Culture, Medicine and Psychiatry

, Volume 26, Issue 1, pp 55–86 | Cite as

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

  • Giuseppe Raviola
  • M'Imunya Machoki
  • Esther Mwaikambo
  • Mary Jo DelVecchio Good
Article

Abstract

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.

depression HIV/AIDS hopelessness Kenya medical education narrative physician burnout 

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REFERENCES

  1. American Psychiatric Association 1994 DSM-IV. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington DC: American Psychiatric Association.Google Scholar
  2. Daily Nation 2000 Why referral system at Kenyatta National Hospital has collapsed: Caseloads have increased by over 70 percent in the last five years (Thursday, October 26, 2000) 29.Google Scholar
  3. 2000 Doctors Also Cry (Wednesday Magazine, September 27, 2000) 1.Google Scholar
  4. 2000 Article boosted medics' morale (Friday, October 13, 2000) 7.Google Scholar
  5. Good, M., M. Machoki, E. Mwaikambo and E. Amayo 1998 Clinical Realities and Moral Dilemmas: Contrasting Perspectives from Academic Medicine in Kenya, Tanzania and America. Daedalus: Journal of the American Academy of Arts and Sciences 128(4): 167–196.Google Scholar
  6. Iliffe, J. 1998 East African Doctors: A History of the Modern Profession. Cambridge: Cambridge University Press.Google Scholar
  7. Jackson, S.H. 1999 The Role of Stress in Anesthetists' Health and Well-Being. Acta Anaesthesiologica Scandanavica 43: 583–602.Google Scholar
  8. Kibwana, K., S. Wanjala and Okech Owiti, eds. 1995 The Anatomy of Corruption in Kenya: Legal, Political and Socio-Economic Perspectives. Nairobi, Kenya: Claripress, Ltd 27–87.Google Scholar
  9. Leaning, J., S. Briggs and L. Chen, eds. 1999 Humanitarian Crises: The Medical and Public Health Response. Cambridge: Harvard University Press143–175.Google Scholar
  10. Machoki, M., M. Good, E. Mwaikambo and E. Amayo 1998 Ethical and Moral Dilemmas in Medical Training and Practice in Kenya, proposal.Google Scholar
  11. Machoki, M., M. Good, E. Mwaikambo, E. Amayo and L. Muchiri 1999 Dilemmas in Medical Education and Practice, presentation.Google Scholar
  12. Machoki, M. 1998 Doing Good. Is it possible in the HIV/AIDS pandemic? The impact of HIV/AIDS and depravity on physician practice in Kenya: pilot project, presentation.Google Scholar
  13. 1999 Moral and Ethical Dilemmas in Medical Training, paper presented at the conference on East African Health and Social Change sponsored by the Department of Social Medicine, Harvard Medical School (April 15, 1999).Google Scholar
  14. Stern, T., J. Herman and P. Slavin 1998 MGH Guide to Psychiatry in Primary Care. New York: McGraw-Hill 667–672.Google Scholar
  15. Mwaikambo, E. 2000 Medical Culture and Training-Ethical Issues and the Physician's Dilemmas of Disclosure in Tanzania, initial overview of interviews done.Google Scholar
  16. New York Times 2001 Zimbabwe Doctors Flee As AIDS Crisis Widens, Poor Pay Tops List of Frustrations. New York Times International (Sunday, June 3, 2001) 12.Google Scholar
  17. SCID-RV 1994 Structured Clinical Interview for DSM-IV Axis I Disorders-Research Version. (SCID-RV). Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
  18. Turshen, M. 1999 Privatizing Health Services in Africa. New Brunswick: Rutgers University Press.Google Scholar
  19. UNAIDS 2000 Report on the Global HIV/AIDS epidemic, 96–97.Google Scholar
  20. Winiarski, M., ed. 1997 HIV Mental Health for the 21st Century. New York: New York University Press.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Giuseppe Raviola
    • 1
  • M'Imunya Machoki
    • 1
  • Esther Mwaikambo
    • 1
  • Mary Jo DelVecchio Good
    • 1
  1. 1.Department of Social MedicineHarvard Medical SchoolBostonUSA

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