Monday, September 21, 2020

HEALTHCARE WORKERS' SAFETY AND CORRELATION WITH PATIENT PATIENTS


As we join the rest of the regions of the world to mark World Patient Safety Day 2020 as adopted by the 72nd World Health Assembly Resolution - WHA 72.6 "Global Action on Patient Safety" in May 2019, it is important to strengthen the fact that both the safety of healthcare workers and that of the patients should be adequately protected. Owing to the COVID-19 impact on health and safety of healthcare workers as was evident globally, it became obvious the need to integrate these two issues into one for global conversation. The World Health Organisation has chosen a very apt theme for this year's event "Healthcare Workers Safety: A Priority for Patient Safety", this could not have come at a better time. This event was jointly organised in Nigeria by Occupational Health and Safety Managers (OHSM), Medical and Health Workers Union of Nigeria (MHWUN), OSHAfrica, International Trade Union Congress (ITUC), Patient Safety Movement Foundation (PSMF), Nigeria Labour Congress  (NLC) and World Health Organisation (WHO).

According to the words of Florence Nightingale over 160 years ago, “the very first requirement of a hospital is that it should do the sick no harm”. As fresh as this statement still is today, the question on the lips of everyone is, do we still play by this rule in healthcare facilities? How comfortable are we when we send our loved ones to healthcare facilities for treatment? Do we still feel sufficiently safe in these facilities? These and many more questions are begging for answers.

As much as we advocate for the safety of patients, we also need to remember that healthcare facilities are also workplaces primarily before being a place where patients receive care. The need to also protect the health and safety of the healthcare workers should be a very important aspect in the conversations that surround patient safety. The honest truth is, if we cannot guaranty the safety of healthcare workers, our hope of patient safety and good treatment outcomes could be adversely jeopardized. This multidisciplinary nature and complexity of healthcare systems is just a good place to start. Good treatment outcomes and the safety of the patients is a combination of many variables, it is difficult to give credit to specific sets of professions within the system. Outcomes are always joint efforts of all employees within the facility, this is one of the reasons why we advocate that safety must start from the boardroom to the bedside, to the gate house and beyond.

According to WHO, healthcare facilities across the world employ over 59 million workers who are daily exposed to a complex variety of health and safety hazards. Lately, the issue of psychosocial hazards in healthcare sector has grown exponentially and this burden has become a key indicator that could be attributed to the increasing risk of patient’s harm. We are all aware how the work shift pattern in hospitals have changed over the years, the increasing rate of workplace violence against healthcare workers by patients and patients’ family members, the increasing rate of the number of patients per healthcare worker in most countries, the high rate of workplace stress and the increasing incidence rate of accidental needle stick injuries among healthcare workers.

According to Dr. Teryl Nuckols, an internist and Assistant Professor at David Geffen School of Medicine, University of California Los Angeles “Residents are working more than 30 hours at a single stretch and often times forgo sleep entirely”. In many healthcare systems across the world, there seems prohibition on “mandatory” healthcare worker overtime but nothing is seen on “voluntary” healthcare worker overtime. Healthcare workers are at risk of violence across the world, between 8% and 38% of healthcare workers suffer physical violence at some point in their careers. According to 2014 report of Bureau for Labour Statistics, 52% of workplace violence reported occurred in healthcare. Emergency Nurses Association Survey of November, 2011 stated that 1 in 10 emergency room Nurses had suffered some form of physical violence in a period of one week. This is the enormity of the concern.

The poor infrastructural design in most healthcare facilities has also posed certain levels of risks to healthcare workers, a number of multiple floors facilities have neither elevator nor ramp. Healthcare workers are made to lift patients or in some instances support patients walking through the steps and this could lead to slips, trips and fall leaving both the healthcare workers and patients with bodily harm. Advocacy for safety at the design stage of healthcare facilities is a new conversation coming out of this program. The Bureau for Labour Statistics in 2007 report stated that slips, trips and fall are the second most common lost work-day injuries in hospitals, it also added that incident rate for healthcare workers are 90% greater than average for all private industries.

We appeal to all employers of labour within the healthcare sector, the government and regulatory agencies to look closely into the issues of healthcare workers safety and protection. The healthcare work environment is highly infectious and what is needed most times is only mitigation which comes in form of safe process designs, improved hygiene practices, use of personal protective equipment and vaccination of healthcare workers against infectious diseases with existing vaccines. In most cases, the healthcare employers are never up to their responsibilities in this regard, so obvious is the absence of duty of care from the employers. If you recall the Ebola outbreak in West Africa 2014, over 378 healthcare workers were infected while 196 healthcare workers death was recorded. When you again juxtapose that with the report from the World Health Organisation (WHO) in July 2020, over 10,000 healthcare workers have been infected in Africa by COVID-19. That report also mentioned that only 16% of the 30,000 facilities surveyed had assessment scores up to 75%, this further explains how vulnerable the healthcare workers are to infectious risks in their workplaces and the need to fix this system towards improving the rate of patient safety and treatment outcomes.

According to Dr. Moeti, WHO Regional Director for Africa, there is an urgent need for us to rethink the entire process, “the Doctors, Nurses, Cleaners and many other group of workers in healthcare sector are our mothers, brothers, sisters and loved ones” and the need to make them feel that sense of protection and care is our collective responsibility. The world is already experiencing a high level of shortage in healthcare workers and the increasing rate of harm, poor welfare and absence of social safety net and protection will further increase healthcare workers shortage and making the sector unattractive for new employments due to the prevalence of risks with obvious lack of the culture of safety.

Our recommendations as we mark this year’s World Patient Safety Day starts with the advocacy for the right kind of leadership in healthcare systems globally and empathy being an integral part of our health care systems. The need to stop the existing defensive culture and replace it with a “just and transparent culture void of blame-game but owns up to responsibility when things go wrong. Remember, we are only human and everyone is fallible. “To Err is Human” according to the Institute of Medicine (IOM).

We need patients to be at the center of their care, if it is all about their health and wellbeing, they should be involved in treatment decisions as it concerns their health. Advocacy for patient-centred care is imminent.

The need to review existing health systems legislations is important, we need policy makers to stand up for change, healthcare technology companies to make the change by designing safe equipment using safe new technologies. We need healthcare providers to be the change through competency improvement and due consideration for patient safety so that patients and their relatives can experience that change.

If we do not urgently commit to actionable plans, the weight of the change of pain will greatly increase and the number of people who are affected by that chain will greatly increase. Remember, when we harm a healthcare worker or hurt a patient under our care, it is not just that healthcare worker or the patient that we hurt, we also hurt their family members.

In the words of a Nigerian songwriter, Timi Dakolo “There is a cry from a mother who just lost another child” The question is, who is next in line? This is a question we must all find an answer to.

 

Ehi Iden

ehi@ohsm.com.ng


References 

Sharples, T. (2009). Are medical students worked so hard? Time Publication

http://content.time.com/time/health/article/0,8599,1900374,00.html


Sung-Heui, B. and Yoon, J. (2014). Impact of States’ Nurse Work Hour Regulation on Overtime Practices and Work Hour among Registered Nurses. Health Service Trust

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213053/


Gordon, L. (2018). Nursing Overtime: The Good, The Bad, The OMG. Elite Healthcare

https://www.elitecme.com/resource-center/nursing/nursing-overtime-the-good-the-bad-the-omg

https://www.circadian.com/blog/item/26-mandated-vs-voluntary-overtime-in-shift-work-operations.html


Violence Against Healthcare Workers. World Health Organisation

https://www.who.int/violence_injury_prevention/violence/workplace/en/

 

Smith, S. (2017). Nurses Testify for National Standard to Prevent Workplace Violence in Healthcare Settings. EHS Today

https://www.ehstoday.com/standards/osha/article/21918176/nurses-testify-for-national-standard-to-prevent-workplace-violence-in-healthcare-settings

 

Docksai, R. Law Makers and Hospitals Take Actions to Curb Violence Against Nurses. Nursing Licensure

https://www.nursinglicensure.org/articles/workplace-violence.html

 

Hospital Workers: An Assessment of Occupational Injuries and Illness. (2017).

The United State Bureau for Labour and Statistics.

https://www.bls.gov/opub/mlr/2017/article/hospital-workers-an-assessment-of-occupational-injuries-and-illnesses.htm

 

Epidemiological Update: Outbreak of Ebola Virus Disease in West Africa. (2014). European Centre for Disease Prevention and Control.

https://www.ecdc.europa.eu/en/news-events/epidemiological-update-outbreak-ebola-virus-disease-west-africa-9-october-2014

 

Over 10,000 Health Workers in Africa Infected with COVID-19 Virus. (2020). World Health Organisation.

https://www.afro.who.int/news/over-10-000-health-workers-africa-infected-covid-19

 

  

 

Wednesday, August 12, 2020

COVID-19, DISRUPTION ON EDUCATION AND SCHOOLS REOPENING APPREHENSION

I really think it is important to hear what various people are saying about reopening of schools and how ILO feels education has been adversely disrupted by COVID-19. 

According to a recent report by the International Labour Organisation (ILO) says COVID-19 has disrupted education of more than 70% of youths and "digital divides" between regions has also made matters worse in terms of virtual learning opportunities. 

In that same report by ILO, “up to 65% of youths in high income countries were taught in virtual classes with video lectures while only 18% in low income countries were able to keep studying online during the period of COVID-19”. Another report from Harvard says “online classes resulted in viral absenteeism and virtual dropouts among students within this period, in Boston Massachusetts, 20% of students did not log into class all through the month of May, 2020”. Now that we have seen the downside of virtual learning among younger students owning to a number of reasons, should we still leave the schools closed? Does anyone really know how long the COVID-19 will be here for? Has it come to stay or it will fade away soon? If it has come to stay, does that mean our children will never return to schools? Let's keep in mind, there is nothing as zero risks, we only can lower the risks. 

In as much as most people like us advocate for government to wait a little more before reopening schools, are we able to also think of the cost of ignorance that comes with our children not able to return to school. We must also realize reopening of schools will allow most parents to return to work. 

There are devastating cost of keeping children out of school, the list is just endless. This is understood but we must also benchmark these costs with the cost of sending children back to schools in this state of COVID-19 scare. The level of apprehension is high, we need to start opening conversations and consultations along these lines and get parents properly engaged. 

Lately, I have also been reading many reports that have alluded to the fact that COVID-19 infection has been found to be growing among children. Having this in mind and looking at poor compliance to the COVID-19 response guidelines and protocols among adult population, I get worried how much of compliance we may expect from children in schools. Reopening of schools is a global discussion that is beginning to have so many divides, we have seen countries that were in a rush to reopen schools and how they hurriedly shut down those schools after the surge in the rate of infection. We have seen this happen in countries like Denmark, Norway, South Africa and others. 

There is the need to keep in mind a new sets of risks are being introduced into schools as they open, we have varied degree of new chemicals now being used for deep cleaning in this phase of COVID-19. These chemicals are not only harmful and exposing the janitors to heightened level of risks, they are also harmful to school children mostly the ones with underlying respiratory condition and other children who may mistake chemicals in non-labelled canisters as water. Have we been adequately trained in schools on safe chemicals handling? How much of risk communication have we had with both school owners, students, parents and cleaners along these lines? Have we been able to request from parents return-to-school health assessment forms where questions of the state of health of each child should be clearly answered with focus on underlying health conditions as asthma and other respiratory diseases? 

In as much as we do not want these children to remain at home, we must carefully and collectively consider what works for us as a people and as a country, it is not a one-style-fits-all approach. The likely death of any school child as a result of school acquired COVID-19 infection will be a huge agony for any parent and this is the point no one wants to get to. The right to education has been classified as a part of fundamental human right of every child in any country according to UNICEF but it is also important to understand no child in anywhere in the world should be made to access education at the expense of his or her life. 

This seems a very difficult conversation for us all and the choices to make are all there but we must by all means assess the prevalent risks associated with each of the choice in the interest of both the school child and their parents.

These are my personal opinions as put together in this write up supported with a number of reports as referred. We will to hear your views, kindly leave a comment for us here. 

ehi@ohsm.com.ng 

Youth and COVID-19: COVID-19 disrupts education of more than 70 per cent of youth 



Friday, August 7, 2020

AFRICAN OSH AND LABOUR INSPECTORS NETWORK: A STRATEGIC INITIATIVE OF OSHAFRICA

 

This is a new strategic project initiated by OSHAfrica to cater for the gap in OSH and Labour Inspection across Africa. This part of Workplace Health and Safety in Africa currently is difficult to understand and organise because of the different standards being used across the 54 countries and we felt the need to look into the issues with the hope of bringing all actors together for sharing of experiences and learning together.

When we refer to the ILO Labour Inspection Convention 81 of 1947 and Convention 155 of 1981 which virtually all African countries have signed and ratified, it becomes obvious how committed we should be in developing our OSH and Labour Inspection standard. Workplace inspection processes ensure organisations implement the practices of decent and safe workplaces especially concerning the protection guaranteed to the workers by social laws and regulations. There is also a requirement for the inspectors to report the gaps or defects within these laws and processes to government for further reviews and implementation.

When we look at the role of OSH and Labour Inspection from this perspective, you will realize they are not just there to inspect safe workplace practices, they are also very important with the feedback needed to strengthen existing OSH and Labour legislation. Having this in mind, we should therefore see this arm of workplace health and safety inspection as a very important component of our work without which the system may never be complete.

In reviewing the place of OSH and Labour Inspection in Africa, we realized there were three critical issues common among all actors across all countries, they are:

Under staffing

 Under funding

Inadequacies in training

Two of those factors are not within our immediate control, though we are able to advice different government on improved staffing and better funding. We realized we are able to immediately bring these inspectors together in one common platform where they can share experiences on good practices and further training which OSHAfrica and other partners can make available to them.

In trying to fully understand the level of under staffing that exists within this unit in Africa, we tried looking at the current staffing levels across 5 African countries and below were the outcomes.

Nigeria: This country has over 200 million people in population (https://www.worldometers.info/world-population/nigeria-population/), there were only less than 350 inspectors until 2019 when the new employment brought the figures to 750 inspectors. This was according to our discussions with the Director of Occupational Safety and Health of the Ministry of Labour and Employment. We see this figure as still grossly inadequate for the population.

Ghana: This country’s 2020 population is estimated at 31, 072,940 people according to United Nations data (https://www.worldometers.info/world-population/ghana-population/) but there exists only 50 inspectors currently and waiting for 6 more to be recruited.

Egypt: With an estimated 102 million population (https://www.worldometers.info/world-population/egypt-population/) has 520 inspectors currently.

Zambia: With a population of 18.3 million people https://www.worldometers.info/world-population/zambia-population/) currently has only 13 inspectors with a plan in place to recruit an additional of 13 more inspectors.

South Africa: With a population of 59 million people, (https://www.worldometers.info/world-population/south-africa-population/) there are 170 inspectors. From all indications, this seems to be the only country where we have a reasonable number of inspector per population. These information were gathered from the interaction we had with the Directors of Occupational Safety and Health and in some cases with the Factory Inspectors in each of these 5 countries.

In OSHAfrica, we already have functional 3 Scientific Committees and we realised the only way we can create an intervention in this arm of workplace health and safety improvement will be to create an entirely new strategic forum that will bring together all OSH and Labour Inspectors. We have succeeded in doing this, we currently have over 170 of such inspectors from over 18 African countries. Western, Southern, Eastern African sub regions are already well represented, we are currently pushing Northern and Central African regional inclusion, once we achieve  this in the next few weeks, we will have the formal launch of African OSH and Labour Inspectors Network.

The whole aim is to be able to offer these inspectors the specific training they need to function rightly, capacity building and competency improvement is a key area we want to help address. We realised most of these people were just employed without any form or requisite training, in some cases where they had training, they were grossly insufficient. We feel the right kind of improvement expected in workplaces may never happen until we commence the intended training and retraining programs focused on OSH and Labour Inspection skills improvement. All existing scientific committees of OSHAfrica will offer support to the new network in line with their mandate. Example is the OSH Legislation and Policy Improvement scientific committee bringing together their expertise in helping to work with member countries in strengthening their labour legislation. The committee on Education and Competency Improvement offering training support while the committee on Research, Data and Publication will also be here in helping them put data together for reporting.

We should be able to harmonize OSH and Labour Inspection across Africa through this intervention and we will keep updating the needed skills of the inspectors. Currently they are all together in Telegram as a group and are able to ask questions in areas they are not so clear about.  As a Nigerian inspector, you do not need to repeat the mistake that an inspector in Congo had already made, you just throw the issues you have into the group for discussion and at the end of the day, and you have a solution. This is the whole idea.

We will be extending our discussions to International Association of Labour Inspectors (IALI), International Labour Organisation (ILO), German Social Accident Insurance (DGUV), European Network Education and Training in Occupational Safety and Health (ENETOSH) and others partners for support in developing the capacity of African OSH and Labour Inspectors.

Nyambari, S. T. (2005). Labour Inspection in Africa- Promoting Workers Right, Labour Education, ILO https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@safework/documents/publication/wcms_108666.pdf

https://www.worldometers.info/world-population/ghana-population/#:~:text=The%20current%20population%20of%20Ghana,year%20according%20to%20UN%20data.

https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:51:0::NO:51:P51_CONTENT_REPOSITORY_ID:2543058:NO

https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C081

https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C155

https://www.ilo.org/global/standards/subjects-covered-by-international-labour-standards/social-policy/lang--en/index.htm

https://www.ilo.org/jobspact/policy/WCMS_DOC_GJP_ARE_DLG_EN/lang--en/index.htm. 

 

 

 

Friday, May 29, 2020

COVID-19: THE CHANGE NO ONE ANTICIPATED AND THE MENTAL HEALTH IMPACT


The outbreak of Novel Corona Virus at the end of 2019 was never thought by many that it could bring forth such forced changes which it has successfully done in global economic landscape, workplaces and patterns of work, families and our overall health and well being. The COVID-19 was trivialized in many quarters and likened to the outbreaks of SARS and MERS that were successfully confined and could not spread beyond Asia and the Middle East regions. But Corona Virus was quick to travel as fast as man could travel and soon landed in every region of the world from where it started making quick entries into countries, cities and later communities. And today, the whole world has changed so drastically to the extent that we now use words as “the new world order”, “the new normal” and many other words that have been introduced in describing the new world we have all found ourselves.


According to Warren Buffet “What we learnt from history is that people do not learn from history”. This is very correct when you relate the COVID-19 to the Spanish Flu of 1918 which was also characterized with shutting down of businesses, places of worship and others while people were forced into isolation. At the end of the Pandemic which has been described as the deadliest plague of the 20th century, most of the survivors suffered heightened mental health conditions, sleep disturbances, depression, mental distraction, dizziness, pandemic related suicide and those who were able to return to work had difficulties in copping at work. This sums up as pandemic impact on mental health.

Are we going to expect similar conditions as Post COVID-19 health outcomes? Predictably, yes. Many of such cases are already spiking and I think what we should be doing in clinical environment is to start documenting cases properly as we see them. Heightened mental health tension induced by COVID-19 is already here with us. The words “Isolation”, “Quarantine”, “Infodemic” and “New Normal” are some of the new words frequently used in COVID-19 and are greatly influencing mental health and well being.

In an attempt to control the spread of this Novel Corona Virus, countries were forced to lock down and businesses within those countries were forced to shut their doors, employees and employees along with their families were forced into isolation. This was never in the 2020 plan of any of us and the pandemic had to override personal and organisational plans, disrupting them to the disadvantage of people whose mood suddenly switched from living to quest for survival. Isolation removed the concept of social integration and put to hold the support we draw from our collective co-existent, broke down ties and threw people into solitary living where a number of them suffered high degree of loneliness and a number of “live-alone” employees suffered lone worker syndrome. This was characterized with fear, anxiety, uncertainties, longer hours of work and irregularities in sleeping patterns leading to varied degree of mental health conditions.

COVID-19 will be over some day, lock downs are being relaxed and people are getting set to return to work, one thing we must keep in mind is that the mental state of these workers may have been impacted adversely by several of the negatives that came with COVID-19. Having this in mind, there is an urgency in reviewing the ways we will relate to workers upon return to work and communication along this line must commence while employees are still working from home.

Do we need to retrain our Managers, Human Resources Team and others on a whole new way of communication and handling of employees? Yes, we should. Remember, there is a whole new work order and we are also dealing with people who are coming back from isolation and not vacation. A number of them are currently flat while others maybe extremely suspicious of everyone and everything. The closeness of seats have been removed to meet the physical distancing protocol required in COVID-19, fewer people are returning to work while others still work remotely, the buddie support system is gone and replaced with the COVID-19 legacy of no “no hug and no hand shake”. Adjusting to all these changes comes with its own mental health constrain and proper management of people has to be the new skills in high demand in the new work order.

These level of heightened uncertainties put further strain on both employees and employers. While employers work so hard for gradual re-integration of employees to the new work pattern, we should also keep in mind that these employers are human beings who also went on isolation and they are not immune to the mental health issues are highlighted above. They do not live in space, they are a part of the society and also need to be cared for. The need to also create a support system for this category of people is extremely urgent because what they mostly do currently is to attend to the need of employees in attempt to get them comfortable. Most of these employers if not cautioned could suffer compassion fatigue and knowing this, we need to consider the option of getting an external mental health support to pull through this phase together.

Management system has changed, they are not just designed for only the people that we see in the offices daily but now we have people who must work remotely, the system must now be reviewed to accommodate these two categories of workers. Global economy has been predicted to be adversely impacted but what does this mean to businesses and employees who work in these businesses? Will this lead to loss of jobs? Will this lead to pay cuts? Has the future of work come faster than predicted? Will some kind of jobs or roles still be needed in workplaces? Will my organisation survive this phase? These and many more questions are raising the level of uncertainties and increasing the mental health burden of both employees and employers.

In the midst of our collective and personal plans came COVID-19, now the world of work has totally changed leaving us all to learn and adjust to the new workplaces and work patterns that are gradually unfolding.


Ehi Iden
ehi@ohsm.com.ng

COVID-19 Series: Urgent Need for Training and Retraining