Bursting at the seams

Medical social workers (MSWs) at the University Hospital of the West Indies (UHWI) are wilting under the weight of thousands of case files as they support patients through trauma and recovery, relying on each other for emotional strength when the burden becomes overwhelming.

Their current caseload at the St Andrew-based teaching hopsital averages at 300 cases per worker, with the ones assigned to patients diagnosed with HIV having more than 650 cases each.

The MSWs’ patients range from children to adolescents, teenagers, and young and mature adults, all needing assistance – from a washcloth to somewhere to live. And, since the COVID-19 pandemic, Sherene Williams-Hemmings, director of the unit at the UHWI, says they have seen a greater demand for direct assistance.

“Medical social workers, as the name suggests, are social workers operating within the confines of a medical facility such as the UHWI. We treat with patients who are admitted or seen at the outpatients’ clinics to identify any psychosocial issues that may be impacting or compounding their medical problems. Whatever that is, and wherever that takes us, we follow through with the change process, as we call it,” Williams-Hemmings told The Sunday Gleaner.

Part of their job is to investigate and interrogate the patients’ social environment, to determine whether their situations precipitated their illnesses.

According to Williams-Hemmings, sometimes poor circumstances lead to medical issues, while a sudden diagnosis may impact families negatively, especially in circumstances where the individual is the sole breadwinner. To prevent such persons from becoming regular patients at the hospital, the social workers become involved.

MSWs are found in all hospitals and some health centres, especially those providing care for HIV patients. They are marshalled by the director of social work and health in the Ministry of Health and Wellness. At the ministry level, they are responsible for the “implementation of strategies and programmes which are anchored in core principles and values to enhance healthy outcomes, focussing on the social determinants of health”.

They must collaborate with healthcare professionals and develop innovative social protection strategies to empower vulnerable individuals and families; advocate for systemic change; and bridge the gap between healthcare and social services, driving improved health outcomes, according to the Ministry of Health and Wellness.

The unit at the UHWI was first opened in 1964 with one social worker, a secretary, and a Peace Corps volunteer. Sixty years later, it has increased to a staff of 13, with Williams-Hemmings – herself a trained clinical social worker – and 11 others, along with a secretary.

She stressed that they are overwhelmed with the load they are carrying, “but we are mindful of what exists, not only within the hospital, but within the wider Jamaica, and we make do with what we have”.

She noted, however, that they “have been lucky” as the UHWI has more medical social workers than any other facility.

WIDE RANGE OF SERVICES

“Similar to social workers employed to, say, Ministry of Social Security, whatever the complaints are, it’s normally grounded in some psychosocial issues. Unlike persons who work for the PATH programme, where they would be getting help to improve their economic situation through grant relief – we do some amount of that as we liaise with our partners in other ministries – but our main focus is to ensure their health issues are being addressed by addressing their psychosocial situation,” explained Williams-Hemmings.

She said that MSWs work with school officials in some cases via the Child Guidance Clinic, as well as Addiction Alert and paediatrics. They help patients islandwide, via referrals. In some areas, she said, the heavy workload is cyclical, while, in others, it is constantly heavy.

“We have an HIV management area and that is always heavy. There are two social workers assigned to that facility. Some areas in the hospital have only one social worker, and, as you can imagine, if there is a high influx of patients, that person can become overwhelmed. But we work as a team and we try to navigate the issues as best as possible,” she explained.

She noted that there was no significant growth in the numbers in the HIV patients, as some die while others are transferred to other facilities. In some instances, when space cannot be found in infirmaries for patients, the MSWs have to act as “brokers” to link them with government agencies social programmes.

“Ideally, we are asking for individuals to have 50 cases. If we want to have a realistic patient load, we would like to have at least four persons for that [HIV] unit, because, on average, you have more than 300 patients seen there per month. So, do the maths, we are not able to see everybody. But then, not everybody requires to be seen monthly,” Williams-Hemmings told The Sunday Gleaner.

She noted that some persons are able to manage their affairs, but many of those struggling often have to make a difficult choice between food and pharmaceuticals.

“We do quite a bit of networking, partnering with entities, whether governmental or non-governmental, [and] charities to help patients through social investigation to find out if an employer or a former employer can provide some support. Does the member of parliament have the facilities or the resources to provide assistance also? So, it’s basically just trying to explore and exhaust all possible avenues for assistance,” she said.

The MSWs rely heavily on Food For The Poor for nutritional support, and on other private partners, especially when individuals become ill as a result of fires destroying all their belongings. Assistance for housing, she said, was slow, but has to be understood as it is islandwide support and issues of land ownership have to be taken into consideration.

She also noted the continued adandonment of patients by relatives who drop them off at hospitals. For those patients, the MSWs must provide even basic personal care items.

Williams-Hemmings wishes to be able to provide play therapy – a modality to deal with trauma among children – in the near future, but noted that this would require individuals with even more specialised training.

She also wishes there were more space for MSWs to carry out their duties and see patients within the hospital.

UHWI CEO Fitzgerald Mitchell accepted that space is a challenge currently, but expressed the hope that, with the planned expansion of the hospital, that space can be created when some sections are moved.

MENTAL TOLL

The job’s relentless demands and its inherent dreariness are taking a significant mental toll on the MSWs at the UHWI.

“We have been trained in understanding human behaviour. Our training exposes us to the evils that human beings perpetrate against each other. However, being in the situation, it hits different from reading about potential scenarios. And that’s why we try our best to debrief, and offer support for ourselves, because there is this thing called secondary traumatisation, or vicarious traumatisation, and that happens when you become traumatised by the trauma that you are treating,” Williams-Hemmings told The Sunday Gleaner.

The team, she said, collectively celebrates patients’ successes as they pledge to work harder for the betterment of those still struggling.

“We work as a team and we use ourselves to debrief and vent, do our own case discussion to see if there is anything else that can be done, and, of course, we reach out to other disciplines for help if we see our counselling is not having the desired results. So we are mindful of our limitations. That’s why we have both internal and external partnerships,” she said.

Williams-Hemmings said there is a need for more social workers islandwide, especially in the schools, and for more rehabilitation facilities to better cater for people in need.

“If we are not able to reach people who are hurting, then we will continue to have a society that is being crippled,” she stated.

It is unclear how many MSWs are currently serving islandwide. However, the health regions were all said to be short of social workers up to 2018 and in 2019, when there were some 3,000 social workers in the public health system.

In March this year, Social Security State Minister Dr Norman Dunn said the demand for general social workers has surged to unprecedented levels, which he believed was a reflection of the critical role they play.

This demand also outweighs the number graduationg annually from tertiary institutions. However, in the past, many social workers bemoaned the fact that, despite the acknowledged shortage, they were struggling to find employment and many sought to find jobs overseas.

erica.virtue@gleanerjm.com