced to just move on and continue working, without properly addressing the matter and getting closure.

"Thanks to the messages, I learnt for the first time in my life that it is alright to not feel okay as a nurse or healthcare worker. In this profession, we are trained to make other people feel better and we also see our work as a calling to selflessly serve humanity. So, anytime I would feel unable to serve my patients, I would always blame myself and feel guilty. This is how I felt after the incidence at the coastal region hospital and afterwards while going through other stressful situations," says Nancy.

"I now know that as a health worker, if you don't take care of yourself, there's no way you will be able to take care of other people. I appreciate the importance of self-care and understand the importance of taking breaks whenever I feel overwhelmed. I also eat healthy foods, drink a lot of water, make time to exercise and do things that I enjoy when out of work. This usually helps me to recharge and continuously feel motivated to give the best to my patients," she says.

Apart from self-care, the text messages also encouraged health workers to embrace optimism as a way of life.

"We were inspired to begin each day by thinking about something positive that we are grateful for, in our lives. Problems will always be there. But training your mind to focus more on what is going on well in your life sets you in the right mood for the day," notes Nancy.

She has also made it a habit to take deep breaths, which calm her down whenever she begins feeling angry or agitated as a result of the stress she experiences at work, while tirelessly serving patients.

"This is a new relaxation technique that I learnt about through text messages. It has helped me to avoid getting angry, which based on my observation, usually happens when I feel tired and under so much pressure at work. This is the point where you need to stop and take a break to recharge."

The mobile-based text message intervention also encouraged Nancy among other targeted health workers to form peer support groups at their working places.

"They say that a problem shared is half solved. Opening up and sharing our problems makes them less stressful as you realise that you are not alone. We are also able to learn stress management techniques from each other and also ways of improving our performance at work," notes Nancy.

Dr Patrick Amoth, the Director-General of the Ministry of Health noted that the government is keen on finding innovative solutions to support the mental needs of health workers who are a key pillar in its universal healthcare coverage initiative.

He noted that the Psychosocial Support guidelines, developed during the height of the COVID-19 pandemic as well as the mental health bill will go a long way in helping to address the mental health burden faced by health workers in Kenya.

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