I first met Gladys Msiska at a postgraduate conference where she presented findings from her doctoral research into nurse training in Malawi. Her research had uncovered a difficult truth – that many nurses in Malawi were suffering from extreme burnout to the extent that they were insensitive or even verbally abusive to their patients. I was struck by her passionate clarity and her determination to address the situation. Afterwards, I asked Gladys if she would tell me more about her work for this blog, and although she was leaving for Malawi that week, we managed to fit in an hour to talk.
The working environment for nurses in the small African country is extremely challenging – there is a vacancy rate of up to 77% in the profession, a legacy of nurses being recruited from Malawi in the last decade by countries that could offer better wages and conditions. 80% of these emigrating health workers went to the UK, and in 2007, it was estimated by the Guardian that there were more Malawian nurses in Britain than in Malawi. The results of the shortage are that 24-hour shifts are common and nurses can be left alone to tend a ward of up to forty patients.
Recent efforts have largely succeeded in halting the brain drain, but Gladys says that she herself might have been tempted to come to work in Britain, had she not had a post lecturing at Kamuzu College of Nursing. Teaching had been Gladys’ first choice of profession, but she had been selected for nurse training after leaving school, and practiced in rural clinics and health centres before merging her interests by becoming a lecturer and trainer of nurses.
In addition to staff shortages, recent cuts in aid due to political tensions have led to a scarcity of drugs and medical equipment. ‘Nurses witness patients dying for lack of drugs. There is nothing they can do.’ She describes the occasions where patients have been verbally abused as ‘manifestations of tension and frustration.’ While nurses in training do find some nurses they can look up to and emulate, 'They know the image of nursing in Malawi has been tarnished, and they are sensitive.’
Gladys was concerned that the training of nurses in the country, especially of the enrolled nurses who make up a large part of the workforce, was task-based, and had no component that dealt with ethics or self-reflection. Says Gladys, ‘They are dealing with people, with suffering others. Nobody chooses to be sick. The world of a patient is a world characterized by fear and anxiety, and you don’t want to increase their apprehension through how you treat them.’
Gladys is devising a pilot programme to train nurses in these issues, and challenge the way that nursing is commonly practiced. In the future she hopes it will extend to all health professionals, creating a more patient-centred approach to care. She is full of plans for new teaching materials and workshops. It is a time of both turbulence and optimism in Malawi, as new president Joyce Banda brings hopes of better international relations and with that, an improved economic situation.
Yet in the very week that Gladys returned to her country, the Malawi Nation newspaper carried a story of a nurse who beat a complaining patient with a metal bar before being restrained by fellow staff. The nurse was swiftly suspended by her professional body, but it is hard not to think of the challenge ahead for Gladys as a daunting one, but never more urgent.
‘I’m just trusting that things will work out well, ’ she said as we parted.
|Kamuzu College of Nursing, Malawi|