Tuesday, June 19, 2012

Zambia: The untold agonies of Care-givers

Picture by Miyon Kautz, World Vision Zambia

Nursing a loved one during an illness comes as a family responsibility to some people and part of the marriage vows to others. But whatever the case, it is an obligation that requires individual sacrifice to save a life.
While it is understandable that a patient receives undivided attention, great care and support should also be given to care-givers, also known as ‘bed-siders’ in most Zambian hospitals.
Care-givers spend countless hours attending to sick family members who may either be in hospital or at home. Their duties are mainly physical and include washing, bathing and feeding the patient.
Depending on the willingness of family members, these duties can be alternated. Unfortunately, some care-givers spend weeks and sometimes months without getting any relief.
Not too long ago, I was hospitalised at Zambia’s highest referral health facility, the University Teaching Hospital (UTH) and I got to see first-hand the emotional and physical stress it takes to take care of a sick person.
My diagnosis, a brain infection, which triggered on and off mild seizures, usually lasted a few seconds and meant I was very much aware of my surrounding.
I was admitted in the heavily-congested ‘Filter Clinic’ for the first night, with more than 15 other patients, each with one or two people by the bedside looking after them. I had my sister spending the night in a chair next to my bed.
We both did not sleep much and we did not talk much either. I felt as if by talking I was being disrespectful to care-givers whose relatives mourned and screamed in pain. I even felt guilty getting out of bed because they had to struggle to put their loved ones in wheel chairs before wheeling them to the bathroom.
Although I did not hear a single one of them complain, the troubled faces of worry and sometimes frustration told all that needed to be said.
The woman next to me was on life-support. A man and woman watched helplessly over her. In a conversation with my sister, the woman explained that her cousin had collapsed the day before. Diagnosis was a stroke. The elderly man who never left her side was her husband.
I also observed a man some few beds from mine. He was the only one in the room who seemed to have had as much energy as I did. He walked unaided to the gents but I was shocked when he died in the early hours of that morning. His bed-sider collapsed. I heard that she was his wife.
The boy opposite my bed had clearly been sick for a while. His body was frail. While his mother made conversations with him and smiled, I caught her in tears when the boy fell asleep.
I could not see the faces of all the patients but I was able to get a clear picture of the care-givers' desperation as they struggled to feed, clothe and make bed changes. It was at this point that I realised the impact of Zambia’s shortfall in health-care personnel.
The ministry of Health estimates that Zambia’s public health institutions, including the UTH are operating at 50 percent capacity; with the doctor to patient ratios standing at around one to 12,000. 
This shortfall means that care-givers have to help-out the few nurses in dealing with the patient needs. Regrettably, due to lack of training and perhaps emotional involvements, the process can be frustrating.
The next day, I was moved to what was to be my home for the next nine days. I felt relieved. Unlike the filter clinic, things at the High Cost wing seemed calm. Perhaps it was because 90 percent of the ward remained unoccupied. In total, it had four patients, inclusive of myself. I was relieved for my sisters who were already taking turns in taking care of me.
The sanitary conditions were better and the over-worked nurses were more attentive.
However, it was there where I witnessed the strength and patience it takes to look after a sick person. Opposite my bed was a woman in her 40s. She was in a state of confusion. The emotional and physical abuse she inflicted on her sister, who she accused of wanting to kill her, shocked me.
Surprisingly though, she developed a liking for one of my sisters who took over the responsibility of feeding her and making sure she took the medication.
Her sister was not allowed to touch her food, not even water. If she did, it had to be discarded. She was forced to sleep under the bed, pretending to have left. One day, I witnessed her bend over and empty a bottle of water on her blanket. The sister took walks to calm herself down.
I also remember Tina, a young lady suffering from malaria who had a lumbar puncture. Her guardian was a heavily-pregnant young lady. Despite her condition, which made it difficult for her to attend to all of Tina’s needs, none of the woman’s relatives came to help her out.
She struggled to feed and bath her knowing that a call for assistance to the nurses meant an extra charge. One evening, after she had tucked Tina into bed, exhausted, she tried to leave and spend the night home, only to be called back by the nurses.
I realised that whether in high-cost or low cost wards, most nurses go to sleep soon after midnight. Their duties, it seems, mainly involve checking the patients’ temperature and blood pressure as well as delivering medication. It was the bed-sider's responsibility to watch over the patient during the remainder of the night.
Two days before I was discharged, I was awakened by someone wailing. The woman in the side ward had died. I never got to see her but had watched her mother trek to the bathroom every so often.
All I knew was that she did not want to die. For two days she screamed, saying she wanted to live and raise her children. Her mother was inconsolable.
Six hours later I was awakened by another cry. Tina had died and we found out that she had been an employee of the pregnant woman who had only worked for a month before she got sick.
Wailing, the lady asked how she would explain Tina’s death to her relatives who lived in another province. She also wondered how she would manage to transport the body and meet the funeral expenses.
Three hours later, the elderly woman who had been brought in two days before, also passed-on. She was the same woman who had been next to me in the filter clinic. Her husband and cousin were witnesses as she took her last breath, both were grief-stricken.
In a country where people do not culturally accept professional counselling and still consider it a trend synonymous to white people, I often wondered where one gets the emotional strength to continue giving support and love to their loved ones during such times even when they are exhausted.
Months later, my siblings and I suddenly became care-givers to my mother who suffered from dementia. The encouragement I got was “be strong, now is not the time to break-down, take it one day at a time”.
I guess this is how bed-siders do it; they take each day it as it comes, watching helplessly and hoping for the best. I realised then that one has to dig deep within themselves to find the strength and patience to care for a person who is ill, especially those suffering from terminal illnesses because love alone is not enough.
Care-givers go beyond relatives and friends. Most of them take the time to nurse even total strangers because of their desire and passion to save a life. We should all salute care-givers, as even in death, they are life-savers indeed.

1 comment:

Vusa Sibanda said...

This is an excellent anecdotal piece.