Saving lives and selling tomatoes
July 6, 2011 -- Two media items appearing today in southern Africa illustrate the tragic conditions nurses face in the region, which is plagued by low salaries, severe understaffing, and the widespread emigration of skilled health care workers. "Zim nurses 'reduced to selling fruit,'" a South Africa Press Association article on the News24 website (Cape Town), reports that nurses in Zimbabwe "have been reduced to selling tomatoes and other fruit to survive due to poor public sector salaries," according to health minister Henry Madzorera. The minister also notes that Zimbabwe has suffered a "debilitating" brain drain of nurses not only to nations like Great Britain, but also to neighboring Botswana. However, on this same day, the Botswana Gazette (Gaborone) ran the strong editorial "Pay the nurse and save lives," which makes clear that Botswana itself faces the same problems. The editorial, relying heavily on Chief Nursing Officer Thandie Kgosiesele, urges the government to find a way to retain and support the nation's health workers. It also gives readers a remarkably good sense of why nurses are important, not just in providing basic custodial care, but also in saving lives, for instance through their close observation of patients. We thank both publications for telling readers about the terrible shortages of resources that nurses face in southern Africa.
"Some senior nurses are selling tomatoes in our streets"
The South Africa Press Association report on the News24 site relies mainly on remarks Minister of Health Madzorera recently made after the United States donated a generator and computer equipment to the Nurses Council of Zimbabwe, which tracks the registration of nurses in the "virtually-bankrupt country." The health minister noted:
We are left with immediately qualified nurses, mostly. Some senior nurses are selling tomatoes in our streets. We need them to teach the young ones.
Madzorera described the health sector "brain drain" as "debilitating," noting that the nation now has "more than 2000 vacancies for senior nurses as they leave for a better life, mainly in Great Britain, New Zealand, and Australia and in the region especially neighbouring Botswana." He stressed the need to "remedy" things that had occurred in recent years, which the piece suggests refers to the coalition government formed two years ago by President Robert Mugabe and Prime Minister Morgan Tsvangirai.The piece closes with a few background details about the poor situation of civil servants in Zimbabwe, noting that they have been on strike for more than three weeks because of endemic "poor salaries and out-of-date equipment." The workers have reportedly asked for a 200% salary increase; the government has offered 50%, and the workers are reportedly divided over the offer. The piece ends by noting that the lowest-paid government workers currently earn less than $200 per month.
The News24 report is short, but it conveys helpful basic details about the situation of nurses in Zimbabwe. It might have told readers what nurses specifically earn, and whether they are among the strikers. But the piece does include the health minister's comment about what the senior nurses should be doing--teaching the newer ones--which at least suggests that nursing is a profession led by senior nurses. And it offers the devastating image of the nurses being forced to sell fruit on the streets to survive. Who knew buying fruit could be that good for you?
"Pay the nurse and save lives"
The Botswana Gazette editorial's headline, above, is a great one. The piece explains that nurses are "critical to life" both because they "save lives when they can" and because they make those who are dying "more comfortable . . . so that they should die in peace." And it is also "usually the nurse, before the doctor, who greets the patient and asks him or her what is wrong," a formulation that is accurate, though it does not quite capture the importance of triage or the expertise required to do it.
However, the piece notes that, as "Chief Nursing Officer Thandie Kgosiesele pointed out at a recent workshop," the nation is not returning the favor and taking care of its nurses.
Nurses are among the worst paid, most overworked and totally unappreciated professionals in this country. In fact it is only when health facilities are run down and are staffed by few, or no nurses at all -- such as during the recent public service sector strike -- when it dawns to us that nurses are not essential in word only, but in real life too. Patients lay unattended at clinics and hospitals during the strike; some facilities were actually closed because the staff was on strike. Then minor ailments became major health problems and some people sadly -- and needlessly too -- lost their lives.
The piece says that the government responded not by addressing the nurses' concerns, but by invoking an "essential services" law and forcing them back to work. The editorial agrees with Kgosiesele that if nursing is considered essential, then it should be rewarded accordingly.
At the same time, the editorial says, Kgosiesele is correct that nurses should be "truly professional," and avoid bad conduct that some of them have apparently engaged in, such as "taking bribes and not wearing the prescribed uniform."
The piece also goes on to add:
We could add a few more that our readers have complained about over many years: neglecting to do such basic nursing duties as feeding or washing patients, which are really not simple but sometimes life saving, as food can be part of holistic treatment while bathing affords the nurse the opportunity to observe the patient's condition closely.
These passages are not happy ones, and of course some of them depict nurses providing poor care. But we are struck by how strongly the piece conveys the importance of nursing to the survival of patients. We note not only the repeated emphasis on saving lives generally, but also the astonishing recognition that "basic nursing duties" like feeding and washing are "really not simple," but can actually save lives because food is part of the nurses' holistic treatment and bathing can allow nurses to observe patients closely. Implicit in that is that nurses have the skill to recognize changes in patient conditions and to act accordingly. In addition, the earlier passage notes that when the nurses were absent during the strike, "minor ailments became major health problems" and patients died. Once again, implicit in this is that nurses would have made the difference. The piece might have spelled out more precisely how nurses save lives, but still, it is unusual for the media to look deeply at what may seem like simple custodial care. We were also intrigued by the statement that "nurses are not essential in word only, but in real life too"--is that a recognition that nurses often receive lip service as wonderful, trusted angels, but rarely get the genuine respect that would justify giving them adequate resources?
While the editorial sees the harm that results from a lack of good nursing, it expresses considerable sympathy and understanding for the nurses' situation, giving readers some idea of why nurses may fail to provide good care by noting that they are "among the worst paid, most overworked and totally unappreciated professionals in this country." The paper says that the nation risks entering a "vicious circle" in which "poorly paid nurses perform poorly to spite their employers, who then perpetuate the poor working conditions," driving the situation in an endless loop. The piece concludes by discussing the damage that will result if the government does not change its "mulish attitude toward such essential workers." The editorial says physicians in the public health service are in a similar situation, noting that "these professionals -- nurses and doctors -- are rare skills in many countries, especially developed countries that are unable to train sufficient numbers to [staff] their health services." If things don't change, the piece argues, these health workers will "take flight to countries which will appreciate them more," and Botswana will have to "scramble around the world" looking to replace them at a higher cost--as the News24 piece suggests is already happening with nurses from Zimbabwe.
The editorial's grouping of nurses together with physicians as "essential" "professionals" whose loss would pose a grave threat to the nation's wellbeing is very helpful. We thank the Botswana Gazette.
See the article "Zim nurses 'reduced to selling fruit'" posted July 6, 2011 on the News24 (Cape Town, South Africa) website. You can write to News24 by clicking on Contact Us at the bottom right hand corner of the article's page.