PUBLIC SERVICE ANNOUNCEMENT

So have you heard there is a new virus in town? I am sure you have. Truth be told it has got everyone in a frenzy.

What is causing the occurrence or recurrence of these new or relatively new infections?  Some of the reasons they are on the increase include resistance to treatment agents, globalization and increased animal and human interactions. Yes, we might discuss that on a later date. For basic information on coronavirus read the following https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

 Despite the progress made in healthcare globally, we still seem unable to quickly contain these infections. This is because we still lack greater than ninety percent compliance in the following areas.
1. Hand hygiene compliance.
2.Cough etiquette compliance.
3. Prevention of corrupt practices.
4. Knowledge transmission to the public and clinicians.

So let me elucidate, any disease-causing organism is transmitted through one of the following ways.

• Direct contact-  ie Human to Human, Animal to Human or Mother to the unborn child. Often these diseases are transmitted through contact with infected body fluids e.g when one coughs or sneezes, unprotected sexual contact, animal scratches, animal bites, etc
• Indirect contact- Through fomites such as when you touch a doorknob handled by someone ill with the flu or a cold.
• Insect bites -Some insects are a medium of disease transmission eg flies and others transmit diseases from one host to another for instance mosquitoes.
• Food contamination- Ingestion of improperly cooked food, fruits or contaminated water.

As the general public, how then do we help in containment of the emergent and reemerging infections?

• Practice effective hand hygiene.

Did you know that effective hand hygiene is actually the most effective way to curb most infections? The World Health Organization defines hand hygiene as any practice that relates to hand cleansing. As of now there are two main globally recognized ways of achieving this. They include the use of soap and water for visibly soiled hands and the use of hand sanitizers. 

Follow the link for more information https://www.ncbi.nlm.nih.gov/books/NBK144046/

For us, as health care workers a lot more details go into all this but for the community at large, it's basically important to practice hand hygiene as often as possible. The common instances to do so include.

1. Before, during, and after preparing food
2. Before eating food
3. Before and after caring for someone at home who is sick with vomiting or diarrhea
4. Before and after treating a cut or wound
5. After using the toilet
6. After changing diapers or cleaning up a child who has used the toilet
7. After blowing your nose, coughing, or sneezing
8. After touching an animal, animal feed, or animal waste
9. After handling pet food or pet treats
10. After touching garbage

Follow the link for more information  on even how to
handwash.https://www.cdc.gov/handwashing/when-how-handwashing.html.

• Cough etiquette/ Respiratory etiquette

Cough/respiratory etiquette are terms used to describe infection prevention measures to decrease the transmission of any disease transmitted through droplets for instance in the cases of flu. Always remember to:

• Cover your mouth and nose with a tissue when you cough or sneeze.
• Put your used tissue in a wastebasket.
• If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.
• Perform hand hygiene after having contact with respiratory secretions and contaminated objects/materials.

• Stopping corruption

 Some diseases are worsened by practices such as paying bribes for false documentation of vaccination, false documentation of treatment received for some conditions and sale of equipment that may be used for diagnosis of diseases and more commonly misuse of funds allocated to educating the public. Once we call out anyone noted to do the above, we then break the chain of corruption, therefore, making sure we are all safe.

In addition to complying to the above. Other ways of mitigating infections include.

• Proper preparation of food- Ensure that you eat properly cooked and stored food. You are at liberty to inquire about the certificate of health from your food provider. Follow the link to read the hotels and restaurants act in Kenya http://kenyalaw.org/kl/fileadmin/pdfdownloads/RepealedStatutes/HotelsandRestaurantsAct_Cap494_.pdf.
• Do not handle carcasses of livestock/ animals that have an unidentified cause of death. Call appropriate health personnel.
• Keep a travel diary of some sort highlighting where you traveled, timespan and occurrence of any illnesses. This makes it easier for health personnel.
• Being receptive to quarantine measures advised. for instance travel advisories issued, use of protective gears offered like masks when offered, etc
• Seek clarification - Always ask when information seems unclear and only visit reputable websites to avoid propaganda.

As I conclude let us aim to always play our expected roles tenaciously and diligently. At a personal level do not forget to

DEPLETED

“Just because you take breaks doesn’t mean you’re broken.”
 Curtis Tyrone Jones

Have you been to a hospital lately? How did your health care professional handle you? Did you find any mismatch between their words and actions?  Were they rude despite being unprovoked? Did he/she look angry, haggard or frustrated?  They are probably suffering from burnout.



Burnout is a state of physical, emotional, and mental exhaustion caused by the depletion of one’s ability to cope with one’s environment, resultant from one’s responses to the on-going demand characteristics. It may occur in any profession but unfortunately, it has often been linked to those who are in the "helping professions" for instance nurses and doctors. Please follow the following links to read more on this https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176698, https://pdfs.semanticscholar.org/6c09/83e788957e79609bb1a19d496e46a6542ad5.pdf. According to the World Health Organization healthy workplace framework (2009), data collected showed that an estimated 2 million men and women die each year as a result of occupational accidents and work-related illnesses or injuries, while 8% of the global burden of disease, is from depression that is currently attributed to occupational risks. This, therefore, means that the healthcare service delivery system is at a threat unless something drastic is done.


Why should I be concerned about the burnout of health professionals? We should be concerned because studies have shown that burnout increases staff turn over, decreased job satisfaction, poor patient interaction and increased possibility of occurrence of medical errors.


Different studies discuss on several causes of burnout, below are some examples.

• Moral distress -occurs when “the person is aware of a moral problem, acknowledges moral responsibility, and makes a moral judgment about the correct action; yet, as a result of real or perceived constraints, participates in perceived moral wrongdoing".
• Physical and psychological environments.
• Dealing with death and dying 
•  Inadequate preparation to address the emotional and spiritual needs of patients and patients’ families
• Insufficient staff support

When W.H.O  established that burnout is indeed a looming crisis. They generated a definition of a healthy workplace environment. They defined it as an environment in which workers and managers collaborate and use a continuous improvement processes that protect and promote the health, safety, and well-being of all workers. To read the full report please follow the link https://www.who.int/occupational_health/healthy_workplace_framework.pdf.

For this to be achieved they recommended that the following needs should be met.

• Health and safety concerns in the physical work environment;
• Health, safety and well-being concerns in the psychosocial work environment including organization of work and workplace culture.
• Personal health resources in the workplace; and ways of participating in the community to improve the health of workers, their families and other members of the community.

How can the community help health professionals?

• Encourage loved ones to take vacations or engage in fun activities; on some days one needs to get away from the hospital setting
• Use encouraging words on them e.g praise one who exceeded their expectations
• Set realistic expectations for them e.g we need rest, we at times cry too when overtaken by grief, we get frustrated, we occasionally need to be reminded why we started out in this field, etc.

In conclusion, as more light is being shed on burnout lets remember that we are all affected both directly and indirectly. There is more that needs to happen such as candid discussions with all stakeholders involved. As we continue to generate an understanding of this phenomenon lets embrace that;

CULTURAL COMPETENCE

Where do you work? Does your job involve interacting with different cultures? Are you aware of the biases that may crop up in you as a health care provider? Unsure of your answer. I hope by the end of this you will realize what I mean.

The American Sociology Association defines culture as" the languages, customs, beliefs, rules, arts, knowledge, and collective identities and memories developed by members of all social groups that make their social environments meaningful". Is this important to us? Yes! It is important because it directly affects how we provide care to our patients. Have you come across the term Transcultural nursing? This is an area of study that focuses on how patterns of behavior in health, illness, and caring are influenced by the values and beliefs of specific cultural groups. It applies this knowledge in the planning and provision of culturally appropriate care. Please follow the links for more information https://journals.lww.com/nursing/Fulltext/2005/01001/UNDERSTANDING_TRANSCULTURAL_NURSING.2.aspx, https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-2-053.php?jid=ianhc

As a nurse one often tends to work in a different set up every few years and with this, one tends to interact with people from different backgrounds. Of all places, Mombasa for me took a bit of adjusting and I think I still am adjusting. Being a tourist destination it is very multicultural. Therefore, it offers a great opportunity to put one's cultural sensitivity to the test. When I now reflect on it. I have realized adjusting was slightly difficult because of one thing, ethnocentrism. 

Ethnocentrism is the view that one's own culture is better than anyone else's culture. It may present itself in the most subtle of ways or at times very blatantly for instance when a patient informs us that they are unwell due to past transgressions. What is the first thing that comes to your mind? Reflect on it. Did it affect how you handled them? Be honest with yourself.

 Do you finally see why cultural competence is important?

From our above definition, we realize that culture can be easily categorized into two; the seen and unseen aspects. See below

 Cultural competence in nursing helps one to

• Develop awareness of one’s own sensations, thoughts, and the environment without letting it have an undue influence on those from other backgrounds.
• Demonstrate knowledge and understanding of the client’s culture.
• Be more accepting and respectful of everyone's cultural differences.
• Aid in adapting care to be congruent with the client’s culture.

So what levels of cultural competence do we fall in? To fully understand this, there exist different self-assessment tools one may use. To access the most recent versions is at a fee but one free example is the Ethnic-Sensitive Inventory ESI; Ho 1991. Look it up. Cultural competence is categorized as

• Unconscious incompetence which is not being aware that one is lacking knowledge about another culture
• Conscious incompetence which is being aware that one is lacking knowledge about another culture
• Conscious competence which is learning about the client’s culture, verifying generalizations about the client’s culture, and providing culturally specific interventions
• Unconscious competence is automatically providing culturally congruent care to clients of a diverse culture.

By understanding the above we then can provide culturally congruent care by 

1. Cultural Care Preservation/Maintenance -where we look at what we can do to preserve and maintain the cultural practices of an individual or family while receiving safe, holistic care somewhere in the Healthcare Delivery System. For example when we allow for a religious leader to pray for a loved one before they are taken into theatre or for instance or we encourage direct care such as bathing, feeding, and other activities of daily living by family members who may be interested in actively contributing in the care of a loved one
2. Cultural Care Accommodation/Negotiation -where we look at what we can do to accommodate the patient and negotiate with the patient/family within the healthcare environment to provide culturally congruent care, For example, when we allow the placing of a band on the navel of a newborn as it is believed it provides healing and protection. 
3. Cultural Care Repatterning/Restructuring- where we look at what we need to do with the patient and family to re-pattern or restructure their lifeways to promote healing and wellness, always being cognizant of the cultural influences that affect why they do what they do in their life experience. An example is when there is a patient who does not believe that they need an advance directive because “death is up to God.” The nurse can educate her about having her wishes being followed when she can no longer make decisions or speak for herself.  Explaining that by creating advance directives, her wishes will be followed

In conclusion, as we continue to make ourselves more visible as professional nurses. It is valuable that we always recall this quote by Maya Angelou which states;

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