Health feature

Why a nurse is a friend to everyone


By Frazer Potani, Lilongwe , Malawi


As they prepare to begin caring for the sick, graduating nurses must lift up a hand to recite a vow pledging to respect the dignity of every patient and general service of humanity.

Recently however, a nurse was reported beaten and further suspended for allegedly refusing to take care of a patient that led to the patient’s death at Mangochi District Hospital .

Some months ago another nurse at Mwanza District Hospital also claimed she was beaten up by a father to one of her patients following alleged misunderstandings on a syringe she wanted to administer a dose of quinine to his child.

The Executive Director for National Organization of Nurses and Midwives in Malawi (NONM) Dorothy Ngoma admitted that her office receives conflict incidences between nurses and patients/guardians.

While not condoning nurses/health workers ill-treating patients/ guardians in hospitals, Ngoma said she is worried with nurses and midwives/health workers’ safety in the country’s hospitals at the hands of patients/guardians.

“We have had several cases [of abused nurses/midwives and health workers at work] referred to us. Generally it’s just not acceptable for any nurse or health practitioner to be abused either by the patients or the guardian or the community,” said Ngoma.

She said that a nurse makes seven out of 10 of all health workers in Malawi hence a vital workforce of the country’s health delivery system therefore, can not professionally and ethically do their job if their safety is compromised at work.

“If they are beaten up or abused whether it is psychologically or economically or in what ever way they will not give us the best and we can’t survive,” said Ngoma.

She said that at one time her office used to receive several cases of physical attacks of nurses by patients/guardians.

“For physical abuse we have had a number of them I remember times …we used to have several cases from the north, St. Johns [ College of Nursing in Mzuzu] being one of them. I remember at one time we did get a report where a nurse was beaten up on duty by the parent of a patient,” said Ngoma.

She added that her union took the case to police.

In one case guardians of a patient pulled knives to stab a nurse because they thought she was playing tricks not to assist them.

“This nurse was actually calling the doctor to come to examine the patient and the doctor was not coming fast enough to assist their patient,” said Ngoma adding, “She [the nurse] was almost killed.”

Ngoma urged security guards on duty to provide maximum protection to nurses and health workers especially at night.

She further appealed to members of the general public if not satisfied with any service in one way or the other by any nurse or health worker in hospitals to report such matters to the authorities at their institutions than taking the law into their own hands.

Ngoma further said that nurses and midwives have a professional and ethical code to follow and where discovered they have seriously breached it they can be barred from practice by Nurses and Midwives Council of Malawi to prevent them from putting human lives at risk.

Malawi Health Equity Network (MEHN) National Coordinator Martha Kwataine said her organization commissioned a survey which also revealed that among other things, health workers including nurses/midwives in the country get ill-treated psychologically, physically and other forms especially in public hospitals.

Blantyre resident Michael Mabeseni however, said some nurses and health workers’ attitudes towards patients/guardians deliberately invite trouble for themselves.

His personal experience occurred when he helped his neighbours take their sick child to Queen Elizabeth Central Hospital (QUECH) in Blantyre .

“The errand ended up being a sad eye-opener, when discovering that not all female nurses are as motherly as their profession demands,” he said.

Mabeseni said a nurse at the hospital stormed at a mother for taking a sick child to the hospital in the night.

“The crime the innocent child committed for its mother was to cheer up a bit in the presence of the nurse. In the eyes of the nurse, by looking cheerful at that moment, the child was not sick,” said Mabeseni.

“My heart missed a beat upon hearing that. Luckily my patience was at its best as it just enabled me to walk away. Thank God the doctor and a student male nurse on duty prevailed over the female nurse and assisted the child,” he said.

Writing in the Malawian Nurse (an official publication for nurses, midwives and health workers in Malawi ) medical practitioner Edgar Lungu said the attitude of some health care workers especially nurses towards patients and clients has been a subject of various discussions.

“The stories of people who have been victims of the poor attitude of nurses have been very pathetic,” said Lungu.

He said of special note too is the fact that most complaints (98 percent) come from patients who had their bad experience at a government health facility.

Lungu said the public response has been almost in unison, wondering why of all people, a nurse who should posses a caring and empathetic attitude to a patient is the first person uttering rude and degrading remarks to a patient.

“The public perception that nurses are rude deters young men and women from joining the profession. Who wants to be associated with rude people?”said Lungu.

He was however, quick to say without defending the nurses ill-treating patients/guardians pressure of work on nurses due to inadequate staff in public hospitals was also contributing to their unethical and unprofessional conduct.

“Some nurses have answered accountably to have treated patients or clients poorly. The nurses explain the unfortunate treatment towards patients and clients is a result of too much work pressure and impatience of patients and clients,” said Lungu.

He disclosed that staffing shortage in public hospitals is a critical issue because instead of the ideal nurse to patient ratio of 1 to 10, practically one nurse is to 50 or above in admission wards.

“This implies that a nurse works five times as much,” said Lungu.

Kamuzu Central Hospital (KCH) nurse Monica Bottoman in Lilongwe disclosed that working as a nurse in Malawi was very tough.

“My ward: Male Medical Ward is one of the busiest wards in the hospital. Referral patients from all districts hospitals in the central region are admitted here. Patients from Lighthouse are admitted here while continuing receiving Anti-Retroviral-Therapy (ART) until they are discharged,” said Bottoman adding that the ward was understaffed.

“Unfortunately we are only four in the ward. If one of us is on day duty, the other is on night duty. The third is on off duty and the fourth is pending night duty. I am the only one on duty on a particular shift against 70 to 100 patients,” said Bottoman.

She said in Malawi there is acute shortage of nurses mainly contributed by the mass exodus of nurses leaving for greener pastures either to the United Kingdom (UK), America , or Non-Governmental-Organizations (NGOs).

“Another challenge is the greatest risk of being infected with infections like Pulmonary Tuberculosis, Meningitis or even HIV [and AIDS]. The ward is usually full of very chronically ill patients because of the HIV and Opportunistic Infections,” said Bottoman.

She further disclosed that her ward admitted patients suffering from among other things HIV and AIDS, Meningitis, those on Tuberculosis investigations, Hepatitis B, Diarrhoea.

“Most of my colleagues don’t like to work in such wards. They are afraid of being contaminated,” said Bottoman.

She said she had then been working in this ward for over five years.

“At the end of each year when time for changing from one ward to the other comes, other nurses refuse to exchange with us from this ward. They say it’s a busy and infectious ward. We therefore, remain here year after year,” said Bottoman.

The nurse further said coupled with hard work and shortage of staff was the shortage of resources.

“The shortage of resources include protective wear such as gloves; drugs. While we try to prevent ourselves from infections by wearing gloves whenever in touch with body fluids from infected patients, most of the times the gloves and other protective equipment aren’t available,” said Bottoman adding that she did not only care for the sick.

“At the same time I care for the dying, including taking a dead body to the mortuary. Sometimes five deaths occur in a single shift. So it’s not easy for one nurse to manage such a ward. Most patients die unnecessarily because of the inability of one nurse to care for all patients at once as expected,” said Bottoman.

She disclosed that during lunch time she was very busy to sit down to eat.

“Worse still due to financial problems I can’t even afford a good meal for lunch to sustain my health but instead, just have a cup of tea without milk plus a snack as my lunch. Yet I am supposed to lift patients or dead bodies from the bed to the trolley,” said Bottoman.

She said on day duty she was busy until 5 p.m. when she was supposed to knock off.

“At the end of the day I find myself very tired, hungry and very weak as if I am sick. The work we do doesn’t tally with the money we receive at the end of the month. You can imagine standing the whole day without finding time to sit down. Most nurses run away due to such conditions,” said Bottoman.

The Malawi Health Equity Network (MEHN) says its studies reveals that nurses’ lives are danger as they risk contracting infections within their working environment.

“57 percent of nurses giving injections for illness reported suffering at least one ‘needle stick’ incident in the last 12 months. As many as one in 10 needles are used more than once. Given acute shortages of gloves and other protective clothing, it is not surprising that 96 percent of service providers perceive risk to themselves from HIV and AIDS exposure, while 93.4 percent perceive a risk to their clients,” says the network.

A Malawi Government study on HIV and AIDS impact on health personnel funded by United Nations Development Programme (UNDP) reveals that death is the highest cause of attrition.

“Death is particularly high in the age groups 30-34(19 percent), 35-39 (21 percent) and 40-44 (19 percent). The highest death rate is experienced by Laboratory Technicians (47.5 percent), followed by Clinical Officers (31.8 percent), Environmental Health Assistants (23.3 percent), Enrolled Nurses (20.3 percent) and Registered Nurses (15 percent),” says the study.

A research by the National Family Council of Malawi funded by says United Nations Population Fund (UNFPA) Malawi a challenge to provide adequate, quality health service to the needy ahead if the number of health workers is not increased.

“One example is the challenge we face in training, recruiting and retaining health personnel. In 1922, [when Malawi’s population was over 8.5 million] there were 1,200 doctors, clinical officers, and medical assistants; that is, one for every 7,300 people,” says the council adding that this coverage was low and the hope was that it would improve.

“In our projections we assume that by 2022 there will be one doctor, clinical officer, medical assistant for every 5,000 persons. If this is the case we would need 4,400 doctors, clinical officer or medical assistant in 2022 under continuing high fertility,” says the council adding,

“Even with declining fertility the number needed would more than double to 3,300.” The Action for Global Health (AfGH) says Malawi desperately needs more health workers because the country has large health problems with Maternal Mortality, HIV and AIDS, Malaria and tuberculosis, which has and annual infection rate of 30,000 and the country’s health system is unable to meet.

“In Malawi there is one doctor for 65,000 people. In France or Germany, the ratio is one to 211, and even there staff shortage is increasingly being felt,” says the Action.


On nurses and health workers attitude proplem towards patients and guardians Principal Secretary for Health Chris Kang’ombe admitted that due to, among other issues overworking, some health workers, including nurses and midwives especially in public hospitals, have an attitude problem.

He further said his ministry welcomes criticisms on such matters because patients/guardians have a right to be treated with respect and dignity.

Kang’ombe however, said while it is not wrong for the media to expose unprofessional health workers for wrong doing, the press can also help health workers with attitude problem change their behavior by reporting about those doing a good job.

On her part Malawi nurses union founder Lucy Kadzamira bemoans in Malawian Nurse that some recruits are joining nursing as a last resort after failing to secure any other job.

“Nursing is a calling which needs to be taken seriously. My advice to upcoming nurses is that they should have patience, empathy and kindness to become a professional nurse,” she said.

She however, said: “It is important that employers give the incentives and all requirements to the employees. Additionally, they have to make sure that enough equipment, drugs and an attractive working environment is provided to the health care personnel as well as the patients.”