PRESENTLY

“One of the most important things you can do on this earth is to let people know they are not alone.”

 Shannon L. Alder

 

Allow me to reintroduce myself, my pseudonym is Lilylovelong and I am on management for a severe anxiety disorder specifically Agoraphobia. I know right...You are shocked so was  I in the beginning. Most people choose to hide but I am not like most people and here is a snippet of my experiences.  I have a great support system and so far I manage it well. Some days have been rougher than others but it is well. Presently, it is been managed with medications, psychotherapy and counselling.

                                                                                      So what are phobias?

According to DSM V, a specific phobia is an intense and irrational fear of a specified object or situation. This overwhelming fear leads to avoidance behaviour or extreme distress. Globally, about 19 million people live with some form of phobia. Is this a significant or a non-significant figure? You be the judge.

How are phobias categorised?

The American Psychiatric Association lists phobias into three broad categories:

1.  Social phobias/social anxiety disorder - is marked by a fear of social situations in which a person might be judged or embarrassed.
2. Agoraphobia - involves an irrational and extreme fear of being in places where escape is difficult. It may involve a fear of crowded places or even of leaving one's home.
3. Specific phobias - it's the phobia of a specific object such as balloons, needles etc

What risk factors predispose one to develop phobias?

The Mayo Clinic (2022), lists the following risk factors

• Gender - Women have a greater risk as compared to men.
• Age - Specific phobias occur by age 10, however, they may develop later on in life.
• Family history - It may be an inherited tendency or learned behaviour eg when a child repeatedly observes a phobic reaction to an object or situation.
• Temperament -  Studies show that risk is higher in people who are more sensitive, more inhibited or more negative than the norm.
• Negative experiences - Experiencing a difficult, stressful, or traumatic event may trigger an onset of a phobia.
• Learning about negative experiences - Hearing about negative information or experiences

Causes 

There is no known specific cause. However, different research studies describe it as an interplay of the above-listed risk factors.

So what is Agoraphobia?

McCabe E. R. (2022), defines Agoraphobia as an irrational and extreme fear of being in places where escape is difficult. In my case, I do not handle crowded places well and when I do venture I always look and seat close to the nearest exit etc.

It can occur independently or alongside a panic disorder. Often occurs in females and is often affiliated with a mood disorder

 

How does it feel like?

I felt trapped in my own body, and my thoughts were erratic due to heightened senses. I had insomnia for several days on end, The thought of opening the door to step out induced panic attacks, I cancelled hanging out with friends and family, and I had to wear earplugs at all times or earbuds and play specific genres of music to keep me calm, I was increasingly agitated in noisy environments at some point I could no longer use public transport and had to use cabs to move around etc. Generally, It was a lot and that's when I decided to take myself in for a mental assessment.

 

What helps me cope?

1. My belief in God has given me peace that I can't describe.
2. Great support networks from family, colleagues, supervisors and my friends- They keep my mind focused on what matters.
3. My doctors for being great listeners, being accessible, personalizing care and for their patience.
4. Understanding that it's a season and the storm will be managed or completely alleviated. There is great progress thus far.
5. Having access to a lot of study materials has kept my mind calm on rough days as it's a great distraction.

 So what type of care did I need in my season?

Now that the shoe is on the other foot I have quickly realized that most of the care we offer is from a sympathetic viewpoint instead of empathy and that needs to change. In my crisis priority needs were

• Readily accessible practitioners- I needed constant reassurance and guidance on the different medications I was on.
• Living with a caregiver - Some medications gave me antegrade amnesia, blurry vision syncope episodes, and dizziness. this made me a hazard to myself. 
• Time off work- My body needed time to recover, rest and adjust to the treatment and this was facilitated.
• Financial planning strategies - Agoraphobia is an expensive disorder;  during crisis episodes, one only moves around in private means, I needed to be in the company of a familiar person, I needed mouthguards, noise cancelling devices,I needed to keep my possessions in storage etc.

As a carer how do you support someone with a mental illness? 

NB: The following advice is not recommended for all patient groups 

(Better Health Channel) 2022 summarises the care into

• Talking openly and encouraging patients to be honest with their friends and family about how they are doing
• Reading about mental illnesses from reputable websites, such as government or health organisation websites or books by specialists
• Encouraging patients to take an active role in their mental health recovery, get out and see people and enjoy a healthy lifestyle
• Setting limits and letting them know what you can do for them and what you are not able to provide
• Finding out about any local or online training courses for mental health carers
• Joining a mental health support group to meet other people in a similar situation
• Take any talk of suicide or self-harm seriously and speak to a mental healthcare professional about it as soon as possible
• Putting plans in place as a backup in case you go on holiday, have to leave town or are not able to care for them for any reason 

In conclusion remember, "Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they're never weakness." Brené Brown

References

Better Health Channel. (2022). Caring for someone with mental illness.             https://www.betterhealth.vic.gov.au/health/servicesandsupport/caring-for-someone-with-mental-illness

Mayo Clinic. (2022). Specific Phobias. https://www.mayoclinic.org/diseases-conditions/specific-     phobias/symptoms-causes/syc-20355156

McCabe E. R. (2022). Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations,   course, and diagnosis. https://www.uptodate.com/contents/agoraphobia-in-adults

THE UNPOPULAR OPINION

"Some people see the cup as half empty. Some people see the cup as half full. I see the cup as too large."George Carlin.

As more and more people get diagnosed with some type of non-communicable disease (NCD), the more one realizes just how insidious these diseases can crop up. At this point in my life, I am of the opinion that each of us has a disease or a group of diseases that are personal to us. One may be living with it/them or slowly or rapidly you have witnessed NCDs impact people close to you. The WHO estimates that NCDs account for 41 million deaths each year and that yearly, 17 million people die from NCDs before turning 70 (World Health Organization, 2022). In comparison with different geographical regions, low and middle-income countries are more affected (World Health Organization, 2022). 

Extensive research studies have concluded that early disease detection,  health screening and treatment plans that encompass palliative care are essential for NCD management (World Health Organization, 2022). Among my list of personal experiences with  NCDs, my greatest one is stroke. Stroke forms my earliest memories of how vastly a disease can impact someone's life. In my formative years, I could quickly identify something that was different about my grandfather. I remember visiting my grandparents and wondering why my granddad had a different gait? My earliest concerns were; why was he using a walking cane? Why did he need that extra hand to perform his daily activities? Well, it turns out that before my birth he had suffered from a stroke and it had left him with hemiparesis (partial weakness of one side). Looking back, I am grateful that he was well cared for and this was evidenced by adjustments made even around his home to make life better for him. Several years later I learnt that the stroke was a result of Hypertension and that shook me. In my still-developing mind, I concluded that HTN and Stroke were synonymous. I am happy to report that I am better informed now but this experience made me realize of how valuable it is to ensure patients and patients' families need to be educated appropriately and guided on how to provide economic, social, psychological and any other form of support needed. To you my reader which disease prompted you to seek more information 

In 2022 we have vast access to knowledge on these diseases. However, it is still a worrying trend to see it loosely translated to most patient groups and families. This has a direct impact as we see it result in frequent unnecessary hospitalizations. 

I believe we can do better by emphasising improving care delivery in the most basic of ways such as

1. Formulate standard procedures and protocols and actually apply them.

It is sad to realize that GOK generates a lot of materials that end up in the archives. few institutions apply them yet a lot of funding had been directed towards their development. For example, (Division of Non-Communicable Diseases Ministry of Health, 2018). For more advanced institutions there are several resources available and of course, the oldest model of all clinical experience that's backed by feasible outcomes is applicable in those resource-limited areas.

 2. Family and patient education

It is prudent to have an honest discussion on the impact of the disease. Practice empathy instead of sympathy otherwise, you may end up having discussions and communicating nothing. Do not approach it alone utilize a multidisciplinary approach. Reinforce the information repeatedly. You also did not understand all concepts on the first encounter so stop expecting too much from them. Any diseases that need long-term treatment or lifestyle modifications are already a source of stress and may hinder comprehension in some people (Traeger et al., 2019).

Key points often missed out include:

• Impact of the medication on their daily activities/ need to modify nutrition due to food & drug interactions, duration of medication use, when to go back for review even if on medication
• Rehabilitation-  Details on how it impacts their health, breakdown of the details on the type of adjustments that may be needed around their homes eg including handlebars, cost of said therapies and how they can access them at an affordable cost but not compromising on quality
• Impact of the disease on their current roles- Roles could be within the family, income generation, societal etc

3. Make appropriate information accessible and available

Stop limiting patients by not recommending reputable sites or resources to them. For those conversant with the world wide web guide them on the selection of online forums, apps etc (Correia et al., 2022). Employing educators is needed, being an educator is among our core roles however it's not viable for staff to deliver when overwhelmed beyond their capacity. 

4. Build or encourage patients to develop support groups

There have been several studies around the role of support groups 1)improved patient outcomes and 2) increased caregiver support. These studies show that patients and families benefit more from recommended therapies if they can identify themselves in others (Enriquez & Conn, 2016). They may be virtual or involve patients' or caregivers' physical attendance. Within them, I would encourage the involvement of a clinical psychologist he/she can cater to their mental wellness when the need arises.

To sum up, there is greater urgency to a well-thought-out multidimensional approach within our different setups. Duplicating without modifying certain elements of patient care is clearly not providing the results needed. If the current situation is unchanged we will still be witnessing an exponential increase in NCDs. Honestly, aside from our clinical roles; factors like environmental influences on disease are still beyond us and what we can do at this time is improve on what is within our control. Hopefully, in this way, we can make the transition through the wellness continuum bearable. 

References

Correia, J. C., Waqas, A., Aujoulat, I., Davies, M. J., Assal, J. P., Golay, A., & Pataky, Z. (2022).     Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis.   International journal of environmental research and public health, 19(10).     https://doi.org/https://doi.org/10.3390%2Fijerph19106128 

Division of Non-Communicable Diseases Ministry of Health. (2018). Kenya National Guidelines for     Cardiovascular Disease Management. https://www.health.go.ke/wp-    content/uploads/2018/06/Cardiovascular-guidelines-2018_A4_Final.pdf

Enriquez, M., & Conn, V. S. (2016, Jan). Peers as Facilitators of Medication Adherence Interventions: A   Review. J Prim Care Community Health, 7(1), 44-55. https://doi.org/10.1177/2150131915601794     Givler, D. N., & Givler, A. (2022). Health Screening.

Traeger, A. C., Lee, H., Hübscher, M., Skinner, I. W., Moseley, G. L., Nicholas, M. K., Henschke, N.,     Refshauge, K. M., Blyth, F. M., Main, C. J., Hush, J. M., Lo, S., & McAuley, J. H. (2019). Effect of     Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low     Back Pain: A Randomized Clinical Trial. JAMA neurology, 76(2), 161-169.     https://doi.org/10.1001/jamaneurol.2018.3376 

World Health Organization. (2011). NCD Global Monitoring Framework.     https://www.who.int/publications/i/item/ncd-surveillance-global-monitoring-framework

World Health Organization. (2022). Noncommunicable diseases. https://www.who.int/news-room/fact-    sheets/detail/noncommunicable-diseases

FINAL LAP

 "Live like a candle which burns itself but gives light to others." Anonymous

This previous month of September has been quite surreal for me. Fortunately, it wasn't a waste as I also learnt a few things. Albeit looking back I can identify a few lessons I would have loved to skip. 

 One specific occurrence that has shaped me has been the death of a former senior colleague. To many she was a friend, a confidant to her family she was a mother, to her spouse, she was a wife and to me, she was a mentor. She was the personification of charisma.  It wasn't because of the words she said but because even in being silent around her I would still learn. Looking back I am grateful that I met her and even more glad to have learnt many things while being in her presence. It is sad that I write this posthumously but it is also so beautiful that I can recall many great lessons and today I chose to share two among the many.

1. She taught me transformational leadership

 As John C Maxwell says, leaders are meant to help others become the people God created them to be and this was her everyday life. A few years back, I had an epiphany about what I wanted to evolve into. Armed with this idea  I approached her, for about thirty minutes she listened as I rambled on quite incoherently, to be honest. I can admit this now but at the end of it, she had accepted my request to shadow her staff in the intensive care department. I needed to learn a few of the basic skills before considering placing my request to switch areas of clinical practice. She quickly highlighted my strengths as exhibited in our previous interactions and linked me to personnel within the team that she considered would be a great asset to me. That conversation and subsequent interactions reinforced my confidence in the acquisition of new skill sets. Well, several months later despite my request being somewhat dismissed and I failing the interview things finally worked out and because of her I followed through on what I had set out on learning.

2. She epitomized being graceful

About 5 years ago, I was writing a paper on Chemotherapeutics and that led me to visit the Chemotherapy unit in which she was actively involved. Observing her made me understand the concept of being graceful because Chemotherapy units are one of those places that need people who have a certain Je ne sai quois about them. On my first visit, the department was quite busy so I just waved her a quick hello and took a seat waiting to get an opportunity to have a brief meeting. From where I was seated I saw patients light up when she attended to them as if on cue to a silent instrumental she met each patient where they were both physically and emotionally. Her zen energy was almost palpable and at that moment I understood why her patients were so much at ease. When a patient was in low moods she pulled a seat and just engaged in a calm conversation with them and by the time they were done you could see the patient's eyes light up. It appeared like with each conversation she rekindled something new within them.

During her hospitalization,  I could not muster the courage to see her, it was traumatic for me to envision her in so much discomfort and despite working in an area where this occurred often she was my kryptonite.  Anyway, through the support of a colleague, I finally managed to spend some time with her. I am glad I did because in that brief encounter I was just in awe of how amidst the ongoing events she tried taking things in stride. Key word being tried, she tried doing her best even when her body was failing. She never even despite the varied emotions coursing through her, let it out on anyone and to me, that spoke volumes. 

In summary, for anyone who is waiting for a time to come, for them to start living their best life may you always remember that "Life is short, fragile and does not wait for anyone. There will never be a perfect time to pursue your dreams and goals other than right now" ~ Rachael Bermingham

COMING FULL CYCLE

“Power always brings with it responsibility.” Theodor Roosevelt

In the recent general elections, so many health workers participated and got elected to different posts mostly the member of parliament and member of county assembly posts. This is a great stride because if they play their cards rights we might finally be heard. However, I do not wish to be the grinch, but I must ask. Do you think we will benefit? Personally, I do not know but time is our ally, and it shall reveal the truth to us.

 

If we were to base it on different experiences in our current or previous workstations we would further appreciate the validity in saying I do not know. For instance, are you a leader/manager in your current role? If not are you happy with the kind of leaders/managers that oversee your practice? What is the reason behind your response? You get the gist, don’t you? If this is the first time you are authentically pondering on it, take your time. If you are a leader ask yourself if the roles were reversed would you be happy receiving the same treatment you provide? If you are not a leader/manager when given the opportunity, will you mimic what you see? 

If you are unsure there are diverse ways to have a bare minimum understanding of your interactions with people. I will just list three and you can look up more later.

1. Ask for an honest opinion from someone you oversee - As you do so please be aware your feelings  may get hurt but it should not give you an opportunity to be vindictive and personalized. Be open to hearing their opinions first and self-reflect. In that conversation, emotional intelligence is key.

2. Use available leadership, management, and accountability assessment tools- Where our system fails is assuming that just because someone is great in the clinical area it automatically translates to them being a good leader or just because someone has taken up leadership courses they translate to great managers. This is a false belief and if we were bold enough to admit it we would realize that it does not always pan out as expected. Being an effective leader and manager is a delicate balance. It calls for building competence in these two fields and dancing to the rhythm of accountability. It calls for continued learning and never getting too comfortable such that one is no longer productive but more entitled and dismissive. It calls for use of regular self-assessment tools to identify one’s gaps. Plainly put such tools are a way to take a personal inventory and identify one’s strengths and weaknesses. Examples of such assessment tools will be highlighted below.

3. Have mentors - Please get someone who is challenging you to be better. Iron sharpens iron. A good mentor corrects you lovingly but firmly, coaches you on the right but often uncomfortable path, and encourages you. Being your best is not for the faint-hearted.

The traits of a good leader can be innate and acquired. However, both require taking time to refine them. Please, do not be hard on yourself if you are yet to get there just keep trying. Some of these skills include:

1. Being an effective communicator- Proper utilization of verbal and nonverbal cues is essential. It is not the number of words/actions spoken its about the quality.

2. Be empathetic - Often when people are elevated to positions of “power” I use this word lightly, of course, we tend to forget our backgrounds and become disengaged. Empathy is a skill possessed by a few, but it creates such a difference.

3. Be an efficient delegator - Do not try to do everything to prove a point but also do not delegate the things you least enjoy doing just because you can. This is an acquired trait so learn about it.

4. Establish trust – Trust builds safety as it allows people to communicate their vulnerabilities, it also may reduce turnover, improves morale, and often also reduces workplace anxiety. Ever wish to open on something and someone quickly responds by saying be careful these walls have ears. BE cautious this is coded language and translates to there being no trust within the organization.

5. Be a lifelong learner- Leadership and management is a great opportunity to acquire new skills. Building a knowledge base in your field is essential to keep people inspired to be better. It has no formula so utilize what works best for you.

6. Empower others- Building the skills you can identify among your team members not only builds respect but is also a great avenue to ensure the team is efficient. Otherwise, if you must always be in the limelight... I need not say more.

6. All the rest- Be great at Organization, Coordination, Collaboration etc

In conclusion, as you seek to evolve into being better at your role or in a new role do not forget that "a good objective of leadership is to help those who are doing poorly to do well and to help those who are doing well to do even better." Jim Rohn

References

1. https://hbr.org/2019/11/the-leader-as-coach

2. https://oxford-management.com/

3. https://oxfordsummercourses.com/articles/effective-leadership-skills/

4. https://www.leadershipsuccess.co/critical-leadership-skills/common-leadership-assessment-tools

WEIGHT, A DICEY AFFAIR

NB: This is work I had published previously on a different platform in 2021.

“Self-care is never a selfish act - it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self and give the care it requires, we do it not only for ourselves but for the many others whose lives we touch.” Parker Palmer

 

Can you perform two minutes of effective CPR without feeling like you may need to be resuscitated too? Most of us dread it. We are so unfit that often it is the main indicator of our fitness level. We spend many hours taking care of others that we forget to care for ourselves. Two minutes of CPR have us breathless and on the verge of collapsing. If you don't believe me just steal a glance at your colleagues after they complete one cycle of CPR during a mega code.

Better still glance at your colleagues as you read this how many of them look fit? To correctly determine one's level of fitness we need to use quantitative measures and merely not visual inspection. After all, are we not the propagators of evidence-based practice? At this time, however,  just humour me and think about your colleagues. How many colleagues are complaining of fatigue yet it is just the start of the shift? How many are undergoing treatment for lifestyle-related conditions? Are you one of them? 

In a study done by Kyle et al. (2017) a quarter of nurses in England hospitals were considered obese. Comparatively, this was a lower figure than for nurses in Australia (28.5%), New Zealand (28.2%),15 the USA (27.0%), South Africa (51.6%) and Scotland (29.4%). What about Kenya? I think it is time we explore the figures.  

Often, the general population expects health workers to have lesser rates of obesity due to enhanced health awareness. However, from different studies such as the aforementioned one we realize that there isn't much statistical weight difference between the two cohorts.

The World Health Organization (2021) article on obesity states that most of the world's population lives in countries where overweight and obesity kill more people than being underweight. The article further details how the deaths related to being overweight and obese are a result of cardiovascular conditions, malignancies, and musculoskeletal disorders. This is quite concerning. So, what makes us be at risk?

Most studies link it to our uptake of longer shifts, notably nightshifts. However, it is not a clear-cut cause and effect due to the association of other confounding factors. Nonetheless, it would be a great area for further exploration. Below are links to some studies on this topic.

Shift work and abdominal obesity

Prevalence of overweight and obesity among nurses in Scotland

Obesity among the general population in South Africa

Prevalence of overweight and obesity among healthcare workers in Nigeria

 Some proposed reasons for the increased prevalence of overweight and obesity among health workers include.

1. Adopting poor dietary habits is linked to frequent snacking and disproportionate caloric intake.
2. Low recreational physical activity.
3. Sleep deprivation- This leads to a decrease in leptin levels which is crucial in appetite suppression. When this occurs it leads to elevated ghrelin levels which enhances appetite causing weight gain. Often this is due to the need for increased caloric intake without adequate caloric expenditure.
4. Night shifts lead to disruption of the circadian rhythm yet it is needed in controlling the sleep-wake cycle and this results in unplanned weight gain.

Due to the nature of our work, we cannot do without shift work but we can try to make some modifications to try to curb this problem. Some recommended solutions by Kelly and Wills (2018) include.

1. Organizational level changes

• Provision of staff meals. There should be an option for healthier food/snack.
• Release staff for exercise sessions within the working days.
• Generate in-house programs that encourage physical activity.
• Conduct yearly staff wellness checks that include nutritional assessments and services.

    2. Personal behaviour changes

• Seek to practise more self-care.
• Be intentional about adopting healthier food options.
• Due to the possibility of decreased physical activity, try increasing the number of steps taken each day.  For instance, take the stairs more instead of the workplace lifts. 

In summary, as we try changing the health patterns among our patients, we should remember that we can only create a permanent positive impact in their lives when we adopt the same because  "The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires." William Arthur Ward

                                                     References

Kelly, M., & Wills, J. (2018). Systematic review: What works to address obesity in nurses? Occupational Medicine, 68(4), 228-238. https://doi.org/10.1093/occmed/kqy038 

Kyle, R. G., Wills, J., Mahoney, C., Hoyle, L., Kelly, M., & Atherton, I. M. (2017). Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England. BMJ Open, 7(12), e018498. https://doi.org/10.1136/bmjopen-2017-018498 

World Health Organization. (2021). Obesity and overweight.

A MOMENTS INSIGHT

"No one can whistle a symphony. It takes a whole orchestra to play it."  H.E. Luccock

Globally, there has been increasing emphasis on effective teamwork in healthcare.  von Knorring et al. (2020) documented how quality teamwork has been linked to improved patient safety. Some of the examples include;

1. Reducing patient complications - Effective communication is a component of teamwork and it allows for discussions on personal, system or equipment errors identified. This, therefore, aids to mitigate or prevent adverse events by formulating solutions. 
2. Decreasing the length of hospital stay- Rendering optimal services by competent teams allows for early diagnosis hence early treatment or initiation of early rehabilitative measures.
3. Improving patient and employee satisfaction - Great relationships in our workstations foster productive environments improving the quality of services rendered to patients.
4. Decreasing costs of care  - prolonged hospital stays lead to increasing financial burdens to patients and their families.

So what is teamwork? 

"Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results."  Andrew Carnegie

Are you part of an effective team? 

Bisbey and Salas (2019), state that effective teams are characterized by the following six Cs. These are  

• Cooperation - Diverse groups of people willing to work together for a common goal.
• Communication - Passing clear and correct information to other people and comprehending what is being said to us.
• Coordination - Ensuring synchrony of different roles.
• Conflict management -  Diverse mindsets create friction hence the need for early identification of problems and seeking solutions before an issue escalates.
• Coaching - A process of equipping employees with the knowledge, tools, and opportunities necessary for them to be effective.
• Shared cognition among team members- Involves having a competent team that understands the task at hand.

Teamwork is affected by many things some within our locus of control and others beyond. This understanding is cardinal in formulating an effective team. The literature describes several internal and external factors that influence teams. Some of these are; 

• Organizational characteristics- does it have a clear purpose, clear job roles among the members, appropriate culture eg support culture of safety, specified task, appropriate choice of leadership, hiring competent personnel, adequate resources
• Individual contributions - Professional self-image,  ability to confer/receive trust, commitment to the task, flexibility to different opinions.

Among the different types of health workers, the bulk is formed by both nurses and doctors, therefore, a lot of literature exists on their interesting team dynamics. Just perform a random search on HINARI, PUBMED etc there is a lot. So how then do we identify if we are part of an effective team? The answer lies in us evaluating our performance measures (Agency of Health Care Research and Quality, 2015)

According to the Agency of Health Care Research and Quality, 2015 & Schmutz et al., 2019 these include; 

• Process-related outcomes( adequate behaviours during processes) - eg Adhering to formulated guidelines, attitudes expressed at work, 
• Outcome related aspects of performance - eg Infection rates postoperatively, patient survival rates etc

In summary; as we look at improving our  output (job satisfaction, patient outcomes let's remember "Individual commitment to a group effort that is what makes a team work, a company work, a society work, a civilization work." Vince Lombardi

References

Agency of Health Care Research and Quality. (2015). Types of Health Care Quality Measures. https://www.ahrq.gov/talkingquality/measures/types.html

 Bisbey, T., & Salas, E. (2019). Team dynamics and processes in the workplace. In Oxford research encyclopedia of psychology.

Schmutz, J. B., Meier, L. L., & Manser, T. (2019). How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open, 9(9), e028280.

von Knorring, M., Griffiths, P., Ball, J., Runesdotter, S., & Lindqvist, R. (2020). Patient experience of communication consistency amongst staff is related to nurse-physician teamwork in hospitals. Nursing Open, 7(2), 613-617.

 

MEN'S PRECONCEPTION HEALTH

"The piece of the puzzle that is missing is the role of the paternal germline in the aetiology of genetic( and possibly epigenetic) mutations in the offspring. Most spontaneous genetic mutations arise in our species via the fathers' germline (not the mothers) and are powerfully influenced by age and environmental/lifestyle factors such as smoking and obesity." Aitken, 2017

I recently nursed a neonate with bradycardia as low as 50bpm. What was of great interest to us was him being in no form of distress or experiencing any other abnormal finding. He was under our care for some time as clinicians worked round the clock to establish the cause and monitor for any cardiopulmonary arrest. This was our greatest concern because for this age group this is absurd. Fortunately, the stay was uneventful and he was stepped down to continue with prescribed antiarrhythmics pending placement of a defibrillator at a later date.

Within the short stay, extensive testing was done to determine the root cause for the bradycardia. Among the ordered tests it was established via an Echo study that he had a congenital heart block. A review of maternal records led to a tentative conclusion that it is closely linked as an outcome of a pre-existing maternal autoimmune condition. No paternal preconception record existed and this drew my attention. Had we missed something more? Or was this conclusion enough?

So what is preconception care?

The World Health Organization (2013), defines preconception care as the provision of “biomedical, behavioural and social health interventions to women and couples before conception occurs. 

It aims to;

1. Improve maternally and child health status by encouraging behaviour modification in both the short and long term (Frey et al., 2012).

2. Allows early detection and diagnosis of certain conditions in the preconception stage allowing for better decision making and planning among the partners. Conditions that may be detected include HIV, genetic disorders, infertility/subfertility, STIs, mental health concerns etc, (World Health Organization, 2013).

This is helpful for it allows for increased preparedness among the couples. For instance, planning may involve considering setting finances aside for frequent future hospital visits, a need for modification of home environment setups if a child is likely to develop congenital abnormalities, adjusting one's career trajectory, discussions on consideration of other alternatives to having children etc.

A review of existing literature reveals inadequate attention to men's preconception health (O'Brien et al., 2018). According to Frey et al. (2012), despite many men being aware of the need for optimal health as prospective fathers, this does not translate to knowledge on the specificities involved in the same which meant that health providers were missing out on this critical information. Within the African continent, it is unfortunate that there exists so much data on preconceptions efforts directed towards the female gender and paucity of data on the same for men. With that being said, it is, important to be cognizant of the fact that healthcare utilization is complex and somewhat inconsistent (Rosu et al., 2017).

Preconception health among men

Garfield (2018), summarizes preconception health for men as a reproductive health plan, health assessment, health promotion, and clinical and psychological interventions to improve adolescent and young men's health.

This is essential as other researchers such as Misra et al. (2010); van der Zee et al. (2013) have identified that, paternal involvement results in better health outcomes  of a nation by;

·       Increasing rates of prenatal care.

·       Decreasing maternal rates of alcohol consumption.

·       Encouraging fathers to actively participate in their children’s lives.

·       Promote good relationships with their partners.

·       Prevents direct and indirect harm to his future child.

How can we enhance preconception health among men?

   Prompt men to develop a procreative consciousness through 

•  Encouraging visualization of their future kids' health by appealing to the concept of the greater good.
• Have lengthy discussions on different health practitioner visits on the impact of age and the ability to promote the conception of a healthy foetus. ( To be aimed for during health screening visits). 
• Address gendered perceptions of men in society and this will most likely encourage a positive outlook towards increasing their screening risks.
• Have more female practitioners provide men sexual health service
• Use creative tools to assess their sexual health issues at different age groups for example use of the HEADSS tool among adolescents and use of SNAP tool among men greater than 40years (Addison et al., 2021, Noble et al., 2015).
• Encourage men to openly discuss their problems with no judgement.
• Providing the services among already existing screening models(O'Brien et al., 2018).

In conclusion, we have learnt that it is important for preconception services to also be provided to men and that we need to be creative while at it. Remember, "Parenting begins the moment you make any conscious effort to care for your own health in preparation for enhancing your child's conception." Carista Luminare-Rosen

References

1. Addison, J., Herrera, N., Tuchman, L., & Bokor, B. (2021). HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents. Hospital Pediatrics, 11(4), 417-421. https://doi.org/10.1542/hpeds.2020-000216
2. Frey, K., Richard, E., & Brie, N. (2012). Preconception healthcare: what do men know and believe? Journal of Men's Health, 9(1), 25-35. https://doi.org/10.1016/j.jomh.2011.11.001
3. Garfield, C. F. (2018, Jan). Toward Better Understanding of How Fathers Contribute to Their Offspring's Health. Paediatrics, 141(1). https://doi.org/10.1542/peds.2017-3461
4. Misra, D. P., Caldwell, C., Young, A. A., Jr., & Abelson, S. (2010, Feb). Do fathers matter? Paternal contributions to birth outcomes and racial disparities. Am J Obstet Gynecol, 202(2), 99-100. https://doi.org/10.1016/j.ajog.2009.11.031
5. Noble, N., Paul, C., Turon, H., & Oldmeadow, C. (2015). Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity (‘SNAP’) health risk factors. Preventive medicine, 81, 16-41.
6. O'Brien, A. P., Hurley, J., Linsley, P., McNeil, K. A., Fletcher, R., & Aitken, J. R. (2018). Men's Preconception Health: A Primary Health-Care Viewpoint. American journal of men's health, 12(5), 1575-1581. https://doi.org/10.1177/1557988318776513
7. Rosu, M. B., Oliffe, J. L., & Kelly, M. T. (2017). Nurse Practitioners and Men’s Primary Health Care. American journal of men's health, 11(5), 1501-1511. https://doi.org/10.1177/1557988315617721  
8. van der Zee, B., de Wert, G., Steegers, E. A., & de Beaufort, I. D. (2013). Ethical aspects of paternal preconception lifestyle modification. American Journal of Obstetrics & Gynecology, 209(1), 11-16. https://doi.org/10.1016/j.ajog.2013.01.009
9. World Health Organization. (2013). Preconception care to reduce maternal and childhood mortality and morbidity: policy brief.

AMYGDALA HIJACK

 

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring; all of which have the potential to turn a life around." Leo Buscaglia

According to the World Health Organization, more than 700,000 people commit successful suicides each year. That is approximately the total population for some countries. One such country is Bhutan it is located in the Eastern Himalayas and has a population of 771,612 by end of the year 2020. (Just google it).  In 2019, suicide was considered the fourth leading cause of death among 15-29-year-olds. Despite the majority of existing studies showcasing increased risk among higher-income countries, the World Health Organization still considers suicide as a global phenomenon. Data from their website show that  77% of global suicide deaths emerge from low and middle-income countries. More on suicides

For most of us, our work environment is quite stressful and, unfortunately, despite being health workers we often underplay its impact. When counselling is provided few if any personnel take it up. In addition, very few healthcare organizations actually budget for out of work activities to aid staff to de-stress. What is worse is that being away due to any form of illness especially ongoing mental health challenges is frowned upon, more especially when one is placed on sick leave. In some instances, these warranted sick leaves are later used as opportunities to victimize personnel.

Depression often seems like a foreign concept to most people and that when our loved ones get diagnosed it is so unfathomable.  I was recently reminded of this and thought I should share for it may help someone else too. Recently, a friend reached out, his phone call actually woke me up from deep slumber. He was crying frantically repeatedly stating that he wanted the world to go quiet. He kept reiterating how he had had enough of everything and wanted the pain to stop. "I can not do this anymore." It is too much". I was so taken aback and so confused for a minute I thought I was experiencing a nightmare. It could not be real, was it? Like how was this happening? Being that as humans we are selfish  my first actual brief thought was, "of all days I decide to pick a phone call it had to be this." ( You can judge all you want but it is true) I quickly got over it and tried to figure out what to do. I was more than 200kms  away. I wondered how could I help? After a quick prayer and the help of other great friends, we managed to neutralize the situation. However, the battle still continues and we are presently working on developing long term solutions to the events that led to that scary phone call and honestly it has not been easy.

So you may wonder who is at risk of committing suicide?

Well, suicide has been linked greatly to anyone experiencing challenges managing daily stressors for example:

1. People living with some mental disorders such as depression, substance use dependence etc.

2. People experiencing any form of abuse (sexual, verbal. physical, emotional).

3. Vulnerable populations such as the LGBTQI, refugees, immigrants etc.

4. People who experience impulsive episodes of crisis such as financial crisis, relationship conflicts and episodes of severe pain in chronic illness among others.

So what little things can you do to help as a health care provider or as a layman? 

It all begins with the basics. 

1. If anyone you know belongs to the populations at risk please keep checking on them despite your busy schedule. You may be the only one who does.

2. While spending time with them physically or via the different digital forums learn to improve your listening. Talk less and listen to them more. Learn their non-verbal cues.

3. Use social media as a tool For instance go to Youtube and learn about conducting a basic mental screening assessment and ways to establish the red flags.

4. If a friend, family member or colleague has a history of a previous suicide attempt or threat limit access to potential items that may be used to commit suicide.

5. For parents with children try to foster socioeconomic skills from a tender age.

6. Eliminate archaic rules to encourage self-reporting of suicidal thoughts. When identified please refer for professional help unless, of course, you can offer it.

7. Keep a list of resources around you of counselling service providers, treatment facilities etc.

As I conclude, in a world most people are marred with dark thoughts be the light that keeps someone going and if you are the one experiencing suicidal thoughts I leave you with  these words by Winston Churchill " Never, never, never, give up."

Resources

1. http://www.befrienderskenya.org/

2. https://www.enableme.ke/en/article/suicide-emergency-numbers-and-free-counselling-centers-in-kenya-3770

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