Monday, March 20, 2017


It has become imperative that we discuss this issue surrounding mental health amongst Doctors and other healthcare workers. The sanity and mental wellbeing of a healthcare worker including the Doctor forms the bedrock of patient safety. It takes a safe and sane person to deliver safe healthcare and we have to give this attention also even as we navigate daily trying to find ways towards improving quality of care within our healthcare systems.

Within the last two weeks in Nigeria, we have had two very shocking incidents which have left everyone rattled and disturbed. The first case was that of a Medical Doctor named Emmanuel Ogah who stabbed his 62 years old mother to death in Lagos. As we were all still trying to come to terms with that incident, on the 19th of March 2017 another Medical Doctor identified as Dr Allwell Orji asked his driver to stop at the middle of third mainland bridge, came down from his car and jumped into the lagoon where he drowned to death before help could come his way. These two incidence happened within a space of one week bringing the loss suffered within the Medical profession to two in just one week.

This has got me thinking as an Occupational Health Consultant and a Patient Safety Advocate, I am battling so hard to balance this out and looking at how it further increases the risk exposure to the patients. These are both Doctors who were trained to care for patients, could they have been overworked? Are there issues surrounding their personal lives as families and other very personal issues responsible for these acts? Nigerians were not known to commit suicide, the suicide index in Nigeria has been very low and non-significant but we cannot boast of that any more, we are fast losing our resilience and copping capacity. Let’s take the issue of being overworked as an example, the population of Nigeria is 173.6 million people according to 2013 report and if we go by this report, Nigeria needs a minimum of 237,000 Medical Doctors to care for the population in line with the World Health Organisation (WHO) ratio of 1 Doctor to 600 people within a population group. But from all reports available within this context, there are only 35,000 Doctors actively working as Medical Doctors in Nigeria and this is just not a good enough ratio and there is no need Doctors will not be overworked. We are invariably having 1 Doctor to 4,960 people following the figures above. By this figure, we can almost conclude that workload may have just been a strong contributing factor to suicide or death amongst Doctors and healthcare workers in Nigeria. Though the Nigeria Medical College has trained more than this number of Doctors, a number of them have long delved into something else as music, sales and marketing, importation and other viable entrepreneurship ventures.

The question is, how does this impact on patient safety?

It is even sad that mental health was not included amongst the list of Occupational Health diseases or illness in International Labour Organisation list of occupational diseases until much later when the toll became so obvious. Psychosocial hazard has become a very huge issue within the healthcare work environment leading to burnout, fatigue, exhaustion, stress, tiredness and sleep deprivation amongst healthcare workers and these outcomes impact negatively on the safety and quality of care within treatment cycle. The need to keep the healthcare workers safe and mentally stable is a thing that needs our collective action and support, it takes a safe healthcare worker to deliver safe healthcare to patients.

We should be looking at the workload and duration of duty shifts within the healthcare sector which has long changed over the years, making workers to engage in longer hours per shift dealing with excess workload beyond their copping capacity. We all agree that in healthcare, we deal with lives and any mistake within the line of service delivery is always a costly one which innocent people pay for with their lives. Work overload is a critical issue surrounding daily patient harm in the hospital, it hurts the patient as a much as it hurts the healthcare workers. This load, if allowed to persist for too long, alters the mental wellbeing of the healthcare worker leading to cheap mistakes, irrational behaviour, lack of co-ordination and a total disrespect towards the right and dignity of patients. This is never in any one’s best interest.

There are many Doctors, Nurses and others who love their jobs and keep giving all they have, giving mutual support to other Nurses who they perceive to be overwhelmed with work, this sometimes lead to collective burnout within a team leading to patient harm. Such healthcare workers are seen as trusted by everyone and tagged “MR FIX IT” because of the willingness he always shown to help or assist. The worker becomes a victim of patients continuous demand, he does not say NO but always there to help, overtime he becomes emotionally overdrawn and this can also lead to patient harm.

Mental health amongst Doctors and healthcare workers should at this point be taken so seriously owing to the new and emerging conditions and disruptive behaviour noticeable amongst healthcare workers. The two Doctors whose cases were sited at the beginning of this write-up are supposed to be managing patients trusted in their care, any Doctor that thinks suicidal for whatsoever reason is a risk within the hospital environment no matter the department or unit he works from. I really think this is where we must be looking deeply into Human Resources management in healthcare environment, this is not a function assigned to a new comer but a role played by a very experienced professional with a strong analytical background in Human Psychology. We cannot rule out the fact that these two Doctors never displayed such violent or suicidal behaviour that would have attracted the attention of co-workers or even the Human Resources Managers who would be expected to have an audience with such an employee with obvious suggestive indicators. We need to start engaging our colleagues, we need to start setting up Employees Assistance Programs (EAP), we need to start looking beyond work and also start getting quick and smart peeps into what happens in the home of our employees. Are there issues? Are there smart ways we can help out? This should be the thinking, it will save both the patient entrusted into the care of such employees and the employees themselves and maintaining good reputation of the healthcare facility.

We must understand that healthcare workers are human beings just like us all, they are not super men, and they are fallible like every one of us. We need to start re-humanise our workplaces, let’s start reviewing the workloads, timelines and deadlines, let’s once again treat these people the way we would want them to treat our patients. Let’s bring dignity of labour back to healthcare, let’s again work like one big family where we all continuously watch each other’s backs, let’s rebuild the lost confidence while having the patient at the centre of these thoughts.

Losing more Doctors and seeing others behind bars due to homicide and seeing others incapacitated and almost invalid when we know the work pressure and work environment contributed to these conditions and states is not a plus to us all, we can change it.

It just takes a SANE Doctor to offer a SAFE healthcare.

Monday, August 1, 2016

Bank Manager Commits Suicide: Is this the last? Unfortunately, No

I logged on to the social medial on Sunday morning and the first story I saw was the trendy headline of the Banker who committed suicide and this got me very disturbed. I was not too concerned about the real reason behind his intentions because there are many versions of that story for now but I was looking at it from the position of Occupational Health and wellness.

I may think in this direction perhaps because of my profession but we have always advocated that employees’ health and wellness must be fully integrated into the overlapping wheels of good business processes. We do not currently have that in most organisations in Nigeria even when the global economic hardship places so much pressure on everyone, we all feel the huge negative effects but no one seems to talk about it. We are all mute and mutually frustrated and productivity suffers leading to more round of pressure on employees to scale up. This has been the cycle.

When we look at the World Health Organisation’s (WHO) definition of Health and Wellness, it says “it is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity. When we look at workplace wellness and health in this context, you will realise an employee can be present at work with no disease or illness and yet not well when weighed in health and wellness balances. The question is, what are we doing wrongly?

In the new global workplace we have all found ourselves, there is this huge temptation to place profit above the health and wellbeing of employees. Even in most places, profit is the only tone and cultural body language present, not employees’ wellness or wellbeing and health. Occupational health has evolved beyond just looking at accident prevention and physical harm to employees but also looking at the harm to employees which we do not see physically, yet the employee is in total distress and suffers silently. This class of harm is the emotional harm suffered by employees in the course of performing within the scope of their task; these are the psychosocial issues such as burnouts, stress, work overload, work-family balance, fatigue, workplace harassment and a number of other associated non tangible issues. Stress for example, is not like an open injury that can be seen and dressed, burnout is not like tumour that can be opened and removed, they are not like open cuts that can be plastered but the effect far outweigh all of the former. Work related emotional harm is a very complex condition that must be systematically addressed from its root.

Workplace health and wellness studies have recommended employees’ engagement as a much useful tool is giving employees the psychological support in delivering in their organisational expectations. This is as simple as doing nothing but because the management process has not been clearly defined in our culture, that become so deficient in our corporate DNA and both the employees and employers suffer for it. Absence of employees’ engagement could make organisations  loose so much without knowing, everyone moves on as it all is well and good. This is where Occupational Health interface with Human Resources has become very imperative; we all must remember that management is all about people, not just things.

Managers need to understand that employees are people with finite emotional capacity. If there is something happening in their personal lives, they have limited capacity left to deal with issues at work. Most of the cases bothering around underperformance by employees, it has nothing to do with work they are most times traceable to homes. Employees’ home and family has become an integral part of employees’ health and wellness. When good people have challenges, Managers and Management need to carry them, pull them through if they are indeed part of your team. We preach team spirit but when things go wrong, we are so quick to execute our team member without looking at how it negatively impacts on team members we have left. If managers learn to carry employees when they most need it, we become a stronger community and we empower people in ways we probably cannot imagine. A re-invigorated broken employee is an organisation’s most powerful force; they become better version of themselves automatically. So we as managers need to understand, it is people we are managing and every act we put up has a great influence on emotions.

Most times employees burnout without anyone recognising it, a most versatile employee who has reclined to the point that he is now hardly seen. We should be concerned and investigate what such employee is going through. We need mutual support to erupt again and let’s remember the employees spend an average of 7 hours in the office, so the work environment and the people are great influencers on the employees’ overall outcomes.

What about Employees Assistance Program (EAP), this is lacking in most work environment that we see day. Who does the employee talk to when he is bereaved? Are there debriefing processes? Are there provisions for counsellors or Psychologists whether within or without? Is there a return to work policy and processes after illness or you just migrate from hospital bed back to the office? Have we created a work environment that creates room for trust so that employees can open up and be frank with the Counsellors and available mental health support professionals?

There are new and emerging workplaces diseases, illnesses and conditions lately and they are all offshoot of the workplace conditions. Globally, ageing workforce is fast becoming an issue; people are also going into early retirement because their health conditions would not allow them to reach the ideal age for retirement. Most of these issues are being linked to workplace conditions.

Now we are having with us not just suicide ideation but suicide in the real sense of it. When we drive employees far beyond what they can handle, we will have issues as these coming our way.

Can we relax the work environment knowing that an employee who is not at his or her peak today could become a super performer tomorrow?

Can organisations focus less on profit and take a look also at the health and wellness of the employees?

Can we change the harsh language  and tone in managing people at work, let’s once again humanise our workplaces and make employees regain pride in what they do and regain self esteem

If the workplaces, processes, management systems and policies do not change, we will have more issues that will break our hearts just like this trendy case of the Banker who committed suicide.


Shane Rogers: Goodstart Early Learning

Tuesday, July 26, 2016

World Hepatitis Day 2016: Know Hepatitis - Act Now

Viral hepatitis – a group of infectious diseases known as hepatitis A, B, C, D, and E – affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year, mostly from hepatitis B and C. It is estimated that only 5% of people with chronic hepatitis know of their infection, and less than 1% have access to treatment.

On World Hepatitis Day, 28 July 2016, WHO calls on policy-makers, health workers and the public to "Know hepatitis - Act now".

The Organization urges them to inform themselves about the infection, take positive action to know their status by getting tested, and finally seek treatment to reduce needless deaths from this preventable and treatable infection.

Activities will take place around the world to improve public knowledge of the risk of hepatitis, and enhance access to hepatitis testing and treatment services.

Know hepatitis – Are you at risk?

Viral hepatitis affects 400 million people globally and, given the size of the epidemic, anyone and everyone can be at risk. It is estimated that in Nigeria, 20 million people are infected while 2 million people die of the consequence.

Know hepatitis – Get tested

An estimated 95% of people with hepatitis are unaware of their infection. Hepatitis tests are complex and can be costly, with poor laboratory capacity in many countries.

Know hepatitis – Demand treatment

Globally, lack of awareness and poor access to hepatitis treatment services mean that most people who need treatment do not receive it.

Over 90% of people with hepatitis C can be completely cured of the virus within 3–6 months. Appropriate treatment of hepatitis B and C can prevent the development of the major life-threatening complications of chronic liver disease: cirrhosis and liver cancer.

Let’s look at Hepatitis B

This is about the most common Hepatitis virus amongst us. Studies have shown that 15% – 25% of people with Hepatitis B will die without treatment. So it is important we”
·         Get educated
·         Get tested
·         Join the fight against Hepatitis B

What is Hepatitis B?

Hepatitis B is caused by a virus that attacks the liver and causes liver inflammation. The virus spreads through contact with infected blood or bodily fluid, it can be transmitted through:

·         Mother to unborn child
·         Unprotected sex
·         Injection or drug use

What are the symptoms?

·         Nausea
·         Vomiting
·         Fatigue
·         Abdominal pain

However, you may be among the about 30% of people who do not have symptoms when they are infected.

Who is at risk?

·         People with multiple sex partners
·         Injection and drug users
·         Healthcare and public safety workers
·         People who live in same household with some who has Hepatitis B

Types of Infection

Acute: Short term, less than 6 months
Chronic: Long term, more than 6 months and it is mostly a life-long condition and requires a long tern treatment to prevent more damage to the liver. Treatment is important because the damage to the liver could cause serious liver problem called cirrhosis.

Cirrhosis of the liver is the destruction of normal liver tissues, harm and scars left behind will prevent blood from flowing through the liver. Cirrhosis certainly sets a stage for liver cancer. Chronic Hepatitis B is the leading cause of liver cancer worldwide.

Screening and Vaccination

Hepatitis B is a preventable disease, the first step in this direction is to undergo screening and when you are found negative, you quickly commence the vaccine which comes in three-course, 0, 1 and 6.


When you turn out non negative to Hepatitis B, the Doctor may order more test to check the state of your liver. It is important you see your Doctor often to check the state of your liver to know if treatment is necessary and to see how well your treatment is working.
Your Doctor may use a variety of test s to check the liver and monitor the amount of virus in your blood. Some of such tests are:

·         HBV DNA test: The Doctor may use this to monitor the amount of virus in your blood and also to measure your viral load.
·         The ALT: This looks at active liver inflammation.
·         Liver Biopsy: This is when the Doctor takes a sample of your liver tissue. This test is used to check the level of damage or liver inflammation.
The Doctor at this point decides what is right for you. If you have high viral load, the Doctor now decides which medication is needed.

High Viral Load

This is a sign of liver damage or you are at risk of liver damage. You may not feel sick but it is important you get treated if the Doctor recommends so. The earlier you treat a disease, the more likely you stay healthy longer. Why there is not cure for chronic Hepatitis B, there are two types of treatment to help:

Antiviral drug: These are to prevent the virus from growing and reproducing in your body.
Interferon: This helps strengthen your body against the virus.

Whether you are taking medication or not, there are things you must do to keep the liver healthy. These include:

Eating right: Eating healthy meals
Rest: Getting enough sleep

Avoid things that may harm your liver such as alcohol, drugs and some herbal medications.
See your Doctor every 6 – 12 months; it is also a part of taking care of yourself. It is only through the Doctor that you can know how the virus is affecting and detect liver cancer.
One of the several things you can do is to learn more about the disease and how to stop the spread of the virus.

This material is a part of publications of Action for Preventive Health Concerns, a Not-For-Profit Social Venture of OHSM

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Friday, March 25, 2016


Oxford dictionary defines sleep as “a condition of body and mind which typically recurs for several hours every night, in which the nervous system is inactive, the eyes closed, the postural muscles relaxed and consciousness are practically suspended”.

Mirriam-Webster sees it “as the neutral periodic suspension of consciousness during which the powers of the body are restored”.

The MacMillan dictionary for students defines sleep as “a naturally recurring state characterised by reduced or absent consciousness, relatively suspended sensory activity and inactivity of nearly a voluntary muscle”.

A slightly more scientific definition can be found in Stedman’s Medical Dictionary which sees sleep as “a natural periodic state of the mind and body, in which the eyes usually close and consciousness is completely or partially lost, so that there is decrease in bodily movement and responsiveness to external stimuli”.

The common threads in these descriptions, which appear to be necessary element in the definitions of sleep, are:

·         It is a naturally occurring state
·         It is periodic and recurring
·         It involves both the mind and the body
·         It involves the temporary suspension of consciousness
·         It involves relaxation and inactivity of muscles

We can see how sleep is an integral part of our overall health and mental well-being. Sleep helps our brain to function well. When we are sleeping, a lot of healing goes on, our brain gets ready for the following day. But when we do not sleep, we create health problems that are acute and chronic. When we do not sleep, we are susceptible to taking very wrong decisions; we become so irrational in thinking, leads to accident and business failure through inability to make the right decisions. We most times feel we are supermen when we burn candles into late nights working, most of us even brag about it “you cannot believe I slept at 2.00am this morning”. Bravo to you! Your friends see you as a hard working superman but you can never quantify the cumulative harm you are doing to health.

It is important to know that adequate sleep improves:

·         Learning
·         Problem solving and decision making
·         Emotional health

In terms of physical health:

·         It keeps our organs healthy
·         It regulates hormones. Some people feel hungry when they are not sleeping
·         Sleep deficiency can also make people more prone to infections and reduce their immunity, this makes infection last longer
·         Daytime performance and safety is also impacted by lack of sleep. Productivity and reaction time slows down as well.
·         There are also evidences of micro sleep – people sitting in classes, meetings or conferences and dosing off. With this, you lose touch with details and this affects your decisions and your ability to learn new things.
·        Inadequate sleep increases accidents on the roads and even in workplaces mostly amongst machine operators and those doing night rotation shifts.

So which ever balances the issue of sleep are weighed, it is safer to have adequate sleep knowing that our body will surely malfunction by the absence of sleep. We always think we have cheated nature by using the night meant for sleep and rest for the work we brought home from our offices. The body always have a way of demanding for it and we struggle with repayment, it is like paying for a loaf of bread already eaten. How difficult this always turns out. But we need to know there is a regulator called the “circadian rhythm” which is often referred to as the “body clock”. This is a 24-hour cycle that tells our bodies when to sleep and when to be awake. So this body clock waits for you in the day time to demand for the sleep owed during the night hours, this is why you see most people having micro sleep and dosing off at intervals during work.


·         People with limited time to sleep – Busy business men and Chief Executives
·        People whose schedules conflict with their internal body clocks. Examples are shift workers or people who travel throughout the night
·       Lifestyle choices that prevent people from getting enough sleep, examples are people who use drugs, caffeine and alcohol to stay awake
·         Medical problems such as anxiety, stress and sleep disorders
·         When we are on medications that interferes with our sleep


Recommended Hours of Sleep
The Elderly
>65 years
7 – 8 Hours
26 – 64 years
7 – 9 Hours
Young Adults
18 – 25 years
7 – 9 Hours
14 – 17 years
8 – 10 Hours
School Age
6 – 13 years
9 – 11 Hours
Pre-School Age
3 – 5 years
10 – 13 Hours
1 – 2 years
11 – 14 Hours
4 – 11 months
12 – 15 Hours
0 – 3 months
14 – 17 Hours

These are the recommended hours of sleep based on age classification, but you will realised we are never able to meet these hours of sleep. The more we drift out of these brackets, the more our immunity is affected making us vulnerable to infections and even making infections last longer than necessary. Getting enough sleep is very crucial to our overall wellbeing.


·         Inability to concentrate
·         Lack of patience
·         Increased intake of high fat and high sugar food
·         Increased risk for heart disease, heart attack, hypertension and stroke
·         Increased risk of Type 2 Diabetes
·         Clinical depression
·         Increased risk of hormonal changes leading to lose of muscle and bone mass with aging


Maintain sleep hygiene: Make your bed room a place for sleep and not an extension of your office. Go into the bed room only when you are ready to sleep, go in with a conscious mindfulness that you are going to sleep. Leave every work and task behind and switch off the lights before getting into the bed.

You must make conscious efforts to make your bed room and your bed look attractive and inviting, do not treat your bedroom without concern and see it as a very important place where you end your day. Some people sleep better in hotel rooms than they do in their homes, the difference is only the sleep environment. You can make yours also relaxing.

You need to develop a sleep pattern, maintain roughly the same bed time and wake time throughout the entire week. Your body over time gets used to this timing.

Keep your bedroom dark and cool, keeping all kinds of lights out. If you must use light, use “sleep friendly” light bulbs. Television in the bedroom is a great source of distraction leading to sleep deprivation.

Do not use the bed as a dining table or desk; it defiles the term “BED”. This makes our bed attractive to ants and other crawling insects that in turn disturb our sleep.

Most importantly, do not bring in your gadgets or phones into your bed room when you are ready to sleep. If you must bring them in, you either switch them off or put them on silence mode. One email or an sms that drops into your phone can deprive you of sleep the entire night. Yes, global economies but your health must not be made to melt with it.


·         Avoid caffeine 4 – 6 hours before bed time. It is advisable to avoid coffee after lunch time.
·         Avoid alcohol 3 – 4 hours before bed time
·         Do not eat large or high fat meals within 2 – 3 hours of bed time
·         Include some exercise every day but avoid vigorous exercise 2 – 3 hours before bed time
·         Learn mindfulness and meditation techniques to help you relax.


Sleep diary: Popularly known as written log. You can use this to know the number of hours you sleep every day. Keep a sheet by your bed side, when you are ready to sleep write the time down, each time you wake up to use the convenience write wake up time and sleep time. This will help you know how many hours of sleep you are getting and how consistent it is.

Tracking device: These are electronic devices worn on the wrist, ankle, chest or head. It depends on the one you find convenient. It helps you track your hours of sleep, some of them also track both your stress level and your heart beat.

Smart Phone Apps: A number of these sleep tracking applications are on Play Store in your mobile phones, you can download them and use them to track your sleeping pattern.
Medical Evaluation is necessary if you suffer from severe sleep deprivation or disorders.


When we talk about poor sleep, we are talking about a number of sleeps and sleep related disorders. Prominent amongst these are insomnia and chronic insomnia.

Insomnia is defined as a state of habitual sleeplessness or inability to sleep. This affects about 10% of a population.

Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. This ultimately affects your inability to getting good enough sleep. Sleep apnea affects 20% of a population and many people have sleep apnea without knowing. It is important to always seek a Physician's review.

Restless Legs Syndrome: If you have followed us in our earlier publication in the same blog, you would have seen the article we published on restless legs syndrome. This is a must-read.

Restless Legs Syndrome popularly known as RLS, is a neurological disorder characterised by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. One of the causes of RLS is excessive use of excess high heels shoes which is fast becoming a global workplace concern. This has a strong relationship with the duration of use, frequency of use and height of the heels. Ladies are more involved in this, though these heels make they look really elegant but the health risks must also be weighed. When these unpleasant sensation starts, it will surely deprive you of sleep. According to studies, 5% of a population suffers from RLS.

Another is Circadian Rhythm Disorders which has 2% prevalence within a population group and this also leads to sleep lose and sleep deprivation.

Narcolepsy is a condition that is prevalent in 20% od a population. Narcolepsy is a condition characterised by an extreme tendency to fall asleep whenever in relaxing surroundings. This is witnessed everyday all around us, most common in new born.This further shows the relationship between sleep and relaxed environment, so we must strive to make our bedrooms more relaxing so we can sleep better.

This topic continues in our next publication, you need to stay tuned for the concluding part.

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