Nurses in Swaziland work in appalling conditions for minimal pay, and it’s time they got some recognition, says Susan Elden
There is no such thing as ‘Nurses Day’ here in Swaziland. We barely recognise, reward or even compliment the nurses for the care they give. The nurses here work the same shifts and provide the same care as nurses in the UK. The big difference is that they do this for a fraction of the salary and in far worse conditions.
The temperature easily reaches 30-35 Celsius and there is no such thing as air conditioning on the wards. Portable fans are few. The beds are always full and space often has to be made for patients to spill out into the hallways and corridors.
The wards are full of TB and HIV patients. Infection control systems are in place to prevent TB transmission but many patients can be admitted for days before TB is discovered. It takes over two months to receive culture results and diagnose a resistant strain, by which point nurses and patients have already been exposed. We give the nurses particulate masks to protect them but sometimes we are in short supply.
Two nurses I know of have had to take post exposure prophylaxis (PEP) after being exposed to HIV. One, a maternity nurse, was splashed in the face and eyes with amniotic fluid attempting to deliver a baby to a HIV infected mother.
The other had a needlestick injury after drawing blood on an infected patient. They were both grateful for PEP which reduced the possibility of getting infected, but it does mean swallowing down numerous tablets every day, enduring the side-effects, and testing and re-testing; each time holding your breath in the hopes that you are still negative.
I don’t know of a single nurse back home who would tolerate working in this physical environment, endure the mental exhaustion of caring for patients who are dying of preventable diseases, face daily risks to their health and accept a salary that is barely enough to provide a family with food and education fees.
Many nurses here feel the same way. I’ve been here for six months and have seen many good, experienced nurses leave. We are likely to lose more. They know that there are other places where they can work in better conditions for better pay.
Some go to a government hospital so they can receive benefits that our hospital can’t provide, like a basic pension or retirement package, and continuing education. Or they go to nearby South Africa where nurses are paid over double what nurses in Swaziland make. Others go further afield to the US and UK. Although this is far from home, the better salary and working conditions are worth the sacrifice.
So where does this leave Good Shepherd Hospital and other hospitals around Swaziland?
From what I see on a daily basis, it leaves us with understaffed wards full of patients run by a few nurses, most of them inexperienced and new to the profession. Morale is low, stress is high, the demands are overwhelming. Over the past few months our hospital lost 33 nurses - over a quarter of our experienced nurses.
They are then replaced by new graduates who must spend days and weeks in training sessions, clinical tutorials and education workshops, just to bring their skills up to the level of the experienced nurses. They stay, gain experience and move on. The cycle continues.
This sounds very dismal. I don’t know the long-term solution for this problem, and I do know that there are some nurses that don’t follow this path. Although they are given no recognition, rewards or additional benefits, some of them stay. For this, I am grateful.
They are the ones who train the new nurses and teach visiting doctors and medical students. They know that, each morning at 7am, there are over 100 patients queuing outside the outpatients department, numerous A&E and ward admissions and discharges. What looks impossible by 9am suddenly becomes possible, and I see the remaining patients leaving by 5pm. These are the nurses that get the job done.
More importantly they provide a memory to this hospital that would otherwise have disappeared long ago. To me, as an outsider, their stories are amazing. They have given birth to their children and seen their families treated here. Their faces tell the stories of the real Swaziland.
I listen in amazement to the stories of the lives, births and deaths of so many. They have told me what it was like working here before they had heard of HIV. They have told me what it was like when they first started testing patients and the desperation they felt when they saw patients dying daily of AIDS with no way to receive antiviral drugs. They have told me what the salaries and conditions were like when they started and have much things have improved. They keep me hopeful.
So this year, I would like to say ‘Happy Nurses Day’ and my biggest thank you to those nurses of Swaziland who decide to stay with us. They are the backbone of our hospital and our only hope for a country with the highest TB and HIV prevalence in the world.