Saturday 7 February 2009

...sick and full of burning

One of the ever-present side-effects of working in the AIDS field is burn-out. I guess we've all experienced it, to a greater or lesser extent. Of course it hits the health care workers most heavily, as Theo Smart of aidsmap has identified in a recent issue of the HATIP (HIV/AIDS Treatment in Practice) newsletter, Caring for the caregivers in the face of HIV and TB. As Theo notes, there is a conception that things have become easier now we have antiretroviral therapy (ART). In theory this means that the hopelessness and helplessness has reduced, and people are not dying in the same numbers. As I've mentioned before, we've certainly seen that here, but... People are still presenting at a very late stage, when even the 'Lazarus' effect of ART cannot be guaranteed. And with the increase in shear numbers of those infected, while the percentage of deaths has fallen dramatically, the absolute numbers still remain awful.

In addition, for those who benefit from the Lazarus effect, there is the ever-present fear of what is called Immune Constitution Inflammatory Syndrome (IRIS), or what the TB old-timers called the Paradoxical Reaction. This appears as a sudden worsening of symptoms in someone who has started ART with a very damaged immune system. In that situation, the immune system has lost its ability to generate a reaction to infection. We often see people with CD4 counts (which measure the state of the immune system) in the single figures who are still apparently relatively healthy.

But after they start therapy, the immune system starts to recover, and often immediately starts to react to the 'hidden' infections. You may imagine the trauma when someone who feels relatively fine starts treatment and goes blind. Yes, that happens; I've seen it twice, a result of a hidden CMV infection which wrecks the retina.

No, ART has not solved all the problems, and has certainly not removed all the stresses which are faced by health care staff and community supporters.

We've just be translating that article by Theo. The first problem we faced is that there really is no translation for 'burn out.' The usual term used, 'jenuh', has more of a connotation of 'worn out', even though the dictionary does say it means 'sick and tired'. Theo also reports a doctor saying that nurses are unable to share their fears with their partners, ‘because they freak out completely’, A serious problem, but at least we had some laughs trying to translate that term!

Even in English, I think the term 'burn out' has become devalued. Back when, we used to talk of a nervous breakdown; I guess that term is no longer politically correct, but it certainly seems to fit what I felt at one stage, and what one of my close friends seems to be experiencing right now. And I guess if we go back a bit further (before my time, Dear!), the shell-shock experienced in the trenches in the First World War had a similar cause.

As Theo notes, "Clearly much more needs to be done to keep our healthcare workers healthy, happy and productive members of the health system." And the same is true of the community members working as buddies, counsellors and case managers, who often lack even the meager institutional support that the nurses get.

Babé

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