– authorities step up efforts to help those battling mental health issues

By Telesha Ramnarine

WHILE nurses are always expected to conduct themselves professionally, there is no shortage of reports in Guyana about many who don’t. In many cases, authorities have found that the underlying reason for improper treatment of a patient really goes back to poor mental health.

For instance, Senior Government Psychologist at the Ministry of Public Health, Balogun Osunbiyi, sees about four nurses each month with mental health issues, and top among the complaints are nurses’ burnout and compassion fatigue.

Nurse burnout goes beyond feeling tired or experiencing a bad day at work. It is the emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It impacts their personal lives, the patients they take care of, and the organisations they work for.

Compassion fatigue, on the other hand, can be experienced by nurses who are constantly seeing and hearing of extreme, at times unspeakable suffering to the point where it can create a secondary traumatic stress for them.

“It is well known in Guyana….members of the public are not treated in a humane manner by those who happen to be serving them,” Osunbiyi, who holds direct responsibility for the ‘Nurses Psychological Trauma Training Programme,’ told the Guyana Chronicle in an interview on Monday.

Speaking at his office, at the ministry’s Mental Health Unit, on Quamina Street, Georgetown, Osunbiyi explained that authorities in the health sector have been taking stringent measures to ensure that help is readily available for nurses in need.
For example, before the launch of the ‘Nurses Psychological Trauma Training Programme’ earlier this year, there was no clear-cut or standardised programme which helped nurses with their own mental wellbeing. This programme is therefore groundbreaking in the health sector and is one that can help to push a revolutionised delivery of healthcare services in the country.

With hardly any assistance available in the past, Nurse Cleopatra Barkoye, who started as a nursing assistant 30 years ago and moved her way up to becoming the President of the Guyana Nurses and Midwife Association, knows the value of having a listening ear when the job becomes overwhelming.

In her experience, she has found that the patient load and not having enough materials to work with are two challenges that can put a strain on nurses’ mental health.
“It’s hard when you come and have to make stone out of bread. You have 20 patients but you only have 10 steroid sets which you have to make do with because you have to do the patients’ dressing. And then sometimes you come and your colleague is not there, so the load becomes heavier,” she observed during a recent interview at her office on East Street.
Mrs. Barkoye, also Principal Tutor of the Georgetown and New Amsterdam Schools of Nursing, recalls vividly the things that further caused her to become stressed on the job. “You don’t have to pay me a lot of money; I can eat two meals a day and I can walk to work, but when I come, I want things to work with. I don’t want that when I’m ready to work, I don’t have a computer, Internet, tutors, and sufficient books. Those kinds of things put a strain on me.”

Many days, Mrs. Barkoye would break down in tears when she realised that it was not within her power to help a patient simply because the right materials or machines were not available.

A case in point that she said she would possibly take with her to the grave was when she encountered a young woman some years ago who was badly burnt about her body, but who could not be treated in isolation because the burn unit was closed for repairs.
“Most of her body was burnt and at that time, we hadn’t a burns unit in operation. It hurts because she said to me, ‘I need to say something to you.’ I was feeding her and told her to take the tea first. I went to do something close by, and by the time I returned, she died. I felt that of utmost importance at that moment was for her to be hydrated, so I never got to hear what it was that she wanted to say,” Mrs. Barkoye recounted.

But the young woman’s death could have been avoided, Mrs. Barkoye believes, had the burns unit been up and running. “I don’t think she needed to die. If we had a unit, she could have been saved. She could have been secluded and treated.”

In instances like this, Mrs. Barkoye is grateful that her husband patiently listened to her when she needed to talk. “I did a lot of talking. Nurses need somebody to talk to. You have to talk; you can’t bottle it up inside because you may end up being abusive to patients and all sorts of things. You have to find a way to let out your hurt and anger.”

Jewel Rahaman, a nurse for the past 12 years, feels the same way. She has found that working extra hours contribute to her fatigue, but she makes it a point to speak to someone about her feelings and to ask for timeout when she feels she needs it the most.

THE ROBOTIC STATE
Ms. Rahaman, who worked on the midwifery ward at the Georgetown Public Hospital Corporation (GPHC) before becoming a nursing tutor, feels that enough attention is not being paid to nurses’ mental health in Guyana.

Due to the pressures on the job, she noted that nurses can sometimes go into a robotic state in which they operate without any warmth and feelings towards their patients. “You have an assignment to do and you just do it without any attachment of emotions; any attachment of attention from you in terms of communicating with patients. You just do things because you have to do it.”

She referred to nurses’ burnout and fatigue which come about after nurses give so much of themselves to the system that they do not have time to care for their own health. “Nurses burnout is a more severe state where you are so exhausted that you cannot do anything but report sick for work, and that in turn puts a strain on your colleagues.”
Earlier in her career, when she was studying the midwifery programme, Ms. Rahaman experienced firsthand how personal issues can affect a person’s mental health and subsequently creep into their place of employment. “People have a perception that once you’re a nurse, you already know how to take care of yourself, but that might not always be true.”

When she started to study for the programme, there came a time when her daughter also needed help as she prepared for the Grade Six Assessment. Furthermore, a bank approved Ms. Rahaman’s mortgage and gave her only a certain time within which to start construction.

“Balancing the program, along with my daughter and building, took a toll on me. I was really overwhelmed and anxiety kicked in. Some days I felt so stressed out,” she recalled, and to compound matters, she was a single parent at the time of dealing with it all.
Fortunately for Ms. Rahaman, she persevered and was able to tackle each issue one at a time. “I decided to challenge these separately. I worked with my daughter first. I asked my supervisor in the maternity unity if I can go in late in the nights and they granted me that. I studied with her up to about 20:00hrs or 21:00hrs in the nights and then I would come into work. She wrote her exam and got St. Joseph High School. I then looked at working out an arrangement with the contractors and then I worked out a schedule of how to study for the midwifery exams.”

Ms. Rahaman’s advice to fellow nurses is if they are not in a position to render optimum care, then it might be best for them to speak to a colleague or supervisor about getting help.

And this is what Dr. Osunbiyi, mentioned earlier, is advocating. “We want to say to people that it is ok in an emotional crisis to seek help. You don’t have to wait until it becomes a chronic condition or a disorder or a full-blown mental health crisis for you to seek help,” he said.

ONGOING TRAINING
Dr. Osunbiyi is one of the country’s two trainers on the ‘Nurses Psychological Trauma Training Programme’ which focuses extensively on how nurses provide for their own mental wellness during disasters and even on their day-to-day activities.
It’s a new programme out of the University of the West Indies School of Nursing, St. Augustine Campus, and is written by PAHO/WHO and UWISoN, led by Dr. Oscar Ocho, who is the director of UWISoN. It also has support from the Johnson and Johnson Foundation which has contributed to it financially.

The programme was rolled out earlier this year and just last week, Dr. Osunbiyi and others were able to complete the first component of training which included not only nurses, but doctors and social workers as well. This is going to be an ongoing training throughout Guyana.

“A nurse, like anyone of us, is a human being. And nurses operate in a very toxic environment; they are constantly faced with stressful situations. Professionally, we know that they are expected to go out there and do their job, but Guyana is now going forward and we need to look more to the mental wellbeing of our staff. Nurses are a critical element in our delivery of public healthcare for the population, so we have to find ways and means of caring for that vital component of our service provision,” Dr. Osunbiyi expressed.
He said the issue also has to do with the stigma attached as people tend to think that nurses are professionals and hence are not in need of any help. “No matter who you are, you are still a human being and from time to time, would need a time out and may need to seek help from an outside source.”

Once he is contacted for help, Dr. Osunbiyi said he would walk the individual through the process step by step to be able to properly advise them on the way forward. He would seek to gain a thorough understanding of what the problem really is before any treatment is suggested.

“We are now trying to have a structured programme for them. We want them to know that if anyone of them has a problem, there is help. Sometimes they just need someone to talk to; someone to listen to them. So far, we have not included a mental health component in their training, but now, those responsible for nurses are in the process of getting that done.”

Even before a nurse may request help, though, Chief Nursing Officer, Linda Johnson, said that once a superior notices a different work pattern in the individual, then counselling would be suggested.

In an interview with this newspaper, Mrs. Johnson said those who are in need of counselling are usually recognised due to a number of factors. “Something is usually different about them; their output, general commitment, and work pattern. They’re always late or unkempt, and they may lash out at a patient or be short-tempered with their colleagues.”
Mrs. Johnson is especially happy that nurses can now be referred to Dr. Osunbiyi as many in the past did not feel comfortable discussing their issues with the social worker who was right there in their setting. “Most persons do not want to be counselled by persons in the system who they know very well; they prefer to be counselled by an outside source.”
A bed-side nurse, Mrs. Johnson knows what it feels like to lose a patient to death, or see their condition regress. “Over the period of weeks and even months, a nurse-patient relationship is built. If anything happens to them, you feel as if there was more that you could have done,” she offered.

At the moment, she observed that there is no mechanism in place for nurses who would have dealt with a loss in this way. In fact, help is only available for someone who reaches out for it, or for those who show obvious signs of poor mental health. There are, however, those who may be suffering silently, but not showing it.

Mrs. Johnson sits at the policy level of the Health Ministry, and she said that discussions have already been held about what needs to be put in place to better the system that is available.

In fact, she said Public Health Minister, Volda Lawrence, only recently directed Chief Medical Officer, Dr. Shamdeo Persaud, and Head of GPHC, retired Brigadier George Lewis, to work out a plan to a have system in place for nurses to be able to access counselling. “They’re now working on how it’s going to be done because we recognise that there is a lot going on and they (the nurses) need help,” Mrs. Johnson said.