‘ Health system buckles under pressure’ was the Jamaica Observer news headline on July 7, 2017.

One may ask, when did we get here? Others may simply resign themselves to the fact that they saw it coming given the upsurge in violence across the country, with one institution seeing almost 430 gunshot wound cases in less than 12 months. These statistics are frightening.

Hospitals across the county are adopting creative measures to ensure accessibility to health services to those in need. For example, the largest referral hospital in the English-speaking Caribbean, Kingston Public Hospital, resorted to stringent measures in order to cope with the increase in trauma cases, especially gunshot wounds. Elective surgeries have been postponed, some patients referred to other hospitals in the South East Regional Health Authority, and referrals from other institutions are painfully rejected.

The current situation is eroding any gains made in improving the public health system and is a barrier to Jamaica achieving universal access to health care. Not only is the increase in trauma cases affecting Type A and B hospitals across the country, but also Type C institutions, where this experience exacerbates the already struggling condition in a resource-constrained system. The work of all departments, and all categories of staff, has been affected and, as such, there is urgent need to address the driving forces behind the increase in trauma cases being seen in our public health facilities.

While I am disturbed about the violence epidemic and its effect on individuals, families, communities, and the nation as a whole, I am even more concerned about the havoc it is wreaking in the public health system. I attempted to find out how staff, more specifically nurses, in public health facilities are coping during these trying times.

Nurses share their experiences:

“Terrible” is one nurse’s description of the current state in the Accident and Emergency Department (A&E) in which she works. Nurses admitted to heavier workloads in recent months with its attendant effect of “extended work hours or working for 16 hours”. One institution sees at least “three gunshot wounds per day in addition to those pronounced dead on arrival”.

Another nurse pointed out that he feels “traumatised when young victims of gunshot wounds die”. He added that it is “very frustrating when there are no available beds in the A&E to stabilise trauma cases”. The lack of bed spaces in the A&E is sometimes due to the large number of patients retained in the area until beds are made available on the wards. Ward beds are sometimes occupied by “social cases”, otherwise known as ‘boarders’.

The result has been that nurses extend themselves to provide coverage due to the perennial problem of shortage of staff. The consequence is that nurses voice concerns about “feeling tired”, “overworked”, “overburdened”, and suffering from burnout. They admitted falling to “physical and mental stress”.

Additionally, nurses expressed concern about their safety when caring for patients from their communities who show up with gunshot wounds. This is due to fear of being caught in the cross hairs of reprisal killings. The reality is that nurses also live in some of these volatile communities, and are therefore crippled by fear as they feel quite unsafe. This is the case especially for those working in A&E departments. Loyalists often show up with victims of gunshot wounds, and one nurse from a particular community had to hide due to fear of being identified by gangsters from her community. This no doubt has compounded an already stressful work environment. No doubt, with extended working hours, nurses are also fearful to go to and leave work on the late shifts.

Nurses argue that once trauma cases, such as gunshot wounds, present to the A&E department all other forms of patient care end up being placed on hold, with patients seeking care becoming upset, sometimes boisterous, because priority is given to trauma cases. This sometimes creates tension in the department, posing a threat to staff, even with security personnel present.

The way forward

In talking with nurses about the way forward nurses argue that there is a “dire need for counselling”, especially for those working with and caring for trauma cases.

Commendation to the Minister of Health Dr Christopher Tufton, who recently announced some kind of intervention for staff working in these high-stress areas as well as attending to increased numbers in trauma cases.

Some nurses feel there is need for expanded emergency care facilities in the hospitals generally, while one concluded that the way forward must include curtailing the ever-increasing rate of crime, violence and lawlessness. The situation requires “reorientation”.

Another nurse felt that focus should be placed on “social interventions, such as the security forces interacting with communities more; continual security forces’ presence in communities; ensuring that youngsters, especially those who are male and of school age, are in school; and increasing employment opportunities”.

It is true that health personnel have become hostages/victims of crime and violence in the work environment, and as such I concur with the recommendations articulated by the nurses.

But, unequivocally, as can be seen from the concerns raised above, providing counselling for health personnel at affected institutions is paramount at this time. The maintenance of the administration and delivery of quality health care demands it.

Commendation to the nurses in the field who continue to do high-quality work and their best under difficult circumstances.

Adella Campbell, PhD, is an associate professor and head of the Caribbean School of Nursing at University of Technology, Jamaica. Send comments to the Observer or adcampbell@utech.edu.jm .