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


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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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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