Culture, Medicine and Psychiatry

, Volume 26, Issue 1, pp 55–86

HIV, Disease Plague, Demoralization and ``Burnout'': Resident Experience of the Medical Profession in Nairobi, Kenya


  • Giuseppe Raviola
    • Department of Social MedicineHarvard Medical School
  • M'Imunya Machoki
    • Department of Social MedicineHarvard Medical School
  • Esther Mwaikambo
    • Department of Social MedicineHarvard Medical School
  • Mary Jo DelVecchio Good
    • Department of Social MedicineHarvard Medical School

DOI: 10.1023/A:1015289132151

Cite this article as:
Raviola, G., Machoki, M., Mwaikambo, E. et al. Cult Med Psychiatry (2002) 26: 55. doi:10.1023/A:1015289132151


This paper describes the experiencesof physicians-in-training at a public hospitalin Nairobi, Kenya, where medical professionalspractice in an environment characterized byboth significant lack of resources andpatients with HIV/AIDS in historicallyunprecedented numbers. The data reported hereare part of a larger study examining ethicaldilemmas in medical education and practiceamong physicians in East Africa. Aquestionnaire and semi-structured interviewwere completed by fifty residents in fourmedical specialties, examining social andemotional supports, personal and professionalsources of stress, emotional numbing anddisengagement from patients and peers, andsymptoms of post-traumatic stress anddepression. The factors affecting residentwell-being are found in this study to be morecomplex than previous interviews suggested. This study highlights the fact that as a resultof working in an environment characterized by poor communication among hospital staff aswell as a lack of resources and high numbersof patients with HIV/AIDS, residents'perceptions of themselves – their technicalproficiency, their ability to care and feel forothers and themselves, and for some theirentire sense of self – are significantlyaffected. Also affected are the patients theywork to treat.

depressionHIV/AIDShopelessnessKenyamedical educationnarrativephysician burnout
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© Kluwer Academic Publishers 2002