How can we make African Teaching Hospitals more conducive?

I was going through “REACHING FOR SUCCESS” my former class at University of The Gambia(UTG)  the 7th cohort’s year book and I could not stop thinking about the challenging seven years of medical education, the two years of house job we have gone through  and the many years post internship that  these same problems continue to surface in The Gambia. In describing our days in training some of us will describe them as sweet, fun and full of memories but on the other hand it is one of those bitter, anxiety, stressful and demanding moments of our lives as colleagues who answered to the callings of the medical profession. If it was not for the interactions I have had with medical students and doctors mostly from Nigeria on social media, I would have concluded that the problems in our teaching hospitals are only unique to the Gambian setup. Thus, inspiring me to write this piece concentrating on making the teaching hospitals a conducive one for staff and users of its services.

In medical school and at the teaching hospital we have lecturers from Africa and those who trained and are citizens of elsewhere. However, the problems encountered both from some colleagues who are mostly citizens and studied from Africa begs for critical analysis and understanding from an objective point of view to enable us to have that conducive environment as in good setups in the world. According to Cambridge dictionary Conducive means providing the right conditions for something good to happen.

A lot of good things have happened to us whilst in training however according to some they have even experienced bullying. Since bullying can be very subjective especially when it comes to verbal bullying and can be accidental according to Parry Aftab’s work. Accidental Bullying also known as unintentional bullying is when a person hurts another through words or actions without the instigator’s knowledge. We understand that our seniors and sometimes young colleagues want the best but the language used, the place it is said, the timing and the people present might have a lot of negative impact on the end of the receiver. It is important to note that there is no intent to harm but at the end of the day the person it is directed at can face a lot of consequences that can result in mental distress like depression, anxiety, social withdrawal, drug abuse, self-harm and even suicide. Although from interactions and observations from colleagues in my country I am yet to come across a case of self -harm or even attempted suicide but these have been reported by Nigerians and Ghanaians tweeters on social media. Although I cannot personally verify those stories at my own level, it is worth reflecting on. Imagine receiving constant harassment from seniors and young colleagues who should have been in a better position to help by providing guidance and even mental support is very disheartening. We are all cognizant of the fact that mental health is not given very much importance in our African setting including medical schools which I believe at personal level  have a lot of negative implications and goes a long way in affecting our patient-doctor, doctor-doctor relationships and by extension to support staff  and the public in general. It is not uncommon to hear from our senior colleagues making complaints about the young generation of doctors and the young too making similar complaints about some of them. At my leisure time whilst meditating trying to understand the problems in our health sector one of the conclusions made is the fact that some are just victims of their own making. Thus, the reason why in a recent piece written for young colleagues it was recommended for my generation to refrain from history repeating itself.

Reflecting on the  old days there are many experiences we have had that could be classified as not ideal however,  I will give two examples, one which happened to us as a class and the other to our group whilst doing our  house job in one of the departments in the hospital. Breaking down our experiences It will be good to mention that we have had some positive outcomes from some of those experiences but it would have been better if the environment was more conducive. I want to believe that some actions of colleagues in the profession calling medical students and young colleagues names might probably be one of the many reasons why some doctors are not respected by support staff especially for those colleagues who were paraded and criticized in their presence. I was able to make such conclusions because I have spent some time in hospitals in Senegal, UK and here in Turkey wherein I have never for once came across seniors criticizing openly with unpleasant words even if trainees happen to give the most undeserving responses to their questions. Also, all my professors and colleagues here encourage exchanging of ideas and knowledge and I am more relaxed as someone will not remind me to keep quiet because they are my senior or even a colleague calling my opinions wrong or irrelevant. This is a welcome change and a drive for me to encourage junior colleagues to speak up but in a very respectful and dignified manner. This should not be taken to mean we do not have seniors who listen back home, there is a good number and some are even mentors to some of us.

Going back to our experiences as members of the 7th cohort during our lab medicine professional exams whilst we were sitting under the trees opposite the old provost’s office waiting for our turns for the oral exams, one of the external examiners a Sierra Leonean with all our stress and anxiety did not find a better way to help us but to add to our sufferings and tortured us even more. The professor told us that the purpose of the exams will be defeated if they are to pass everyone and started explaining a story about how he failed his own relative if my memory can serve me well; he mentioned his younger brother. His comments might have made some sense but was said at the wrong place, time and to the wrong audience. When he left it was my turn to go in for my oral exams that took place in the provost office where one of the panels had their base. Even with the initial stress and anxiety, I was doing well with the questions until one of the profs in anatomical pathology said to me “Mariam you will have to come back for more questioning after the other team finishes for a bigger panel”. He did not go further to elaborate and I was only able to understand after the second big panel (about11 profs firing from all directions) ended, I was asked to tell them the difference between Chlorophyll and Hemoglobin which at the time I didn’t know the answer which hastened by exit from the second torture chamber. An emotional Mariam after the first encounter started crying and went to wish her friend the next candidate good luck and the friend was so devastated seeing me crying that much, probably with an adrenaline rush and wondering what her fate will be. Thank God the majority of the class passed and the few unlucky who did not, make it after six months and all that remains now is history.

My first six months as a House officer was going very well asides from small issues I usually have once in a while with a colleague mentioned in my last piece. The second six months was hell for me and many colleagues, although it has helped me grow to some extent but there are still some scars remaining. My group was very unfortunate because our numbers were small and some team members were not very helpful at all when it comes to teaching and supervising us. Also, anytime we lodged complaints to serve our clients better and improve our welfare we were blasted more with unpleasant words. In that particular department we worked as orderlies, nurses at the same time as doctors leaving us very exhausted at the end of the shift. No wonder most of us lost a lot of weight and people used to ask me and even my mother whether I was sick. Asides from a renal colic which sometimes used to disturb me I was ok but mentally I was not. It is like yesterday to me, one whilst we were sitting at the hospital canteen a colleague told one of the seniors that I do abuse ‘Tramadol’. I wasn’t taking it daily but sometimes after me on calls to help me relax and sleep I take some 25 to 50mg. This I will not recommend to anyone to do and I stopped immediately after that discussion thanks to that colleague and the senior .There came a time after presenting our cases during morning meetings If questions were asked regarding problems during the shift; we  always used to prefer to stay silent rather than receive more blasting for things not directly under our control. One thing amongst many the hospital has taught me is to never repeat bad experiences hoping change will come one day. Justice to the piece will not be done if the attitudes of some young colleagues which lead to poor outcomes are not stressed on. The problems of punctuality  , failing to communicate , not supervising , not correcting mistakes of colleagues, not documenting notes properly, disrespect to colleagues and seniors , dishonesty ,poor supervision , concentrating on things outside work , blaming those working hard whilst they are not putting the same energies are some examples amongst many that is making the work environment very stressful and possibly leading to poor outcomes and bad image of Gambian doctors by the public.

How can we improve the working environment and improve medical care in our setting? Change is what is needed and it has to start with everyone from Juniors filtering down to the old generation of Doctors. We need to be better communicators and stop using words, if directed to us we will not like it; We should endeavor to make the learning environment conducive for everyone and help doctors regain their respect by not blasting them amongst colleagues and support staff. It will be also nice if we are not constantly reminded of sufferings received during the past 20 years because continuous suffering will never lead to growth of the mind and individuals. The medical school needs to consider increasing the contact time for mental health courses and also the Medical and Dental councils should be doing more to train and provide counselling services to its members on issues pertaining to mental health and related issues. We should have a system where people can anonymously send their concerns about colleagues whose behaviours might be considered as inappropriate to help prevent future unfavorable outcomes. The various residents and general medical doctors’ organizations can also be engaging with colleagues to see how best the problems outlined can be overcome. The teaching hospitals should provide service rules for all its employers and also engage in orientation and frequent training on medical ethics and counselling programs for all staff.

To end it is important to note that it is not only the responsibility of senior colleagues , medical schools, teaching hospitals and medical associations to make the working environment conducive, as young people the individual roles we are to play is more important and will help us a long way in becoming better professionals.

By Dr Mariam Jaw Mbowe EFSTH,

Trainee Physiologist AYBU, Ankara