On an interesting phone call with one of my mentors, who happens to be a nurse, she made a comment that strongly affected me.
She pointed out that midwives can sometimes seem rather severe when dealing with patients who have “normal” complaints, for example, headaches.
Even though the patient is actually in real pain, the reaction might be something like “it’s not that serious”. Her reason for this was not that the midwives didn’t care; rather, since they spend their entire careers dealing with a kind of pain most of us will never have to experience: the pain of labour and childbirth. A headache can begin to seem minor in comparison.
The comment is in fact a narrative concerning the fate of those who spend their whole careers taking on other people’s suffering, and it highlights a point which Ghana’s health system fails to address sufficiently: the people who look after the sick also need to receive care.
This is unfortunately a documented pattern. The mentor’s observation corresponds to a phenomenon that has been well studied in the research literature. When caregivers have repeated close contact with other people’s pain and trauma, this affects the way they process pain, including their own ability to empathise. Those who study this phenomenon describe two related effects:
Burnout involves emotional exhaustion, depersonalization (which is a form of emotional numbing or detachment from patients), and a reduced feeling of achievement in one’s work, all of which are caused by chronic stress at work.
Compassion fatigue: this is the particular kind of toll resulting from prolonged emotional involvement with other people’s suffering rather than just from a heavy workload. It appears in the form of irritability, a decrease in empathy, and a reduced sense of satisfaction from work which had previously seemed meaningful.
A study involving doctors discovered that more experienced physicians assessed patients’ pain as being less severe than their less experienced peers did when viewing the same video footage.
This measurable reduction in the perception of pain corresponds to the number of years they have been in practice. Midwifery research has come up with a comparable result: continuous empathetic involvement with women in labour, particularly in cases involving traumatic births, can result in emotional exhaustion, secondary traumatic stress, and even symptoms of post-traumatic stress.
One study in the UK found that about one-third of the midwives who had experienced a frightening perinatal event met the clinical criteria for PTSD. Researchers are now more and more referring to this as a known hazard of jobs in the caring professions, rather than as a personal shortcoming.
The evidence from Ghana specifically shows that this isn’t only an international pattern.
A study involving 365 health workers at 12 major healthcare facilities in Accra revealed that although the majority were managing themselves reasonably well, almost one in five were in an “alarming,” “acute crisis,” or completely “burned out” condition.
The fact that burnout was linked to occupation, length of service, marital status, and having children indicates that the effects increase with both the amount of work exposure and with personal responsibilities outside of work.
While dealing with COVID-19, healthcare workers in hospitals in Accra said that they experienced considerable stress and burnout since the hospitals had not been adequately prepared for the extent of the crisis, alongside feelings of fear, anger, and depression. They still managed to remain compassionate towards their patients.
Throughout the country, there is a severe lack of support for those who are supposed to provide mental health care. While Ghana has about 3,300 doctors and more than 84,000 nurses and midwives, it has only 39 psychiatrists and 244 psychologists altogether. There is almost no formal support available for the workers who suffer the most daily emotional strain.
The remark made by the mentor regarding midwives and headaches is not actually an example of poor bedside manner; it is merely a symptom. When healthcare workers are subjected to continuous emotional exposure, three things tend to occur simultaneously:
The patient’s experience is harmed since burnout and compassion fatigue lead to a dismissive attitude towards minor complaints, shorter tempers, and less warmth, precisely in those situations where a patient leaves feeling as though they have been ignored or where a frustrated exchange becomes unnecessarily worse.
The quality of clinical care is compromised. Research shows that burnout is associated with more mistakes, slower decision-making, and decreased attentiveness, which pose actual risks to patient safety, not merely a problem relating to communication style.
The number of workers decreases since exhausted health workers are more likely to quit the profession or to leave the country altogether, thus worsening the staffing shortages which already make health work in Ghana so demanding.
The case for therapy should be routine and not remedial. The main point is simple in that when you spend your entire working life taking in other people’s fear, grief, and suffering and at the same time try to maintain a family life and a personal life, you need a place where you can relieve yourself of it.
At present, most health workers in Ghana have no such place. The mental health services in Ghana are overextended and therefore unable to reach the general population, never mind offering regular, structured support to the staff working in hospitals.
After traumatic cases such as a difficult birth, a preventable death, or an aggressive patient interaction, there is a built-in debriefing rather than staff being required to go straight to the next patient.
Confidential counseling should be part of the hospital’s human resources procedures, just as physical health checks currently are.
Offering training that specifically identifies compassion fatigue and burnout so that the staff has some terminology to describe what they are going through rather than just feeling as though they are failing at their job.
This situation does not immediately remedy Ghana’s fundamental lack of psychologists and psychiatrists. Yet it properly redefines the issue: a midwife who appears harsh about a headache isn’t the disease; she is displaying a symptom of a system which has asked her to bear a huge amount of other people’s pain without having once asked her how much pain she is carrying herself.
By Keziah-Norah Breindel Lécosson