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The trauma of nursing
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4 years agoon
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The PostMASERU – FIRST they come in as patients, and then they turn into friends and become part of the family.
For nurses, forming close bonds with patients – especially those who stay long at the hospital – is often unavoidable. But it comes with risks, chief among them the despair that follows when such patients die.
As a result, many of the nurses end up suffering from depression while others develop compassion fatigue with time.
Take ’Mapakiso Hlomeli, a nurse at Pshatlella Health Centre in Ha-’Mantšebo. As a new nurse in 2002, she had her first experience with the loss of a patient under her care.
Hlomeli still freshly recalls her first traumatic experience with the death of a patient close to two decades ago.
She says at times she visualises seeing the man dying, 18 years later.
“He was a cute man in his late 20s,” Hlomeli says.
“When he got to the hospital he became my patient and I was hoping that my first experience was to become a positive testimony,” she says.
“I saw him die one day and that hit me hard.”
Hlomeli says she “could not stop crying because I felt I had failed him and my profession”.
She is still struggling to get over the experience, just like she wishes she could erase from her memory several others that happened later in her career.
“Every time a patient dies I feel like a part of my heart is being ripped off,” she says.
Another nurse, ’Malillo Mothuku, who works at Motebang Hospital in Leribe, says she too is yet to get used to losing patients.
“Every patient is unique to us, their life matters individually and we cannot say some deserved to die or we didn’t feel sad when they died,” Mothuku says.
She says it is even harder when they have to inform the next of kin or relatives of the death of their loved ones.
Another stressful part of the job is the requirement to give a report to the doctor and the relatives.
“As you keep narrating what led to the death of the patient you feel the pain build up and the reality of the death becomes clearer,” she says.
“You see the disappointment in the family’s eyes when you tell them that the patient has died.”
Every life is precious, she says.
“Even the terminally ill have a right to live, they come to the hospital with trust and believe that their health will be restored but when it doesn’t happen it hits us hard.”
She adds: “We do what we can but when that fails God takes control. There is so much that we can do as health practitioners but the question of who lives and who dies is all in God’s hands,” she says.
’Mathato Motanteli has been a nurse midwife for 35 years but losing a patient still hurts.
Like many nurses, she experienced the death of a patient in her first year of service 35 years ago but it still haunts her.
“I felt like I had failed as a nurse,” she says.
“I did not want to do anything that day, I slept and cried because my grief was unbearable,” Motanteli says.
Motanteli says health training institutions do not prepare students for such experiences, and the first reaction to the death of a patient is shock.
“It is worse when you see it happen, when they take their last breath and there is nothing you can do about it,” she says.
These nurses talked to thepost at the launch of International Year of the Nurses and Midwives at the Ministry of Health last Friday.
Another nurse, ’Mabakoena Lekaota, says there is need for tailor made traumatic counselling for nurses at every health centre.
“It has never been established and I think it is high time that the Ministry of Health establishes that (the extent of trauma among nurses and the need for therapy),” Lekaota says.
So far research on the prevalence of post-traumatic stress disorder (PTSD) among health professionals in Lesotho is thin, say the nurses.
Therefore, both the health professional associations and the Ministry of Health have no data on the issue.
However, the Ministry of Health says nurses are being counselled.
Mpoetsi Makau, the Director of Nursing in the Ministry of Health, says the ministry has “four pillars and all of them work towards caring for the welfare of health practitioners”.
Makau says the Nursing Council, the Nursing Association, nursing and midwife training institutions and the Nursing Directorate all work together for the welfare of nurses.
Makau says they have a wellness programme that provides for all health care practitioners together with their families to receive health services as a priority.
She says they also have mental health service provisions for nurses who require counselling and psychiatric help.
“PTSD is an invisible illness. It manifests itself in different ways and it requires a leader or manager in health who recognises the changes that their nurses or any of their workers are going through,” Makau says.
She says like many Basotho, nurses are reluctant to report stress, trauma or mental breakdown because words like, “It is ok”, “I will get over it” or “this isn’t much of a problem” are words people use to escape reality while blinding themselves to the mental effects of their work experiences.
“Nurses need to be cognizant of each other’s behaviour and change thereof because some change in attitude may mean someone is going through a traumatic or stressful situation that needs attention,” Makau says.
“Some misconduct by a health practitioner is a call for help and does not require extensive disciplinary measures,” she says, referring to compassion fatigue that some health practitioners display because of work-related stress.
“Even in nursing school, there is a provision for pre-counselling where we refer nurses to the family health division in the adolescent and young adults department for younger nurses who have taken up nursing as a health profession,” she says.
“We are aware of trauma they might be going through and we want the best welfare for them so that they perform as expected and even more,” she says, adding: “Nurses are still human and they go through all kinds of abuse and trauma just like everyone else.”
Makau says if nurses’ “personal stresses are not addressed they will underperform at work and at times hurt patients”.
She says they crafted a care-plan for nurses who have experienced PTSD or other forms of mental illness because they need to be monitored and cared for through the whole process.
A 2011 study on the prevalence of factors associated with burnout among health professionals in Maseru found that work overload was a major factor to stress and compassion fatigue among nurses.
Appolinaire Tiam, who conducted the study and submitted it to the Faculty of Health Sciences at the University of Witwatersrand, noted that Lesotho had adopted a nurse-based care and treatment approach where services are offered to more people through task shifting and decentralisation of service provision.
“This has drastically increased workload for the limited number of health professionals, especially coupled with loss of up to 20 percent health care workforce to HIV epidemic,” Tiam notes.
“All these factors are probably expected to add to the already existing stressors in the workplace leading to possible burnout,” Tiam says in the report.
Tiam called for more research focusing on the prevalence of burnout factors in relation to workload in the clinical setting.
Another researcher, Kopo Manamolela, who is a psychiatric nurse at Berea Hospital, wrote in 2017 that depression “is one of the challenging mental health conditions in Lesotho”.
Manamolela says in most cases “it goes unreported until the late stages whereby measures to manage the condition are compromised and result in admission to hospital”.
“Health care workers are also high-risk groups because of having to work under stressful conditions with lack of staff and facilities and approaching retirement,” she says.
According to a research by Meridith Mealer, an Associate Professor at the Anschutz Medical Campus at the University of Colorado, nurses’ work puts them at risk of “triggers and traumas of PTSD”.
“Nurses see people die. They work on resuscitating patients. They try to control bleeding. They have end-of-life discussions,” Mealer says.
“And sometimes they are verbally or physically abused by patients or visiting family members,” she adds.
Rose Moremoholo
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THE police have launched a hunt for former police minister, Lepota Sekola, who is suspected of involvement in stock theft.
Police want to arrest Sekola in connection with two cattle carcasses that were found at his grandfather’s funeral in Borokhoaneng three weeks ago.
During the initial interview, Sekola had insisted that the cows belonged to his late grandfather who had kept them in South Africa for better pastures.
The police didn’t arrest him at that time because investigations were still in the early stages. Further investigations have however led the police to believe that the animals were stolen from South Africa.
But when they were ready for the arrest, Sekola could not be found at his home or on his phone.
Police say Sekola will be charged with unlawful possession and illegal importation of two cows from South Africa.
The National Stock Theft Coordinator, Senior Superintendent Mapesela Klaass, told thepost last night that they “have completed investigations but he (Sekola) is nowhere to be seen”.
“We cannot get him on his mobile phones,” S/Supt Klaass said, adding that the police have been “visiting his home but he is not there”.
“His family members are aware that we are looking for him,” he said.
S/Supt Klaass said they are continuing with their search and as soon as they find him, they are going to drag him to the courts.
He said the police suspect the cows were brought from South Africa to be slaughtered for Sekola’s grandfather’s funeral.
Police sources told thepost that one of the cows had new branding while another had nothing. Both had holes on the ears that signalled that they used to have ear tags.
Majara Molupe
A Maseru magistrate, Nthabiseng Moopisa, this week stayed the criminal prosecution of Advocate ’Mamosa Mohlabula who is accused of tax evasion, money laundering and corruption.
In her application Advocate Mohlabula, who is the director of Women and Law in Southern Africa (WILSA), said the Director of Public Prosecution (DPP) should not charge her pending finalisation of her tax evasion case.
Advocate Mohlabula is out on bail after she was formally charged with tax evasion in July last year.
She told Magistrate Moopisa that the DPP, Advocate Hlalefang Motinyane, was wrong to have agreed with the Director General of the Directorate on Corruption and Economic Offences (DCEO) to bring charges against her.
“In my viewpoint, the DCEO cannot be heard to charge me in relation to matters already seized with this Honourable Court,” she said in an affidavit.
She also said there is a pending civil case in the High Court in which the DCEO’s abuse of power is referenced, saying the precise way the case is handled will depend “on the way an alleged offence comes to the light”.
“Before that pending case is finalised, DCEO has no jurisdiction to detail me to court over isolated phenomenon of tax evasion and or over grievances of former employees of WILSA,” she said.
Advocate Mohlabula was charged together with the WILSA’s chief accounting officer.
She argued that it was WILSA that was being investigated, not individuals, further saying that was “a significant safeguard that the DCEO was impartial from an objective viewpoint”.
“To exclude any legitimate doubt in this respect the DCEO returned the items it seized from WILSA,” she said.
“This was a realistic and practical step towards administering justice and to avoid premature embarrassment to the management of WILSA.”
She said the Board of Trustees of WILSA were sent briefing notes which in certain respects reflected that the DCEO returned the properties of WILSA without warning them that they were suspects.
“In any event, we proceeded to fashion our arguments before the High Court. There was, and could be, no evidence to back up the decision of the DCEO to apply for the search warrant,” she said.
Advocate Mohlabula said before they took the matter to the High Court, she cooperated with the DCEO and it conducted an inquiry into the alleged crimes.
“Now that the matter is pending before the High Court, there is no more reason for the DCEO to remand me before the pending cases are finalised,” she said.
Staff Reporter
THE All Basotho Convention (ABC) has barred former Government Secretary Moahloli Mphaka and three others from contesting for the deputy leader’s position at an elective conference set for this week.
The three are Kefeletsoe Mojela, Katleho Molelle, and Lekhetho Mosito.
Mosito was an MP who was appointed Defence Minister for a day and removed the following day during Dr Moeketsi Majoro’s premiership.
The elective conference is set to be held at the Leqele High School hall this weekend.
A circular from the ABC said the three did not qualify to enter the race because they had not held any positions in the party’s committees.
The decision to bar the three is reminiscent of the same tactics that saw former leader Thomas Thabane block Professor Nqosa Mahao from contesting for the party’s deputy leader’s position.
Professor Mahao subsequently walked away and formed the Basotho Action Party (BAP).
A weakened ABC has never recovered from that split.
Mphaka and his colleagues were vying for the deputy leader’s position until they were stopped in their tracks by the circular which was issued out on Monday this week.
Dr Pinkie Manamolela is the current deputy leader.
She was plucked from the women’s league to replace Dr Majoro who had resigned from the national executive committee after losing the leadership race to Nkaku Kabi in 2022.
There is a high chance that the four could drag the ABC to court to assert their right to contest. The legal wrangles will likely destabilise the party that is still smarting from a thorough thrashing in general elections held in October 2022.
Mphaka this week told thepost that he will challenge the decision to block him in the courts of law.
“They are crazy people,” Mphaka said.
“I will not allow this to happen,” he said.
“I have already instructed my lawyers to launch an urgent application in the High Court to challenge the decision before Friday this week.”
He complained that it was not clear why the party had decided to kick him out of the race after he spent a lot of time and resources campaigning.
Mphaka said the national executive committee “usually allows members to contest for positions without considering whether they were ever in the constituency committees or not”.
The contenders in the race are former Water Minister Samonyane Ntsekele, ex-Police MP Lehlohonolo Moramotse, former Minister in the Prime Minister’s Office Leshoboro Mohlajoa, and Maseru Star Taxi Association member Sekhonyana Mosenene.
A member of the national executive committee told thepost that “many of us support Mphaka and Kefeletsoe at all costs”.
“We were dismayed when we saw the circular removing the duo from the race,” he said.
He said many ABC members were rallying behind Mphaka because “he has been campaigning even before everyone could start”.
“They know he has lots of followers.”
He said it is unfair that Mosenene has been allowed to run but he has never held any position in any constituency except that he represented his taxi association in the ABC national executive committee.
“Why has he been allowed to contest yet he is just like Mphaka and Kefeletsoe?”
He complained that Sekhonyana, while representing taxi operators in the committee, was eventually made the deputy party spokesman despite not being in any constituency committee after ’Matebatso Doti resigned from the position.
“Mphaka was chosen by the party to lead the 2022 elections campaign teams and develop a party manifesto,” he said.
“He was allowed to do all that without being involved in any party structures.”
The party’s spokesman Montoeli Masoetsa declined to comment.
Dr Manamolela told thepost that “the decision was not made by the party’s national executive committee”.
“I do not want to talk much …but it is not true that the party’s NEC decided to remove Mphaka and Kefeletsoe”.
Kabi could not be reached for comment.
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