Researchers have warned that healthcare workers were at high risk of mental health issues due to their experience of moral distress in their working environment.
Unless real support is provided for healthcare workers whose moral suffering is already reaching epidemic proportions, the disease of burden will be fatal, argued the University of Cape Town (UCT) Professor Jackie Hoare and Dr Heidi Matisonn in a commentary published in the South African Journal of Science.
Hoare, the head of the Division of Consultation-Liaison Psychiatry and a senior consultant psychiatrist at Groote Schuur Hospital, and Dr Matisonn, a moral philosopher based at the EthicsLab in the Department of Medicine at UCT’s Neuroscience Institute - argued in their commentary titled “From the burden of disease to the disease of burden”, that moral distress in healthcare occurred when healthcare workers were constrained from doing what they believe is right for patients by institutional policies, hierarchical structures, or limited resources such as reduced theatre lists or limited access to therapies.
“This feeling of knowing what to do to care for patients but being unable to do it due to factors outside of your control is morally distressing because it involves a feeling of powerlessness to assist patients who are suffering. Moral injury is seen as a trauma experienced by healthcare workers,” they said.
According to the report, South Africa’s public healthcare system, where 20% of the nation’s doctors attend to 84% of the population, was in 2024, facing an ‘existential crisis’ due to the crippling effects of the national financial crisis in healthcare, which has resulted in healthcare posts being frozen and services to patients constrained.
Hoare and Matisson added: “While these cuts have had – and will continue to have – catastrophic effects on patient care, we also need to recognise the effects they have on the healthcare workers themselves,” they stated.
A survey released in October 2023 revealed that over a third (35%) of healthcare practitioners in South Africa feel that their mental well-being had worsened compared to the time during the Covid-19 pandemic.
It was further stated in the report that healthcare workers who are traumatised, burnt out, or depressed are less likely to provide the best possible care to their patients.
“We need an end to the current financial crisis caused by the national government, and we need urgent reinvestment in public health. While reinvestment in health will take time, we can and must, in the interim, and as a matter of urgency, recognise that the problem of moral suffering in healthcare workers exists, is real, and most importantly, is not shameful,” read the report.
The researchers revealed that the country’s healthcare workers were left alone to heal themselves.
“Instead, healthcare institutions should offer a multi-pronged approach to the problem. In healthcare environments where stress and moral injury are commonly experienced, we need to improve workplace culture, create psychologically safe environments, and develop interventions to improve clinical team connection and teamwork.
“During the Covid-19 pandemic, healthcare workers endured the unimaginable and the inconceivable. We faced traumas and bore witness to unspeakable suffering and death. Many of us have not yet recovered from those experiences and yet find ourselves having to endure another crisis, again one not of our own making but rather the consequence of a national budget crisis. Working in healthcare is a privilege and can be the most rewarding profession, but it comes at a cost to our well-being,” said Hoare.
Matisonn stressed that the responsibility to confront challenges in healthcare systems generally, and those under pressure specifically, should not be placed on the shoulders of healthcare workers already shouldering so much.
The Department of Health did not respond to questions from the publication which sought to establish whether the department would intervene.
A Brasil de Fato report compiled in 2020 stated that the disregard for health workers was also seen in South Africa, adding that the country failed to provide necessary support to nurses and doctors during the deadly Covid-19 pandemic.
At the time, Lerato Madumo, on behalf of the Young Nurses Indaba Trade Union, revealed that workers also did not have extensive tests or available PPE and, after announcing that they would go on strike if their claims were not met, they were threatened by the government.
The president told them they would be committing a crime under the Disaster Management Act, passed in 2002.
Sunday Independent