“I Don’t Do Anything; I’m Just Being Taken Care Of”: Experiences of Patients and Their Caregivers Transitioning Back into the Community Following Traumatic Injury in Northern Tanzania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Research Team and Reflexivity
2.3. Setting
2.4. Participants and Recruitment
2.5. Data Collection
2.6. Data Analysis
3. Results
3.1. Biological Factors
3.1.1. Experiences and Impact of Pain
INT: Ok, how does pain affect your activities? How does pain affect what activity you are doing?
P567 (M): Since the hand can’t work, so the work I was doing I cannot do.
INT: So, you don’t have any activities that you do right now?
P567 (M): At the moment I have no activities.
3.1.2. Perceived Impact of Injury on Health and Physical Function
P111 (M): Yeah, about losing memory, at first there was that problem, but it reached a point where he got it back. But after coming back from the hospital, it was hard with his memory, but after some time at least now we see the memories are coming back.
3.2. Psychological Factors
3.2.1. Emotional and Psychological Well-Being
Uncertainty about the Future
INT: […]How long do you think that will take? Until you can feel that you are better?
P593 (M): I think not yet, because I listen to the doctors. […]I may wait a long time, I think up to February maybe, I am worried about something like that.
P240 (M): When I went to see the doctor, he gave me some information that bed rest was part of my healing process, he gave me some advice but still my mind did not agree to it. But in the end, I decided to change myself, but inside my mind I thought I was already incapacitated. I questioned myself, who will take care of my family? Who will take over the work I was doing? Every time I thought about it, I got very stressed. I wanted to start taking alcohol which I was not taking before [the injury].
Impact on Family Members’ Health
Impact on Patients’ Mental Health
P111 (M): Because of my thoughts, pain, loneliness. I want to get out there, but I can’t so that it affects me, I’m lonely, I want to walk but I can’t. For example, I can call a child to bring me drinking water, but the child was washing clothes so that might delay him from coming. I may see him to have despised me although it might not be the case. It has affected my mind a lot.
Unadjusted Coping/Failure to Ask for Support
3.3. Social Factors
3.3.1. Community, Friends, and Family Support
Definition of Community
P699 (M): Can usually say that my community is the people around me, people close to me, even those who are far from me are my community, because the one who are close to you are not the only one who look after you, those who look after you are many, let me take example from the accident that I got, the moment that I have got an accident, I failed to walk, even if people who don’t know me I believe that for the condition that I had they can help me, therefore sometimes a community can be the people you know and the people you don’t know.
Level of Community Support/Lack of Support at Home Post-Injury from Community Members
INT: All right, who is helping you and your family in dealing with these problems?
P389 (M): Aah currently there is no one is helping me.
INT: Community, family, church, at work?
P389 (M): There is no [support].
INT: Ok, mmh how have you been accepted or received back into your community due to the new changes in your life?
P313 (M): They feel okay, they feel sick there are things now you see you can do but they see you still can’t do, so you find yourself, it is like they monitor you too much, ‘let us help you, stop doing that,’ but you feel you have the ability to do that. Let’s say it is to that extent but now I don’t know if it helps how the patient feels that there are things he can’t do, until you force him now, you will have to force [the patient] doing things.
Injury Leads to Lack of Active Community Engagement
Level of Support from Religious Community
Level of Family Support
P397 (F): For the things that I need after I got injured, mother is providing everything. Therefore, if I will need anything, mother is always serving; therefore, there is nothing I need.
Injury Impacted Family Daily Activities
INT: Please, can you explain how your normal day has become after the injury, after getting injured when you came to the hospital and got discharged, how your normal day has become.
P359 (F): It is very bad.
INT: Bad in what way?
P359 (F): I cannot do anything anymore, taking care of my children, even cooking for them, I can no longer do that.
Expectations for the Support System
INT: Ok. What do you expect from the community? The community around you?
P577 (M): Mainly what I expect from the community is just love and unity, that’s it, but I know that is the output of how you invest on them, to me that is how it seemed because I live with people well in the religion, in the working part, with neighbours, even children used to come here, because they missed me, so to me I am very grateful, I feel, I felt different, you know at first when I came from the hospital, because when they came they used to be limited with time, come at this time, come at this time, yeah, it is good for the patient’s health he is supposed to rest but even if I limit their time when I need them I can see them so to me as I sleep I hear them telling stories, the sickness is like going away, half of it, you feel like you are part of the community.
Structured/Organized Support Systems
3.3.2. Impact on Activities of Daily Living
Injury Impacting Daily Activities or Ability to do Housework
P67 (M): To be honest life has changed a little bit because I don’t do anything; I’m just being taken care of.
Growing Ability to Perform Daily Activities with Less Support
Environmental Changes (House, Assistive Devices, Transportation, etc.)
3.4. Contextual Factors
3.4.1. Finances and Income
Injury Negatively Impacted the Ability to Generate Family Income
INT: So now, how has it affected you?
P64 (F): I have no income if I fail to feed the chickens, and I have no one to help me. I have no helper or worker.
P593 (M): Yes, they are the problems, mostly food, for instance yesterday we didn’t even have anything to eat, you just stay like that, that’s it, this morning I got some tea here from this neighbor, she gave me tea with nothing else, I sat right on the bucket there.
Injury-Related Costs Increase the Financial Burden on the Family
P183 (M): There is huge money deficit like when we are required to go to [city] for MRI tests, in fact it has come to a time when we need the help of close relatives because if you look at KCMC, costs are very expensive, from the time he was admitted at KCMC until discharge it was costly, we even used all the savings we had.
Found New Ways to Generate Income/Savings to Help Cover Costs
P329 (M): […] Maybe in a week you give eleven thousands and later on you receive something, maybe later when you need a loan, so those changed too because you stay for several weeks without contributing, you are sick and you can’t work so you have several weeks without giving, we usually have plans in these groups that we will do this and this with these contributions, now there are things like that which stopped, so after coming back home I saw that it is hard to pay like my fellows do. There is a bicycle here, let me sell it and return it back there so I can be equal with them.
Financial Burden Impacting Emotional Well-Being
INT: Ok, how do you think these economic barriers have affected your mental health?
P67 (M): Aah mental health, not much as I said. You are thinking about things but sometimes you just say these are normal things they will pass, I can’t say there are no effects, it affected me a little bit but not so much, because if the effects are big then they may bring up other things in the head, so it affected me a little bit.
3.4.2. Access to Healthcare, Ability to Follow Healthcare Recommendations
Discharge Planning
Injury Impacted Transportation Abilities
Lack of Infrastructure Impacting Management of Care after Discharge
Limited Healthcare Provider/Resources Availability
Compliance with Doctors’ Prescriptions
Pain Management Strategies
INT: Due to pain, you said you’re taking painkillers like tramadol, and other substances; by any chance are you addicted to any of those?
P240 (M): By good luck I got some information from my neighbor, the owner of […] Pharmacy about drug use and painkillers like tramadol which, she said, can be addictive.
INT: Okay.
P240 (M): After I have been discharged with tramadol at KCMC, I wanted to use them, but she warned me that they might be addictive, so I should be careful. So, I had them just for emergencies; and I only took them when I could not tolerate any more pain.
Communication with the Healthcare Team
Knowledge of How to Access Healthcare Resources after Discharge
INT: Ok, where or to whom do you usually go when you need health care?
P329 (M): For advice maybe? There is one woman, a neighbor who is a nurse, a close neighbor if there is something you may ask her, that there is this and this and she tells you just go to the hospital, do this, she is a nurse here at KCMC.
4. Discussion
4.1. Biological Factors
4.2. Psychological Factors
4.3. Social Factors
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Sakran, J.V.; Greer, S.E.; Werlin, E.; McCunn, M. Care of the injured worldwide: Trauma still the neglected disease of modern society. Scand. J. Trauma Resusc. Emerg. Med. 2012, 20, 64. [Google Scholar] [CrossRef] [Green Version]
- Bedard, A.F.; Mata, L.V.; Dymond, C.; Moreira, F.; Dixon, J.; Schauer, S.G.; Ginde, A.A.; Bebarta, V.; Moore, E.E.; Mould-Millman, N.-K. A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes. Int. J. Emerg. Med. 2020, 13, 1–19. [Google Scholar] [CrossRef]
- WHO. Injuries and Violence: The Facts. 19 January 2021. Available online: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence (accessed on 24 August 2021).
- World Bank Data Help Desk. World Bank Country and Lending Groups. Available online: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups (accessed on 24 August 2021).
- Sawe, H.R.; Mfinanga, J.A.; Mbaya, K.R.; Koka, P.M.; Kilindimo, S.S.; Runyon, M.S.; Mwafongo, V.G.; Wallis, L.A.; Reynolds, T.A. Trauma burden in Tanzania: A one-day survey of all district and regional public hospitals. BMC Emerg. Med. 2017, 17, 30. [Google Scholar] [CrossRef]
- Mwandri, M.; Hardcastle, T.C.; Sawe, H.; Sakita, F.; Mfinanga, J.; Urassa, S.; Mremi, A.; Mboma, L.N.; Bashaka, P. Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management. Afr. J. Emerg. Med. 2020, 10, 111–117. [Google Scholar] [CrossRef] [PubMed]
- Rezaei, S.; Arab, M.; Matin, B.K.; Sari, A.A. Extent, consequences and economic burden of road traffic crashes in Iran. J. Inj. Violence Res. 2014, 6, 57–63. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nilsen, P.; Hudson, D.; Lindqvist, K. Economic analysis of injury prevention—Applying results and methodologies from cost-of-injury studies. Int. J. Inj. Control Saf. Promot. 2006, 13, 7–13. [Google Scholar] [CrossRef]
- Davey, S.; Bulat, E.; Massawe, H.; Pallangyo, A.; Premkumar, A.; Sheth, N. The economic burden of non-fatal musculoskeletal injuries in northeastern Tanzania. Ann. Glob. Health 2019, 85, 23. [Google Scholar] [CrossRef] [Green Version]
- Banks, L.M.; Kuper, H.; Polack, S. Poverty and disability in low- and middle-income countries: A systematic review. PLoS ONE 2017, 12, e0189996. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Larner, S. Common psychological challenges for patients with newly acquired disability. Nurs Stand. 2005, 19, 33–39. [Google Scholar] [CrossRef]
- Rios-Diaz, A.J.; Lam, J.; Zogg, C.K. The need for postdischarge, patient-centered data in Trauma. JAMA Surg. 2016, 151, 1101. [Google Scholar] [CrossRef] [PubMed]
- Toomey, N.; El-Gabri, D.; Nickenig Vissoci, J.R.; Bettger, J.P.; Staton, C. Post-hospital care for people recovering from acute injuries in low and middle income countries: 5 domains of health management. Gestão E Soc. 2017, 11, 1704. [Google Scholar] [CrossRef] [Green Version]
- Borrell-Carrió, F.; Suchman, A.L.; Epstein, R.M. The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Ann. Fam. Med. 2004, 2, 576–582. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wade, D.T.; Halligan, P.W. The biopsychosocial model of illness: A model whose time has come. Clin. Rehabil. 2017, 31, 995–1004. [Google Scholar] [CrossRef] [PubMed]
- Jette, A.M. Toward a common language for function, disability, and health. Phys. Ther. 2006, 86, 726–734. [Google Scholar] [CrossRef] [PubMed]
- Altfeld, S.J.; Shier, G.E.; Rooney, M.; Johnson, T.J.; Golden, R.L.; Karavolos, K.; Avery, E.; Nandi, V.; Perry, A.J. Effects of an enhanced discharge planning intervention for hospitalized older adults: A randomized trial. Gerontologist 2012, 53, 430–440. [Google Scholar] [CrossRef] [Green Version]
- DeCaporale-Ryan, L.N.; Ahmed-Sarwar, N.; Upham, R.; Mahler, K.; Lashway, K. Reducing hospital readmission through team-based primary care: A 7-week pilot study integrating behavioral health and pharmacy. Fam. Syst. Health 2017, 35, 217–226. [Google Scholar] [CrossRef]
- Liss, D.T.; Ackermann, R.T.; Cooper, A.; Finch, E.A.; Hurt, C.; Lancki, N.; Rogers, A.; Sheth, A.; Teter, C.; Schaeffer, C. Effects of a transitional care practice for a vulnerable population: A pragmatic, randomized comparative effectiveness trial. J. Gen. Intern. Med. 2019, 34, 1758–1765. [Google Scholar] [CrossRef]
- Wang, H.; Rosemberg, N. Universal Health Coverage in Low-Income Countries: Tanzania’s Efforts to Overcome Barriers to Equitable Health Service Access. Universal Health Coverage Studies Series; No. 39. World Bank, 2018. Available online: http://hdl.handle.net/10986/29174 (accessed on 24 August 2021).
- Tanzania—Country Commercial Guide Healthcare. International Trade Administration. 12 February 2021. Available online: https://www.trade.gov/country-commercial-guides/tanzania-healthcare (accessed on 24 August 2021).
- Muhanga, M.; Malungo, J.R. Health literacy and some socio-demographic aspects under one health approach in eastern Tanzania: Connections and Realities. Urban Stud. Public Adm. 2018, 1, 89. [Google Scholar] [CrossRef]
- Tanzania. Data. Available online: https://data.worldbank.org/country/TZ (accessed on 24 August 2021).
- Casey, E.R.; Muro, F.; Thielman, N.M.; Maya, E.; Ossmann, E.W.; Hocker, M.B.; Gerardo, C.J. Analysis of traumatic injuries presenting to a referral hospital emergency department in Moshi, Tanzania. Int. J. Emerg. Med. 2012, 5, 28. [Google Scholar] [CrossRef] [Green Version]
- Staton, C.A.; Vissoci, J.R.N.; Toomey, N.; Abdelgadir, J.; Chou, P.; Haglund, M.; Mmbaga, B.T.; Mvungi, M.; Swahn, M. The impact of alcohol among injury patients in Moshi, Tanzania: A nested case-crossover study. BMC Public Health 2018, 18, 275. [Google Scholar] [CrossRef] [Green Version]
- Kilimanjaro Christian Medical Centre. Available online: https://www.kcmc.ac.tz/index (accessed on 24 August 2021).
- Goldsmith, H.; McCloughen, A.; Curtis, K. The experience and understanding of pain management in recently discharged adult trauma patients: A qualitative study. Injury 2018, 49, 110–116. [Google Scholar] [CrossRef] [PubMed]
- Davidson, G.H.; Austin, E.; Thornblade, L.; Simpson, L.; Ong, T.D.; Pan, H.; Flum, D.R. Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities. Am. J. Surg. 2017, 213, 910–914. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Clarke, H.; Soneji, N.; Ko, D.T.; Yun, L.; Wijeysundera, D.N. Rates and risk factors for prolonged opioid use after major surgery: Population based cohort study. BMJ 2014, 348, g1251. [Google Scholar] [CrossRef] [Green Version]
- Fakhry, S.M.; Ferguson, P.L.; Olsen, J.L.; Haughney, J.J.; Resnick, H.S.; Ruggiero, K.J. Continuing trauma: The unmet needs of trauma patients in the postacute care setting. Am. Surg. 2017, 83, 1308–1314. [Google Scholar] [CrossRef] [PubMed]
- Holbrook, T.L.; Anderson, J.P.; Sieber, W.J.; Browner, D.; Hoyt, D.B. Outcome after major trauma: Discharge and 6-month follow-up results from the Trauma Recovery Project. J. Trauma. 1998, 45, 315–323. [Google Scholar] [CrossRef]
- Bright, T.; Wallace, S.; Kuper, H. A systematic review of access to rehabilitation for people with disabilities in low- and middle-income countries. Int. J. Environ. Res. Public Health 2018, 15, 2165. [Google Scholar] [CrossRef] [Green Version]
- Naylor, M.; Keating, S.A. Transitional care. Am. J. Nurs. 2008, 108, 58–63. [Google Scholar] [CrossRef]
- Bernabe-Ortiz, A.; Diez-Canseco, F.; Vásquez, A.; Miranda, J.J. Disability, caregiver’s dependency and patterns of access to rehabilitation care: Results from a national representative study in Peru. Disabil. Rehabil. 2016, 38, 582–588. [Google Scholar] [CrossRef] [Green Version]
- Schumacher, K.; Beck, C.A.; Marren, J.M. Family caregivers: Caring for older adults, working with their families. Am. J. Nurs. 2006, 106, 40–49. [Google Scholar] [CrossRef] [PubMed]
Patient Age, Mean (SD) | 37.7 (11.1) |
Male, N (%) | 21 (80.8) |
Residence, N (%) | |
Moshi Urban | 15 (57.7) |
Moshi Rural | 10 (38.5) |
Other | 1 (3.8) |
Tribe, N (%) | |
Chagaa | 16 (61.5) |
Pare | 2 (7.7) |
Zigua | 2 (7.7) |
Other | 6 (23.1) |
Marital Status, N (%) | |
Married | 16 (61.5) |
Single | 9 (34.6) |
Separated | 1 (3.8) |
Years of Formal Education, N (%) | |
7 | 16 (61.5) |
8–11 | 2 (7.7) |
12–13 | 3 (11.5) |
14–16 | 5 (19.2) |
Payment Method for Medical Costs, N (%) | |
Cash personal payment | 18 (69.2) |
National Health Insurance | 7 (26.9) |
Other | 1 (3.8) |
Cause of Injury, N (%) | |
Road Traffic Injury | 17 (65.4) |
Assault | 2 (7.7) |
Fall | 3 (11.5) |
Other | 4 (15.4) |
ICU stay, N (%) | |
Yes | 0 (0.0) |
No | 25 (96.2) |
Unknown | 1 (3.8) |
Surgery performed, N (%) | |
Yes | 18 (69.2) |
Time of interview since injury, N (%) | |
1–2 months | 18 (69.2) |
3–4 months | 6 (23.1) |
5–7 months | 2 (7.7) |
Caregiver characteristics, N (%) | |
Wife | 5 (45.4) |
Sibling | 2 (18.2) |
Other (child, cousin, sister-in-law, grandmother) | 4 (36.4) |
Major Theme | Sub-Themes |
---|---|
Biological Factors | |
Experiences and impact of pain | - |
Perceived impact of injury on health and physical function | - |
Psychological Factors | |
Emotional and psychological well-being | Uncertainty about future; Impact on family members’ health; Impact on patients’ mental health; Unadjusted coping/failure to ask for support |
Social Factors | |
Community, friends, and family support | Level of community support/lack of support at home post-injury from community members; Injury leads to lack of active community engagement; Level of support from religious community; Level of family support; Injury impacted family daily activities; Expectations for the support system; Structured/organized support systems |
Impact on activities of daily living | Injury impacting daily activities or ability to do housework; Growing ability to perform daily activities with less support; Environmental changes (house, assistive devices, transportation, etc.) |
Contextual Factors | |
Finances and income | Injury negatively impacted the ability to generate family income; Injury-related costs increase the financial burden on the family; Found new ways to generate income/savings to help cover costs; Financial burden impacting emotional well-being |
Access to healthcare, ability to follow healthcare recommendations | Discharge planning; Injury impacted transportation abilities; Lack of infrastructure impacting management of care after discharge; Limited healthcare provider/resources availability; Compliance with doctors’ prescriptions; Pain management strategies; Communication with the healthcare team; Knowledge of how to access healthcare resources after discharge |
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Share and Cite
Tupetz, A.; Barcenas, L.K.; Isaacson, J.E.; Vissoci, J.R.N.; Gerald, V.; Kingazi, J.R.; Mushi, I.; Peter, T.A.; Staton, C.A.; Mmbaga, B.T.; et al. “I Don’t Do Anything; I’m Just Being Taken Care Of”: Experiences of Patients and Their Caregivers Transitioning Back into the Community Following Traumatic Injury in Northern Tanzania. Trauma Care 2022, 2, 341-358. https://doi.org/10.3390/traumacare2020028
Tupetz A, Barcenas LK, Isaacson JE, Vissoci JRN, Gerald V, Kingazi JR, Mushi I, Peter TA, Staton CA, Mmbaga BT, et al. “I Don’t Do Anything; I’m Just Being Taken Care Of”: Experiences of Patients and Their Caregivers Transitioning Back into the Community Following Traumatic Injury in Northern Tanzania. Trauma Care. 2022; 2(2):341-358. https://doi.org/10.3390/traumacare2020028
Chicago/Turabian StyleTupetz, Anna, Loren K. Barcenas, Julia E. Isaacson, Joao Ricardo Nickenig Vissoci, Victoria Gerald, Julius Raymond Kingazi, Irene Mushi, Timothy Antipas Peter, Catherine A. Staton, Blandina T. Mmbaga, and et al. 2022. "“I Don’t Do Anything; I’m Just Being Taken Care Of”: Experiences of Patients and Their Caregivers Transitioning Back into the Community Following Traumatic Injury in Northern Tanzania" Trauma Care 2, no. 2: 341-358. https://doi.org/10.3390/traumacare2020028