Like most of us, medics also suffer mental breakdowns from dealing with traumatic events and tear-jerking medical cases exacerbated by long, odd working hours. Though the general public perceives medics as superhuman, the recent case of James Gakara, who was found dead in his house in Nakuru alongside his two children in September, drew attention to the vagaries of mental stress in the profession.
The other case was that of Lydia Wahura, who died by suicide at a Kenyatta National Hospital parking in June. The 35-year-old postgraduate medical student at the University of Nairobi had even notified close family and friends of her intentions: “I am so so so so sorry but I don’t expect forgiveness,” read her suicide note. I am scared of dying, but I am more scared of living...life is not what I expected.”
Yubrine Moraa, an internal medicine consultant and health advocate, knows too well what medics go through and says she sought help to deal with trauma when she was overwhelmed by the earliest cases of Covid-19 in Kenya.
She recalls trying to act like a motivated soldier, “but long working hours or watching your colleagues succumb to the virus” would put her down, besides having anxiety and panic around her being the possible next person to acquire the virus “or the uncertainty of what will happen to you beyond the professional life.”
Dr Moraa’s fear of contracting the virus and transmitting it to her family made it impossible for her to attend to her children, who could not run and hug her like before. “They knew mummy had to clean up and change,” she says, adding: “I knew they were missing out on maternal love... then the stigma against them by our neighbours because their mother is a doctor and could be the one spreading the disease to them.”
Mental terror struck when her colleagues started succumbing to the virus. Experiencing symptoms similar to a Covid-19 patient worsened matters. “I would sit down and cry wondering if I was next, yet everyone expected me to just show up. There were mornings my body would not even move,” says Moraa, who sought help when she realised she was snapping at the slightest provocation.
“We are only human. The perception out there is we chose this career because we are made of steel. There is that expectation that we don’t get affected. People should not think we have any superpowers; we are just ordinary people doing an extraordinary job,” says Moraa. She advises colleagues to be self-aware and open up, especially during debriefing after handling traumatising cases.
Davji Atellah, the Secretary General of Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) concurs with Moraa that doctors are human and experience all things other people experience, especially during the pandemic.
According to Dr Atellah, financial constraints are some of the main causes of mental stress to medics since devolution of healthcare also came with the attendant hazard of delayed salaries leading medics to be blacklisted by the Credit Reference Bureau for defaulting on loans.
Besides stress and frustrations from their employer, Atellah reckons long working hours due to shortage of workers does not augur well, “considering we also have people who have underlying conditions.”
He says Dr Gakara and Dr Wahura’s were cases of mental stress stretching to breaking points from bottled up emotions, including going through trauma after some surgeries and preventable deaths due to lack of proper equipment and drugs.
KMPDU, says Atellah, has a committee dealing with doctors’ welfare. That includes dealing with “stigma regarding the mental health of the doctors”, besides offering them “psychosocial support and safe spaces to open up”. This, he says, should get to the counties to ensure proper numerations, timely payment of salaries, bridging of manpower gaps and having safe spaces for debrief.
However, Grace Gitau, a counselling psychologist and chair of the Counselling Psychology Department at Nazarene University, says some mental issues emanate from medical training institutions.
“The curriculum is very demanding, very costly. Some toxic relationships between the lecturers and students are never well resolved because they do not know where to take their issues,” she says. “That is why you find them having several retakes or taking a long time to complete the course.”
Dr Gitau also reckons that some join medical school with their own underlying issues, or had traumatizing experiences during internship translating to a mentally unstable medic when they eventually start practicing.
“Whatever you went through, if it was not processed during training, most likely you will carry it wherever you go,” she explains adding medics who harass patients are themselves “products of harassment because what you get is what you give, and you act on your autopilot brain.”
Dr Gitau concludes that “counselling in medical training institutions should be made mandatory because most medics may shy away from seeking help due to the nature of their job. They need to address burnout and stress before trauma affects the function of the brain.”