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SA Doctor Inoculates Herself from Stress

I have the best job in the world. I get to meet amazing people who share their life stories and a wide variety of fascinating current challenges with me, and I get to walk alongside them for a short while - thinking and learning with them, together cracking open new ways of thinking and being and, best of all, celebrating the results of their personal and professional evolutions and revolutions. Since other people’s heroic stories have so enriched my life and my faith in what’s possible for us all, I figure these stories should be shared.

Like most of the people I work with, Aina Ayodele considers her work to be a central part of her life purpose and it’s always been important to her that her work is both successful and significant. As a medical doctor responsible for running a primary health clinic in one of the most under-resourced areas in Cape Town - an area rife with social and health problems (TIK abuse, HIV/AIDS, TB, violence, just to name a few), Aina has a strong sense of the significance of her work. But in an under-resourced and over-burdened system, in an impoverished and trauma-ridden community, “success” often feels impossible.

The hero’s saga is a standard theme in any popular book or movie, and there’s a reason for that... the hero’s saga is universal. We all identify with the story of having a big dream, setting out into the world confident in our dream, having prepared for all sorts of obstacles and challenges, and getting smacked to the ground by some proverbial dragon just as we step out the door. Unfortunately, that’s where so many real life stories end, and the reason why so many people shelve their dreams and settle for mediocrity. It’s also the reason why we’re all so inspired by stories of people who got up again... and again, and again, and eventually achieved their big dream. Aina’s story is a real life hero’s saga of someone who got smacked down and got up again.

The Ravensmead Community Health Clinic had been running without a Principal Medical Officer for over 5 years when Aina was appointed in April 2008. During that time, the clinic had atrophied from 24 to only 15 members of staff, who were functioning haphazardly with no systems in place. There was no triage system for identifying emergency cases and responding to critical priority patients first, there were no systems to facilitate continuity of care, and patients were sent to and fro between health professionals without effective record-keeping, resulting in duplication, wasting of resources and high rates of misdiagnosis, morbidity and mortality. In spite of the very high levels of HIV in the area, there were no daily HIV counseling and testing services at the clinic and they frequently turned away 75 or more patients a day, because they didn’t have the capacity to help them.

Having worked as a doctor in SA for 11 years, Aina was no stranger to the challenges of the SA health system, and she knew that the significance of their work depended on the success of their work. They could only make a significant difference if they began to work more effectively. Aina’s vision was big and she pushed herself out the door by letting her imagination loose on her dream and creating a really clear picture of her promised land: “an adequate, effective, and comprehensive health care service that is sensitive to the community’s needs and promotes service excellence that reflects the meaning of my name.” Ayodele means “joy arrives home” and Ayodele wanted her patients to feel as comfortable as if they were in their own home, and joyful, as a result of the excellent service and improved health they experience through the Ravensmead clinic service.

The most useful model for understanding and overcoming stress that I’ve come across is based on the idea that stress happens when the perceived threats are greater than the perceived resources and the perceived rewards. When we take up a challenge, no matter how great the perceived threats are, so long as we think our resources for dealing with those threats are greater, and perceive that the ultimate rewards of overcoming those threats are greater, we’re immunized against stress. This is because when the scales are stacked this way, the stories we tell ourselves go something like this: “This is hard, but it’s all going to work out in the end,” and we continue to let our imagination play with the potential positive future scenarios.

As soon as the scales tip and we think that the threats are greater than our resources, we start to tell ourselves a story along the lines of, “things aren’t going to turn out well” and our imagination runs riot, producing multiple worst-case scenarios, and before we know it, we’re having difficulty sleeping or eating, we’re feeling ratty and snapping at people, we’re making silly mistakes, losing or gaining weight, feeling tearful, and developing aches, pains and illnesses. The wort part is that stress creates a negative self-reinforcing cycle: when our stress response is triggered, our neurology changes so that we use more blinkered vision and thinking and we focus more on threats. This is useful for our survival: if you’re being chased by a lion, it’s better to focus on just the lion, and not be distracted by the beautiful sunset on the horizon. But what we focus on grows, and when we focus more on the threats, we start to delete the resources and rewards from our awareness. And this creates further stress, because our perception of the threats becomes even greater than our perception of our resources and rewards. To top it all off, stress often gets us stuck in the problem, because it’s much harder to think creatively and generate possible solutions when we’re using blinkered thinking and focusing on the threats instead of the resources.

And this is what happened to Aina. In spite of all her careful thought and hard work, the obstacles seemed to grow, and resistance from already burned-out staff was high, until a huge challenge that Aina had never anticipated knocked her to the ground. During a national spate of violent xenophobic attacks, Aina, who was born in Nigeria but is now a South African citizen, was threatened and intimidated by some of her staff and community. Aina and I started working together shortly after this traumatic incident, when she was suffering typical symptoms of stress, burnout and depression. Usually cheerful, friendly and outgoing, she had become socially withdrawn, tearful and unable to eat or sleep. She was ready to give up her faith in her vision for success and significance and was considering resigning and retiring from medicine altogether... because the perceived threats seemed so much greater than her perceived resources and the perceived rewards.

Over a series of 6 weeks, Aina processed the trauma of the event, dissolved many of her fears, restored her faith in her vision, got her health and vitality back, and put her whole self back into making her vision a reality at the Ravensmead clinic. How did she do it? It all comes down to one key word in the model of stress: PERCEPTION. Stress happens when the PERCEIVED obstacles/ threats are greater than the PERCEIVED resources and rewards. While our circumstances provide the triggers for stress, it’s our PERCEPTION and the stories we tell ourselves about those circumstances that create stress feelings and symptoms. While we can’t control everything in our circumstances (in fact trying to control everything in our circumstances is a recipe for stress!), we can always change our perception and the story we’re telling ourselves.

As a result of her new-found ability to inoculate her mind against stress, some of the successes Aina and her team have already notched up include:

• The establishment of an effective triage system where emergencies are prioritised
• Aligning the clinic services with provincial priorities (HIV/AIDS, TB, STDs)
• Increased human resources and improved equipment
• The appointment of a school nurse to address TIK concerns in the community
• Involvement of the clinic staff in a training program at the clinic
• Health education programs for patients with chronic illnesses
• An increase in TB detection
• A significant decrease in morbidity and mortality.

In November this year, Aina and her team ran the clinic’s first ever community education and outreach program, with great success. The theme was “Taking Charge of Hypertension - a Disease of Lifestyle” and made such an impact that people are still talking about it. Aina and her team are receiving much-deserved letters of congratulations and acknowledgment from senior officials in the Health Department. But even more important to Aina are the letters and words of gratitude she’s been receiving from community members, thanking them for the changes they’ve made in the past 5 months and pleading Aina to never leave the community clinic. In spite of all the odds, Aina is living up to her name and creating a place of “joy arriving home” for the community they serve.

Aina’s words of wisdom for us all? Aina says that the people in your life and your faith are vital sources of support in overcoming major obstacles - “whatever I am today, I owe to God and my parents, as well as the support of my friend, Louise Appolis.” She adds: “Be positive, stay strong. The road to success isn’t smooth, but if you endure, you’ll overcome. Tough challenges are there to make us stronger.” And as someone who’s name (Aina) means “child born with an umbilical cord around her neck”, it seems another part of her life purpose is revealed - to overcome major obstacles and constraints, and to inspire others to do them same. Aina, you’re an inspiration!

Had a tough year? Drop us a comment about your hero's saga and let us know how you got back up again...