When a class of 40 newly graduated Swazi nurses left the country en masse a few years ago, the government decided it had to find an effective way to stem the loss of this precious human resource.
The solution was to create the Swaziland Wellness Centre, a place where healthcare workers receive medical attention themselves, participate in continuing education programmes and get counselling to help manage work-related stress. The centre is open to their immediate family members.
With the help of international partners, the wellness centre model has been replicated across the region. Lesotho opened a similar centre late last year and Zambia and Malawi are about to follow suit. Apart from national governments, funders include the International Council of Nurses, the Danish Nurses’ Organsation and the Stephen Lewis Foundation.
With 26% of its population HIV-positive, Swaziland has the world’s highest levels of HIV infection. Healthcare workers are doubly affected, both because of the increased workload that HIV/Aids causes and because they and their relatives are directly and indirectly affected by the epidemic.
For Swaziland — and other countries in the region — retaining staff is a major problem. Masitesela Mhlanga, former president of the Swaziland Nurses’ Association, said that from his class of 33 nurses who graduated 14 years ago, only six are still in the country. About 96% of Swazi nurses go to the United Kingdom, but Australia is gaining in popularity. In total Swaziland has about 8 000 healthcare workers — of which 3 054 are nurses — serving a population of about one million.
According to the World Health Organisation (WHO), sub-Saharan Africa carries 25% of the global burden of disease, comprises 11% of the world’s population, but has only 3% of the world’s healthcare workers.
Surveys of Swazi nurses who had left the country were conducted in 2003 and 2004 and found that money was not the main issue. Rather, nurses said they were not appreciated by patients or managers. Nurses also felt their authority was undermined because when they themselves were sick, they had to queue alongside their patients for treatment and medicine.
Healthcare workers are at greater risk of infections, which they can catch if they are exposed to the bodily fluids of their patients, for example, through needlesticks. Mhlanga said the counselling service is particularly helpful because it allows healthcare workers to develop trust in the counsellor. ”When they come, they are offered VCT [voluntary counselling and testing]. Because of the stigma they have never been able to open up and felt the stigma from the population they serve. Now they can confidentially discuss other cultural and personal issues.”
A donation from pharmaceutical company Merck Sharpe and Dohme and from the United States’s medical technology company BD means that through the two existing wellness centres all healthcare workers in Swaziland and Lesotho will be offered the hepatitis B vaccine. Hepatitis B is a viral infection that can lead to liver damage and cancer. The WHO estimates that about 40% of hepatitis B and C infections among healthcare workers worldwide are because of exposure at work. The BD donation is for disposable syringes, part of a campaign to prevent the re-use of needles to curb the spread of infection.
As well as providing testing, counselling and antiretroviral drugs, the Swaziland Wellness Centre collects data to get an accurate estimate of the levels of HIV infection among healthcare workers. However, Mhlanga said he has noticed that the impact of HIV/Aids seems to be abating among his colleagues, mostly because of better access to treatment. In 2004 every weekend there was a funeral for a healthcare worker; now there seem to be fewer deaths. ”Maybe we will have a sustained, healthy workforce,” he said.
So far about 5 200 healthcare workers and their immediate families have used the centre. Mhlanga said an important facility is the grief healing garden: a private place where people can mourn their own losses and cope with the pain they see daily at work.