Academic journal article Human Organization

Causes and Effects of Occupational Risk for Healthcare Workers on the Maternity Ward of a Tanzanian Hospital

Academic journal article Human Organization

Causes and Effects of Occupational Risk for Healthcare Workers on the Maternity Ward of a Tanzanian Hospital

Article excerpt

Introduction

On my first day on the maternity ward in 2014, having just arrived at the Mawingu Regional Hospital to start fieldwork, I was on rounds as the night nurses handed over to the incoming day shift nurses. We went woman to woman and, in the course of these proceedings, we came to a woman who had been throwing up since she had arrived at the hospital in labor. Not knowing this, I was standing near her bed, under which was tucked her requisite plastic basin from home, when she once again began to throw up. I happened to be within vomiting range and soon found her vomit spattering my shoe and left pant leg. This was, I knew from previous experience, not an isolated encounter with bodily fluids. Throughout my time at the hospital, there were many incidences in which I or the nurses only had barely enough time to hastily pull on one sterile glove before catching a baby. In other instances, amniotic fluid could splash or spray long distances when a woman was in the midst of a contraction or while pushing. As one nurse told me, "If you don't know the taste of amniotic fluid, you haven't worked long enough on maternity." More than other wards, on which bodily fluids emerged generally with less force, a much slower pace, and considerably more predictability, maternity ward staff members regularly came into contact with amniotic fluid, vomitus, blood, urine, feces, sweat, vaginal secretions, and breastmilk on a daily basis as they served the more than 500 women who gave birth on their ward every month.

Combined with this high likelihood of frequent contact with these bodily fluids, were shortages of drugs and medications and a limited supply of the personal protective equipment (PPE) the providers would have worn to protect themselves during interactions with patients under their care. It was in this context that I began to ask the maternity ward nurses and doctors about how they thought of their work environment and whether or not they were ever concerned about their ability to protect themselves while in such intimate contact with women's bodies at nearly all times. Throughout these discussions, the word risk repeatedly surfaced as the doctors and nurses explained the maternity ward as work environment. The nurses and doctors at the Mawingu Regional Hospital faced the threat not only of physical infection but also the inversion of roles; they risked becoming the patient through contact with bodily fluids from women who might be harboring unknown infections, unclear HIV statuses, STIs, contagious skin infections, and/or Hepatitis. The risk inherent in maternity work added an additional burden to providers already operating in extremely strained environments and was compounded by structural problems including the supply chain for PPE and the improvisation which the work environment necessitated.

Through analysis of healthcare workers' experiences and interpretations of their occupational exposure to risk, this article adds an important new perspective to the body of medical anthropological literature on risk. Ordinarily, the healthcare professionals figure into these works as actors meant to help their patients calculate and mitigate risk factors for various health conditions. However, in the context of the Mawingu Hospital maternity ward, it was clear that even as nurse-midwives and doctors sought to reduce the risk of maternal health complications, their own occupational exposure to risk weighed heavily on their minds and, ultimately, influenced the care they provided.

Maternity ward staff members repeatedly mentioned that the hospital administrators did not adequately acknowledge the risks maternity care providers were facing every day. Subsequently, the hospital leadership did not display the desired level of care for their employees, which resulted in employee dissatisfaction with their work and abusive interactions between staff members and women who came to the hospital to give birth, who became the recipients of the nurses' frustrations. …

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