Role of Stigma and Culture in Reporting of BBFE
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Dr. Moazzam Zaidi MBBS, MFOMI, MPH, DIH, CIH, CRSP, CCEP Branch Medical Advisor ACC, Adjunct Lecturer Occupational and Aviation Medicine, Otago University 45 Wilson Street, Wanganui, PO Box 435 drmoazzam@hotmail.com (P46, Friday 28, Civic Room 1, 2.30)
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Role of Stigma and Culture in Reporting of BBFE
- 1. Role of Stigma and Culture in Reporting of BBFE Towards 2020 Challenges and Changes in OH&S 28 October 2011 Dr. Moazzam Zaidi Dr. Robin Griffiths
- 21. Thanks
Notas do Editor
- The research was conducted at Sheikh Khalifa Medical City in UAE, which is a comprehensive health service agency that is in effect the public health service of Abu Dhabi. The study was conducted in the hospital which is an emerging multi national tertiary health care facility with staff from all over the world. It was a two year intervention. In which a comprehensive BBFE program was introduced.
- Move this slide forward
- Not needed. You probably won’t have time
- Need to say what your slide will discuss, as these are complex concepts. Maybe expand some of your discussion about culture?
- This needs a LOT more explanation – make notes on these and read them!
- Don’t like this slide – use one which shows reporting as crucial. Say that factors affecting reporting are Systemic factors Access factors KAP Culture! In our hospital the OH&S committee was given the task to involve HCPs and debate on how to develop a practical and effective program. As mentioned our challenges were different; the program had to be sensitive to the culture and legal environment. We started with developing a hospital policy and procedure for mandatory reporting.. it encourage reporting HCPs were involved so that they would own the program Mandatory immunization for Hepatitis B Development of a BBFE treatment protocol after consensus Read slide.. Each intervention will be discussed with reference to what we learned from it
- First would read the 3 bullet points. What was the purpose of the in-depth interviews You will need to define and explain grounded theory Both need comprehensive and clear explanation!!!!!!!!! The exposure to infection was viewed by the participants as threatening every aspect of their lives: their health, their social standing in society and among peers, their family life, their professional life and employment, and their residence in the country. Then the 4 built point
- The participants included two men and two women, who were employed as two doctors, a nurse and a lab technician. All four of the participants were expatriates; three from Asia, and one from Europe. The events resulting in BBFE for these participants included needlestick injuries and blood splashes.
- Need to explain how you obtained the themes from the interview transcripts – the technique will not be familiar to delegates
- Most accidents are unexpected, unplanned and unwanted – BBFE exposures similar to any accidents. The difference may be the potential seriousness of the consequences which are delayed, potentially life-threatening, and which have effects that permeate every aspect of their lives and livelihood, and those of their families. The HCPs participating in this study were clearly aware that BBFE was an occupational hazard of their work, and took this risk seriously, but nevertheless, when exposure occurred the experience was unexpected and shocking. 1 extract The participants described having performed the same procedures many times without any exposure or concern; knowledge of the patient’s disease status also tended to make them more cautious. 2 extract
- Despite their knowledge of the infectivity – describe how physicians and surgeons view this – many are fatalistic – this may affect whether they seek help. Reduces compliance with post-exposure programme and reporting. Need to get accurate information to affected staff immediately. Role of counselling The emotional impact of an exposure from a patient known to have HIV but these were Hep C too was so significant that some of the HCPs described feeling as if they had lost everything, even before the outcome of exposure could be determined. 1 Extract The HCPs experienced many adverse psychological feelings, such as nervousness, anxiety, and depression following exposure. 2 Extract
- Previous studies found negative attitude towards PLWHA; in our study the HCPs had a positive attitude but felt the tension between the risk and responsibility while performing their tasks. the participants came to question their continued involvement in their profession. However, once they had time to accept that exposure had occurred, moved from anger onto feeling that the risk was worth the professional satisfaction they achieved by serving others. Both extracts
- Extract 1 and 2 This shows the severity of stress the HCPs were going through after the exposure. It is evident that the level of stress was not due to the biological consequence of the disease but due to the stigma associated with it and the way the society would react. (Next slide to compare)
- On the other hand Ms. C and Dr. D had very different views of the same incident in a similar medical and legal situation. They did not show that level of stress mainly because they came form a society where HIV was more acceptable. Nevertheless, the stigma of HIV was still considered significant enough to impact on her future employability, and therefore of concern from an economic perspective A clear contrast Dr. D, who was exposed to hepatitis C rather than HIV, expressed similar concern regarding the impact of stigma associated with infectious disease on his future employment. He expressed frustration about the influence of political and religious views on what he viewed to be entirely a clinical issue.
- all four people involved in this study faced possible legal implications in terms of their employment, residency in UAE, or both. Of note in this study, those participants who were from communities where HIV was stigmatized tended to be more concerned about the cultural consequences of the disease rather than the legal or financial consequences.
- Differs from the NZ experience and most countries where BBFE programmes have been reported in that ACC or Workers Compensation kicks in to take care of the exposed person’s injuries, work incapacity and personal losses. Middle East countries because of their system discriminate against affected people and punishes them for illness sustained during their work as a health care provider!
- The hospital had factors specific to the working environment to Middle East which were different from those of other developed countries; requiring an indigenous BBFE program. BBFE reporting was influenced by stigma, and other social factors (health insurance, financial motives, and support services) which need to be recognised and addressed to develop a BBFE. If the HCPs believed that post exposure PEP treatment gives a good opportunity to prevent disease (HIV) compared to the risk of not taking the PEP; they will report the exposure
- The study suggests that BBFE reporting is not merely an organizational issue – it needs to be addressed at a societal level. Public awareness campaigns and advocacy is required to increase awareness of different modes by which HIV/AIDS can be transmitted and the availability of post-exposure treatment