“I solemnly pledge myself before God and presence of this assembly;
To pass my life in purity and to practise my profession faithfully.
I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practise of my calling.
With loyalty will I endeavour to aid the physician in his work, and devote myself to the welfare of those committed to my care.”
At the end of a grueling training, all nurses take the Nightingale pledge as a commitment to serve humanity with dedication, professionalism and empathy. Yet, despite this cadre of healthcare being the most critical to service, rarely do they get the recognition they deserve.
Three years ago, a gentleman I know, a young able-bodied man, was in hospital for six weeks following an accident in the football field that left him with three broken bones. He was admitted in hospital for emergency care and a series of surgeries to restore function to his bones.
He was under the care of a fine orthopaedic surgeon who did a great job of restoring him back to near normal function, but he rarely saw him apart from during the morning ward rounds or when he was in the operating room.
Over time, he realised that his care was heavily dependent on the instruction given by his surgeon being carried out by a host of other professionals with absolute precision and skill. The physiotherapists, the occupational therapists, the phlebotomists and the nutritionists all added value to his care.
But the professionals he will never forget are the nurses. His most important revelation was that when you are single and your family is as small as his is, that is when you realise that even friends do not enjoy hospital visits. Prolonged stays are coupled with intense loneliness and boredom. His only source of sanity was the nurses. As a grown man who has taken care of himself for many years, he could not believe that an adult would serve him a bed pan and help with his ablutions without flinching, and that when he was in pain, the first word on his lips was ‘nurse’.
Ill health will reduce even the mightiest of all to a point of need. As your doctor works to diagnose your illnesses and treat them, without your nurse, nothing moves. Nurses will dispense your medicines, give injections, ensure your comfort, encourage you in your pain, monitor you like a hawk when your systems are unstable, measure your fluids going in and out of your body, keep your wounds clean to prevent infections, hold your hand and wipe your brow when you are in labour and a host of other things that are not even defined in the book. The things a nurse will do for a patient, even a sibling, a spouse or a parent may balk at the thought of doing the same.
Nurses are at the fore in defending patient rights. They are bound by their vow to maintain patient privacy. They advocate for the patient’s well-being, they are the first on call for a patient by their continuous presence. They handle the patient’s medical, physical and emotional needs. They are family when no one is there, they are a shoulder to lean on when relatives lose their loved ones and they celebrate every single achievement for the patient on their long walk back to health. They are your parent, sibling and friend rolled into one.
To the doctor, a nurse is the most important partner in the patient’s care. It is interesting how a great surgeon in the operating room will not function without a competent scrub nurse assisting in the surgery. This is the person who sets up the surgical tray, ensures all instruments are sterile, functioning properly and made available at the right time. Yet the patient will never even know the face of their scrub nurse.
Palliative care is mainly nurse-driven. These nurses care for the patient in hospital and at home, relieving pain and discomfort and adding life into the days of patients with terminal illnesses. They hold the hands of their patients as they breathe their last, ensuring they do not die feeling neglected. They perform the final farewell care named the last offices before the body of the deceased is moved to the mortuary.
Nurses are the drivers of health campaigns, from health education, nutrition, immunisation, cancer prevention, hygiene and sanitation and prevention of communicable and non-communicable diseases. This they do every day in their practice, in programmes and in their individual capacity in their neighbourhoods.
In Kenya, there are slightly over 54,000 nurses in practice, 30,000 of them in public healthcare. Nurses make up the largest health workforce (more than 50 per cent) in any health system as it is by virtue of their responsibility.
The WHO recommendation for nurses and midwives is 3 per 1000 people. It is therefore glaringly obvious why overworking and demotivating these special cadre of health professionals is not in anyone’s interest.
For every negative story we see about a nurse in the media, let us remember the untold positive ones that we never hear of. My special medal of honour for humility in service is reserved for a special nurse I met in 2005 when I was still in medical school. He worked in Keiyo, at a small dispensary and he was passionate about ensuring babies were vaccinated.
For this reason, this man woke up every Monday at five o’clock, cycled seven kilometres on his bicycle, walked through rough terrain for five kilometres and took a matatu the last seven kilometres to the district hospital to collect vaccines for the week. He would then make this journey back to his dispensary to ensure the little babies never suffered polio or measles.
He had to take this trip every Monday as he had no electricity to keep the vaccines cold. He was not compensated for his journey and it never even occurred to him to ask.
He was just serving his community. Wherever you are today sir, God bless your soul!