Trends of Violence against Healthcare Workers and Facilities
What did Adam say to eve on being driven from paradise? Well my dear Eve, its time yet again for transition. The irony of this joke is that it still holds true, every society is in a continuous wheel of transition .Today’s norms will be tomorrow’s myths, What’s true now will be false tomorrow. In the same context what’s being practiced now will be shunned later. It is how things are and will be. But we cant deny importance of change in development of a nation, if that change is productive what more can we ask for, that’s not always the case, some changes push back nations further steps and one such example is violence.
Violence is the next big epidemic; it started as a spark and is now blazing in most if not all countries. This global issue has been pondered on so many times that even World Health Organization gave forth a definition, it defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation”.
Although trends of violence has increased in all fields be it education, politics, industries, social and economical but the most devastating rise of violence is seen against healthcare workers and facilities. For who else you turn to when you are in pain? In the past hospitals were considered sacred places and doctors were regarded as saints who sacrificed their personal pleasures to care for the sick ",who kept their life on hold so yours can be save. Medicine was considered a prestigious field but the past is gone with winds, Nowadays the most exploited profession is medicine. Every second a healthcare worker somewhere faces violence by the hands of patient or their attendants. Between 8%-38% of healthcare workers suffer physical violence at some point in their careers. Even more have to face verbal abuse. In disasters and conflict situations violence and political aggression is directed towards healthcare workers.
Saving a life is as if saving whole of humanity. Who else does this ayah best define than a doctor, an individual whose life highlight includes easing suffering of injured, abused, burnt, diseased, to comfort those in pain. To ensure whatever life an individual has left will be socially, economically and personally productive. He, who eases the transition from this world to hereafter, And to think this person will be the most celebrated, admired and respected is a lie. Alas, with the unstable political and economical situation doctors are now contemplated as formed mafia, whose purpose is to cash the patient’s suffering and bring worldly benefits.
Do you know how hard it is for a doctor to work efficiently despite being under continuous stress? Be it work place stress, long working hours, devising treatment plans and establish that no harm gets done and the list goes on. The irony to think it is wise to add on to that burden and envisage a better service. Every ward of every hospital tells this story. Just last month, I witnessed an attendant having a heated argument with a doctor, right across the across the emergency department, disrupting the environment of the hospital. The said doctor was scheduled to operate on the patient and his attendant had the gut to provoke him just before the procedure, the nerve of him! A patient or visitor may witness or participate in a violent event but will soon be gone from the hospital, the care provider however have to stay in that environment and will have t face violence day after day. This leads to continuous physical, mental and emotional suffering.
Violent against healthcare worker is a challenging and persistent problem faced by health care professionals. Violence can take any form from verbal abuse to threat to kill. It can range from intimidation, harassment, stalking, beating, stabbing, shooting and other form of assault. If the healthcare provider happens to be female lets not forget sexual harassment. Last year during my summer internship at PIMS a house officer was sexually assaulted in the doctor’s on-call room in the wee hours of one dreadful Tuesday. The shameful fact is that it happened within the premise of PIMS, was caught on CCTV camera and the assailant even forgot his mobile phone, but despite that he was never caught and no action was taken against him. This incident instigated immense protests from young doctors but justice is always late. The fear of the incident caused me and my friends to quit our internship and many doctors also resigned. The already short-handed staff further decreased leading to longer waiting lines, less patient satisfaction and paving way for more violent acts.
Stick and stones will break my bones but words will never harm me_ an old adage but so painstakingly wrong. According to a survey, In Pakistan 77% of physicians has faced verbal and physical abuse. Verbal abuse can vary from name calling, degrading, intimidating doctors with their power, threatening, humiliating refusing to listen to basic instructions, being provocative about treatment options, shouting, regarding doctors an enemy instead of an ally, lashing out on doctors out of mere frustration, taking it an insult to have to wait for your turn, demanding a general practitioner listens to all your family and work related problems in setting where roughly five to six minutes are allotted to each patient and demanding to be treated royally. These may all seem trivial but added up to the stress level of an already overstressed, over worked doctor, it can lead to dire consequences. Instead of thank –you, you get bah! Humbug. Instead of gratitude notes you get death threats. Doesn’t the old African proverb_ the gratitude of a donkey is a kick, portrays the mass’s behavior to heath workers.
I remember reading an article by a doctor on how its like to work in England’s failing national healthcare system, he explained the situations a healthcare system has to face in due to shortened budget, less staff, unavailable medication, refusing admittance to people with common ailments so more critical patients can be admitted. These situations favored more violence attacks to health workers. The British doctor after completing 32 hour duty on exiting the facility fears attack by the angry patients, so much so as if he awaits one to jump out of a bush armed with knives and gun to attack him. Physical abuse is intolerable. We don’t have to quote example of physical abuse from other countries while we ourselves are flourishing in this matter. Every week there is a news headline of a doctor being beaten by an angry patient or target killing of health workers.
As shown by a survey, a total of 105 such incidents were reported leading to loss of 52 precious lives of doctors. These killings are not random by any means and have a disturbing pattern of selection. Usually a result of political, racial differences, religious issues, class difference, and personal grudges fueled by medical error, negligence or just out of pure spite and hatred. To shoot a sign of peace, a white flag, a shade protecting you is nothing short of a cowardly act. According to 2017 revised declaration of Geneva, a doctor pledges to not let any age, gender, creed, ethnic origin, political affiliations, race and social standing intervene between his duty and the patient’s welfare. Its due time we stand by them and ensure to maintain same behavior of society towards doctors as well.
Does the healthcare consist of only the high and mighty glorified doctors only? Of course, not. Team work makes the dream work. Healthcare workers include nurses, hospital staff, lab technicians, ward personal, lady health workers and pharmacists. Their job status does not preclude them from workplace violence. In fact nurses have to interact more with the visitors, patients and their attendants. At present more than five million healthcare workers perform wide range of duties. They ate present are not protected from many health hazards including violence.
Nurses face violence in the form of backlash, rude remarks, frustration, impatience frequently when they try to set restrains on eating, smoking, drinking and maintain discipline in the hospital or when any service is refused. They are the moderators who have to ensure that everything works in order and discipline is maintained at all times. As a rule, disruptive behavior increases during high activity periods and at times when there is interaction with multiple patients for instance during visiting hours, emergency situations, meal times, patient transportation and we can not miss the fact that general level of violence increases during summers and especially during Ramzan. Lack of respect towards the nursing profession in the Pakistani society is a significant contributing factor. There are many reported and unreported cases in which nurses face rape, violence and verbal abuse.
Yolanda Preston, a nurse from Michigan with over 27 years of experience has experienced her share of violence including been screamed at, bitten, punched and had IV poles thrown at her by the patients. Similar cases are observed in Pakistan but are not reported for fear of further injustice, incomplete investigation and careless attitude of policemen towards health workers.
It is often believed that male nurses are better able to cope with such situations but that is not true, in any medical setting whenever there is an un-usually disruptive and aggressive patient they are automatically handed over to the male nurses. Any delay in service, lab report or failing to magically summon doctors during busy hours for their ordinary issues results in brawl from patient’s attendant. Last year in Lahore General Hospital seven staff members were attacked one of them suffered life threatening injuries by the hands of attendant of a patient. The patient was admitted in the emergency unit following traffic accident. The only crime of the staff members was that they according to protocol were not allowing more than one person to visit at a time. Adversity does at a time makes you stronger but if continuous can also cause you to retreat back into shadows. Had mother tressa in return of all her selfless and devoted work and kindness received; Who the hell are you? Why the hell you care? Would she have been able to change healthcare system? I believe not!
To overcome disease you either have to combat it heads on or to increase resistance to its spread and invasion that is possible through vaccination. Many efforts are being taken by the government in this concern, most outstanding is Expanded Program on Immunization, a World Health Organization funded program with an aim to make vaccination available to every child. At present one of its goals is to eradicate polio from this world. Prime Minister, Benazir Bhutto in 1994, founded lady health worker program covered by ministry to provide health care facilities to vulnerable societies. Services include at home treatment, safe deliveries within the comforts of home, counseling, guidance about mother child health, family planning and provision of vaccines at home. According to World Health Organization it was decided on Pakistan National Immunization Day held in November to vaccinate 34 million children. World Health Organization survey reports that 2.34 million children were missing during the vaccination campaign and were not able to get vaccinated. There is an increase in anti vaxers who believe that vaccination is a cause of autism. How anti-vaxxers do statistics: if you have four pencils and I have seven apples, how many pancakes will fit on the roof? Purple, because aliens don’t wear hats. All joke asides, the increased number of unvaccinated children is posing a huge threat to disease outbreaks and causing them to become endemic. This will not only increase burden of disease but also drain of resources and health funding. One of the reasons of failure of vaccination program is the back lash on workers by the society. There have been numerous killings and opposition from tribal areas, mainly the outskirts of Baluchistan and Peshawar. In addition to that anti vaxxers who believe to be harmful to their children causing mental and infertility issues. This retaliation has claimed many lives, drained many resources, driven volunteers away from this campaign. For this very reason Pakistan is one of the two countries where polio has not been eradicated. Vaccinators are not solider they are not trained to battle , the real heroes of this campaign are the vaccinators who keep doing their jobs in high risk areas without fear. If there is anyone who deserves to receive Nobel Prize, it is the health workers.
The first point of contact which a patient has with healthcare system is via emergency services notably ambulances. They provide instant service in the face of accidents, acute severe illness like chest pain, coma, heart attack and gun violence. There purpose is to ensure that patient reaches hospital on time. In a developing country resources are limited, budget provided for healthcare is scanty. To provide efficient services in this meager budget is quiet a task. On top of that in every political crisis the first vehicle to be burned down is usually always an ambulance or a police mobile. Ambulances are destroyed by the attendants whenever their is delay in reaching the hospital and patient expires. What they don’t consider is that instead of making way for emergency vehicle, many motorists and automobile drivers are racing ahead of them or following closely behind them to pass more quickly through the traffic. This attitude of our society needs to be highlighted. They are in dire need to be educated on this aspect. Traffic police should formulate rules regarding ambulances. A careful check and balance is to be maintained and any wrong doer should be fined. Nothing will ever change if we ourselves are not willing to change.
How do you define a sacred place? It is a space distinguished from other spaces, a space which focuses on reforms of its visitors, and a place which offers shelter and heals them. In this context hospital is regarded as a sacred place where person goes to be healed when he is sick or injured. Violence to any religious group comes bundled with attack on their sacred places, be it mosque, temple or church. Similarly whenever there is any hostility against health care workers or agencies funding them, there is concurrent attack on hospitals. An extensive system of basic health units was laid down in Pakistan which was designed to be the primary level of healthcare provided to the people. Had it been successful it would have completely revolutionized the way we see healthcare system. But it could not flourish and vanished because of opposition to that government. Whenever there is medical error, negligence, mishap or death of a patient the relatives retaliate by breaking down windows of hospitals, setting fire to it or causing damage to hospital facilities. What takes man years to build is destroyed in a glimpse by angry people. It is true you are not you when you are angry. Four days ago angry mob set basic health unit ablaze after minors fell sick from anti-polio vaccines. Will this behavior restore their health? Or the treatment they could have been provided in the burnt health units? That could not be possible because of chaos created causing workers to flee from the scene, just cause of their violent actions. Many critical patients would have to face hindrances in provision of their treatment. On top of all that damages have to be repaired, resources which would otherwise have been used in some other necessity are consumed here, that is, of they are ever repaired. Our government and security services need to come on ground with this matter. Silence encourages the tormentor never the tormented.
The world suffers a lot not because of the violence of bad people but because of silence of good people. Violence is an undeniable part of human experience, be it social, occupational or political, it creates immediate damage and brings forth life long changes in victim’s perspective and behavior. Health care workers who were exposed to abuse and violence early in their careers become uncertain about their life choices, they retreat from their careers and some abandon them altogether. The psychological sequale resulting from violence include fear, anxiety, mistrust, frustration, hesitation, depression, nervousness and reluctant to approach patients leading to loss in workplace productivity. They will avoid volunteer works and will favor fields with less patient interaction.
Violence directed against health care workers is a breech in basic human rights. These consequences can have a negative impact on staff retention. They will feel powerless, worthless and will fear criticism. This will result in loss of concentration in their work resulting in more errors, blunders, less patient satisfaction further harming this vicious cycle of violence. It will not only harm the repute of health care workers but also jeopardize hospital’s reputation which in turn will affect patient selection. Hospitals where there is an increased number of violent acts are not favored by patients. Less patient inflow will disrupt funding, budgeting and economy. Reputation of a health facility also influences the worker’s preference to work there, resulting in staff shortage and patient outnumbering staff. Due to increased violence rate against health workers less people go into this field. Medicine is a field which requires continuous inflow of enthusiastic young individuals with innovative ideas. We cannot plant a garden without seeds. Medical students despite increasing violent rates still keep entering this profession willingly with iron hard courage, they are enthusiastic in bringing change in our system and progressing medical advancements further ahead. Let’s not burn out this light but channel it so this light guides more. Many developed countries have already taken this matter into account and they have introduced heath care reforms which provide more security to the workers and the management is designed in a way that there is zero violence policy. Patient rights as well as health care provider’s rights are safeguarded. That is the reason why young graduates prefer working abroad.