Jones* was absolutely heartbroken when he found out that he
was not eligible to join medical school in Kenya when he finished high school.
Coming from a humble background, he could not afford to pursue his dream.
However, Kenya was just starting to train nurses at degree level and Jones was
able to get into the pioneer class.
Four years later, with a degree rightfully earned, Jones
headed off to practice an art he had come to love. He took the Nightingale Pledge
to heart and practiced it with his whole being. He loved his patients and
worked with utmost dedication. Within a few years, he was back to school
studying hard to become a critical care nurse. He had found his calling.
Away from work, Jones spent his free time playing basketball
at a local club. He had played for his high school team but had been away from
the game for quite a while. It felt good to be back in practice. He also
started dating a young doctor he met during his specialist training. Life was
turning out pretty well for a young man who had thought he would never recover
from losing his dream.
However, one evening, during a basketball tournament, Jones suffered
an injury and fractured his tibia and fibula, the bones of the leg. What
followed was a dark period of excruciating pain and frustration at not being
able to do either of the things he loved. He underwent surgery but had to
remain in hospital for some time.
To manage his pain, he would receive opiod injection
medication every eight hours. The shots would be a welcome relief as not only
would they suppress the pain but would also knock him out and allow him to
sleep away the endless hours he spent lying there. When he went home, despite
having adequate pain relief from the oral tablets that he was prescribed for,
he struggled to sleep.
With his girlfriend being a doctor, it was possible for Jones
to get a prescription for sleeping pills
but he wasn’t quite able to get the kind of knockout he wanted. He pleaded
with her to bring him prescription opioid injection medication and he would
inject himself to sleep.
Five months after the injury, Jones was back to work. He was
happy to get back to doing what he loved. However, despite healing well, the
12-hour shifts in the critical care unit spent on his feet were heavily taxing.
His leg would throb after work and he couldn’t wait to get home and put it up
and rest. However, he found himself drifting back to sneaking in a shot of the
opioids to alleviate the pain and sleep.
Before Jones knew it, he was regularly injecting himself
prescription medication to sleep. He began pilfering the medication from the
dangerous drugs locker in the critical care unit to meet his needs. What
started as a medical need was turning into a monster that Jones was having
trouble taming. He did not have the capacity to face up to the magnitude of the
problem.
The addiction roller-coaster had long taken off. Suffice it
to say, Jones never played basketball again. His relationship with his
girlfriend hit the rocks and his supervisor caught up with his pilfering.
Instead of a disgraceful dismissal. Jones was offered an opportunity to hand in
his resignation.
The cycle of addiction is the same irrespective of the drug
of addiction. A bright young nurse who was on the path to a bright future, was
instead on a downward spiral to oblivion. Seven years of moving from one job to
another, one seedy apartment to the next, losing friends and family eventually
culminated in finally losing his license to practice for grossly endangering
patients’ lives.
There a many reasons why anyone would find themselves going
down the slippery slope of addiction. Many are harshly judged, especially when
they are hooked onto illegal substances. For healthcare practitioners, the easy
access to prescription drugs of addiction easily fuels the addiction flames in
record time.
Unfortunately, no one is usually paying attention until
things get out of hand. Unfortunately in Kenya, there is no mechanism in place
to deal with health workers who get into prescription drug abuse. In the Unites States of America, there exists
a robust physician health programme that is set up to support practitioners whose
ability to practice safely is impaired. The impairment may be medical such as
mental illness, cognitive impairment or drug addiction.
The risk these practitioners pose to patient care cannot be
underestimated. Nobody wants to be under
anesthesia and the doctor responsible for your life slumps in a corner from the
effect of a pethidine shot he gave himself instead of you. Of that moment when
you are bleeding out and the doctor’s hands are shaking too hard to put in the
lifesaving cannula required to transfuse you. Or when your teenager is writhing
in pain from a sickle cell crisis and the nurse has injected him with saline
since she cannot account for the pethidine via meant for him but she has
already injected herself.
A health practitioner suffering addiction, and specifically
prescription medication addiction, is not only a danger to himself but is an
even bigger danger to the patients. As we strive to take care of our patients
struggling with addiction, we need to set up a system to ensure the same care
is extended to our health workers.
The system must work by providing a safe place for them to
seek help without judgement. We must also enable fellow health workers to
report their colleagues who may be unfit to practice due to addiction. However,
the reporting should not be for punitive purposes but for enabling access to
support and care. It is definitely time for a physician health programme in
Kenya!