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Nurse on the frontline tells it like it is

DREADFUL: Sir Ketumile Masire Teaching Hospital

Two weeks back, I wrote an article chronicling my harrowing experience as a critical care patient at Princess Marina Hospital’s SSU ward.

This week, as a follow up to that, I sit with Bothepa*, who worked for 4 years as a general nurse at Marina, but has since moved to a relatively better environment.

After spending weeks trying to make sense of the toxic culture of that SSU ward, I decided to talk to a healthcare worker to help me come to terms with my trauma.

Before I begin to fire away with questions, Bothepa has already anticipated where the interview is going, so she is quick to address what she refers to as the biggest challenge in her field; “We are under-resourced. We work in an environment where each time we go to work, we are forced to over-compromise, for the sake of the patient. So, we end up demoralised. For example, there’s a persistent shortage of beds, then you’re forced to prepare a floor bed, using a worn-out mattress. Overall, I can say the environment is not conducive, neither for the nurse nor the very lives we are to care for and preserve,” she explains, further stating that patients also don’t seem to have an appreciation of the sacrifices nurses make and the fact that where nurses’ duties end, the doctors’ begin.

“There’s a clause in our employment – ‘any other duties’.” Bothepa opines it is a major source of growing discontentment within the fraternity. She puts the blame squarely on ineffective managers as she says the leadership style of managers and supervisors causes much displeasure among nurses.

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“Our supervisors are deeply insensitive to our needs so they turn a blind eye to our plight, as if they’re unable to relate. With Covid, the public health sector is overwhelmed and frustrated, yet the government is doing nothing to address this. If I can show you the heated exchanges on the Nurses Union WhatsApp group, you will see the kinds of complaints and concerns I’m talking about. Our system doesn’t recognise up-skilling and doesn’t care to motivate us. Even if you wished to do a management cause, it will mean nothing. So, we sit back because we’re tired of going an extra mile in a community that doesn’t appreciate our efforts, sacrifices and contribution.”

Bothepa, who is married to a doctor, says with the numbers of nurses dying from covid rising by the day, self-preservation is now the order of the day.

“Go into our clinics, there’s no PPE’s, if one of us tests positive, we’re told there are no contacts at work. We also have children and family who love us hence don’t want us to die. We don’t want to leave orphans behind, too. And the heavy workload; the ministry is aware the hospitals are understaffed, thus nurses are overworked. Our managers totally neglect our wellbeing. You’d think during a crisis like this one, matrons would pitch in to help but no, they sit comfortably barking orders from their offices.”

UNDERPAID

Bothepa says the issue of remuneration is another factor that causes widespread dissatisfaction, thus impacts greatly on the quality of care provided to patients, leading to many eventually searching for greener pastures or exiting their profession.

‘Before you even compare with countries in the region, let’s not go far. Take a nurse at University of Botswana (UB) for example; at entry level, a nurse employed by UB earns about 29k while their counterparts in government are on C1 scale, which is around 15k – that’s a massive difference; such a huge margin. In South Africa, nurses live a very decent life. We are not even given accommodation yet the police and teachers are well taken care of, you’ll hardly see a police officer using public transport, yet nurses still use public transport. Before, Marina had staff transport where you’d get dropped off if you worked evening/night shifts, but they stopped that. There is no shift, risk or call allowances either, yet we use the phone to carry out duties. As it is, we’re being threatened to buy uniform as from 2 months back, they began giving us a meagre P300 uniform allowance, which does not suffice. We recently received a communiqué instructing us that as of 1st October 2021, everyone is expected to wear full uniform; our shoes are so expensive to start with. Imagine in this pandemic. Well, they promised back pays; however, it doesn’t make sense because of infection-control issues, yet they back-up their enforcement with archaic laws! The health sector is gravely disappointing. Our managers seem threatened by us. On paper, they’re more experienced and qualified than us, in practice, the opposite is true.”

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I quiz the forthright nurse about rumours that service at SKMTH is worse and she bluntly concurs that indeed the place is a hellhole.

“People left for myriad reasons. When they were employed, they were under the impression that they’ll earn more money, have various allowances etc. The terms of employment were that the University of Botswana would absorb people but it turned out the hospital was no longer under the management of the university but government, which was prior to the onset of the pandemic. A lot of the employees were unaware that government had taken over the running of the institution 100%, around 2018/19. It was basically a departmental transfer, save for the first cohort of employees.”
Compounding their frustrations was the shortage of drugs. Good specialists left and the place was left with inexperienced staff. “We ended up with a magnificent structure sans resources! Such a colossal, well-appointed building lacking medications is an embarrassment – a crisis within a crisis. So, basically, all patients get at SKMTH is oxygen, you may as well rent an oxygen cylinder if you can afford it and stay at home. Recently, a patient was discharged with paracetamol and a cough syrup, imagine! That place is a disaster!”

“Patient to nurse ratio is ridiculous, the poorest! Usually, a critical care ward would have just three nurses, in a 30-patient ward, it’s impossible to give the best care even if you wanted to hence interns are often overworked and abused. I also cannot prioritise ‘any other duties’ over my core duties. For instance, at a health post, I may be forced to carry out certain duties; drawing blood is the job of Phlebotomists, not a nurse, but we’re forced to do that. And you wonder, why can’t government hire Phlebotomists? Boitekanelo College produces them every year! ”

So I ask the passionate nurse what accreditation bodies stipulate, she states; “The Health Service Accreditation of Southern Africa (COHSASA) may recommend the following: critical care units like the SSU or SKMTH or the ICU (intensive care unit) ratio should be 1:1 for the most critically ill patients, or 1:2 or 1:3 for patients who are severely ill but whose vital signs are stable. Elsewhere, the ratio might be high up – 1:5 or 1:8 – and totally dependant upon the condition of patients.”

Bothepa reiterates, “A shortage of experienced nurses and doctors means that we go an extra mile a lot. We had thought that during this pandemic, during the State of Emergency, government would begin to recognise and prioritise the health sector for once; instead covid has exposed a lot of dysfunction within the system. They couldn’t even prioritise us when vaccines arrived.”

Botswana – sub-Saharan Africa – has over the years lost highly qualified professionals especially in the health sector to first world countries like the UK, Ireland, Canada, the U.S and Australia.

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This brain drain can be attributed to “lack of opportunity for professional development, unavailability of equipment and supplies, heavy workload, low wages, low job satisfaction, and the threat of political instability and conflict.”

Our country remains one of the unhappiest in the world, and it’s easy to see why. If the caregivers of a nation are this aggrieved, how can we expect anyone to be happy?

Where do the priorities of the leadership of this country lie? Almost every Motswana has lost a loved one this year, and still many continue to, in a country that is economically stable than most – a middle-income country that aspires to have high income status. What a pity!

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