“A lot of people are leaving healthcare … but why should we stay?”

Dr Zolelwa Sifumba S’ouvre dans une nouvelle fenêtre had a harrowing start to her medical career. While working in healthcare settings as a student, she contracted drug-resistant tuberculosis, unaware that as a medical student, she was at an increased risk for exposure. “Getting TB was the first time I'd ever heard of anybody getting it because of their exposure to it,” she said. “I really thought it was not right that I had no idea about my risks until I actually caught TB.”

This was the start of what she calls the worst 18 months of her life.

Now a Project Manager for recruitment at the Clinical HIV Research Unit S’ouvre dans une nouvelle fenêtre (CHRU) and an HBNU Fogarty Global Health Fellow at the National Institutes for Health, Dr Sifumba reflected on the implications of her experience as a junior doctor in a hospital in South Africa: “If the health system is a burning building, then we’re inside — we're inside suffocating.”

Contracting TB changed her understanding of the disease. She knew about TB from a medical perspective, but not what it felt like to suffer from it and to have to seek treatment for it.

“I started to understand the public health system in South Africa and how difficult it can be to navigate as a sick person,” she said.

She remembered her own symptoms being used as a teaching moment by the diagnosing doctor, undermining her status as a patient. Taking 21 pills a day and a painful injection, she experienced difficult side effects. The additional medical burden caused her to give up on her treatment for ongoing depression and anxiety and left her feeling like she wanted to give up every day. “I was really struggling psychologically, mentally,” she recalled. “I was isolated. My family was all the way in the Eastern Cape and had no idea how painful what I was going through was.”

Fortunately, Dr Sifumba encountered an organization called TB Proof S’ouvre dans une nouvelle fenêtre, started by group of health workers who each had experiences with TB and who raise awareness of occupation risks and lobby for improved medications. With their support, she began her journey of activism and advocacy, starting with her fellow medical students:

“There was a group of second-years that usually go to a TB hospital, but we weren't really notified of how risky it was to be there. The year that I started talking and sharing my own story, the second years basically decided to tell the faculty that they wouldn't be going to the clinic unless they were given protection, which really was a big thing.”

After completing her treatment for TB, Dr Sifumba returned to medical school and graduated in 2017. She did her residency at a hospital in Durban. She said the increased pressure of the role, coupled with witnessing the bullying and harassment within the healthcare system, negatively affected her mental health. Meanwhile, she said, the hours required by the internship meant she was not able to access the psychological support she needed. After her internship, she became a resident at a rural hospital in 2020, just as the COVID-19 pandemic struck.

Due to her experiences with TB Proof, Dr Sifumba was already aware of the measures in place for infection prevention and control within the hospital setting, and during the pandemic, she recognized that where she was working was not adequately set up to be able to deal with the number of patients coming in for care.

“I did a lot of speaking up about it,” she said. “I spoke to newspapers, on the news, everywhere I could, screaming from the frontlines and saying, ‘Look, we need support; it’s not enough to clap, it’s not enough to send congratulations — we need real-time support.”

Her struggles came to a head in 2020 when she got into a car accident after a 36-hour shift.

“That was basically the year that I was just like ‘No. I can’t, I can’t!’ So at the end of 2020, I left without a plan. My parents weren’t happy with my decision at all. I had no income, no medical aid, nothing.”

Thankfully, Dr Sifumba was able to continue her TB advocacy. She took part in a documentary about health workers who have firsthand experience of drug-resistant TB, allowing her to meet researchers at the documentary opening and helping her find her current position of Clinical Research Fellow, conducting research in subclinical TB.

A struggling healthcare force

Dr Sifumba knows she is not alone in feeling isolated and depressed while working in the healthcare industry. She feels the lack of support for health workers means they are left struggling with severely impact mental health, unable to provide the level of care required of them. “People end up in bad situations,” she said. “Some people end up committing suicide, some people end up addicted to drugs, addicted to alcohol. Health workers were dying — are dying!”

Some of these struggles are due to the nature of working in the field. As Dr Sifumba pointed out, “We sustain multiple traumas in a day. You are resuscitating a patient first thing in the morning — that patient dies. Guess what? You have to move on to your next patient.”

Some of the pressures come from an under-resourced system, she said: “It is lovely to know you’re saving lives, but it’s the worst when you know that you’re part of a system that could be saving more. If there's 10 beds and 15 patients, that hurts. You go to bed thinking about that. Months later, you’re thinking about this child that died under your watch. And there's no debriefing for that. I don't understand why we don't debrief, why we don't have places to speak about our pain.”

Extra pressures come from the public and lack of support within the industry. “People were always asking, ‘Why are the nurses so mean?’ And I’m just like, ‘Do you know how much nurses go through?’”

Dr Sifumba feels that health workers are not being valued: “It's crazy because we want the health system to work, but health systems are made of people. There is no room to go cry and if somebody at work sees you crying, we're just mean to each other, bullying each other. People don’t know how to handle it.”

Despite these many pressures, access to therapy for health workers is limited as therapists often have working hours that clinicians are not able to take advantage of. This is coupled with what Dr Sifumba notices as a reluctance for healthcare workers to show vulnerability: “Some of us are slow to acknowledge when we aren't okay. And that makes us also slow to go out and get the help that we need. We also don't allow ourselves to be weak, to be not okay.”

As a result of the lack of support, a lot of people are leaving the health force. As Dr Sifumba put it: “People are dissing them for leaving. And it’s just like, ‘But why should we stay?’ I think my story shows that the health force hasn’t been ok — and then 2020 came and it got even worse.”

Dr Sifumba is not alone in that feeling. In Elsevier’s 2022 report Clinician of the Future, clinicians reported that the added pressures of the COVID-19 pandemic have exacerbated an already difficult situation. In the survey, respondents shared whether they were planning to leave their current role within the next two to three years; almost one-third (31%) said they were. Only 30% of clinicians globally reported feeling that government officials fully appreciate the critical importance of the work they do, and many think roles are changing for the worse: 71% of doctors in the US and 66% in the UK agreed their roles have become worse in the last 10 years, and 26% of clinicians surveyed agreed that wellbeing support is a priority.

How do we transform empathy into action?

Dr Sifumba continues her activism and advocacy for occupational health and wellness in the health force and is looking into how we can find solutions. “I really want to do work that unites us, that reminds us that we're all one health force,” she said. She believes healthier clinicians, health workers and students will translate into healthier communities, and she said her own work was better when she felt better and more limited on the days when she wasn’t doing so well.

Dr Sifumba’s vision for a healthier and more supported health workforce includes space for workers to talk about their experiences. “The biggest thing that helped me was the ability to express that I'm not okay and I need to do something about it,” she recalled. She said improved Employee Assistance Programs and better access to therapy would allow health workers to express themselves — not only for the sake of expression but for the sake of improvement.

Sharing personal experience is also important for creating a supportive and understand environment as well as advocating for change. Dr Sifumba believes that sharing her story, and being open about how difficult it was for her, is encouraging people to think about their options. She also believes talking about her experiences with TB can help others understand how people struggle with the disease and its treatment. “It was good for health workers to hear about what the actual struggles are,” she said. “It helped, actually, to mold me to become the kind of doctor that I needed.”

There is also support that can be offered by the community. As Dr Sifumba had the opportunity to relate to the then Duke and Duchess of Cambridge as part of the BBC’s celebration for Commonwealth Day 2021, there are ways we can all better support health workers:

“If you know a health worker, then just love on them,” she recalled telling them during their online conversation S’ouvre dans une nouvelle fenêtre. “And that means offering childcare services. It means offering to drop someone off somewhere. It means if they’re hungry and they come back from work late from a call, then as their neighbor, somebody who loves them, just to prepare a meal for them, just some kind of support. Because what I have seen is that as much as we’ve been calling for a resilient health system, we haven’t actually been focusing on the people themselves.”

While she thinks access to therapy and mental health would be beneficial, she doesn’t think therapy alone is the answer. “I am a big advocate for us caring for ourselves as well,” she said. “I’m not trying to push like self-care is going to fix all the issues. Issues that we have personally could benefit from therapy, but there are also systemic issues that affect how we do our work.”

So how can we address those systemic issues?

“I'd love, as a project one day, to restructure a room in a health facility to just be for the workers,” she said. “And you go there to cry, you go there to scream, whatever you need to do. A place to shower, a place to rest that is actually a nice place to be in. My dream is that in every city in the world, there is a place once a month for health workers to meet other health workers and just express themselves, whatever that group feel they need to do, and then once we get critical numbers of people, then we start calling for things for things to change."

In hopes of making this dream a reality, Dr Sifumba recently started a network called When Healers Connect, which will serve as a movement to promote unity among healers, creating a sense of community for those who need it. 

“Our insights are going to be the things that that help move us forward. I've always been very vocal about things that need to change — not to be a problem but to say, ‘Look, when they change, they improve for all of us.’”