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Medical social workers (MSWs) at the University Hospital of the West Indies (UHWI) are overwhelmed with thousands of medical records, helping patients through trauma and recovery, and leaning on each other for emotional strength when the burden becomes too much to bear.
Currently, each staff member at St Andrew’s Teaching Hospital is responsible for an average of 300 HIV cases, and the staff responsible for treating HIV patients is responsible for an average of more than 650 cases.
MSW’s patients range from children to teens, teenagers, young adults and adults, all in need of help — from towels to a place to stay. Since the COVID-19 pandemic began, Sherene Williams-Hemmings, director of the department at UHWI, said they have seen an increase in the need for direct assistance.
“As the name implies, medical social workers are social workers who work within the context of a healthcare facility, such as UHWI. We provide treatment to patients who are admitted to the hospital or seen in an outpatient setting to identify any psychosocial issues that may be affecting or exacerbating their medical problems. Whatever the issue is and wherever it takes us, we adhere to what we call the transformation process,” Williams-Hemmings told The Sunday Gleaner.
One of their job duties is to investigate and inquire about the patient’s social environment to determine if their situation contributed to their illness.
Williams-Hemmings said sometimes poor circumstances lead to medical problems, and a sudden diagnosis can have a negative impact on a family, especially if one person is the sole breadwinner. To prevent these people from becoming frequent visitors to the hospital, social workers are involved.
Social work assistants are found in all hospitals and some health centres, particularly those that provide care for HIV patients. They are supervised by the Director of Social Work and Health in the Ministry of Health and Wellness. At the ministerial level, they are responsible for “implementing strategies and programmes that are based on core principles and values to enhance health outcomes, focusing on the social determinants of health”.
The Ministry of Health and Wellness said they must work with healthcare professionals to develop innovative social protection strategies to empower vulnerable individuals and families; advocate for systemic change; and bridge the gap between healthcare and social services to drive improved health outcomes.
The department at the University of Washington Health and Research Institute first opened in 1964 with a social worker, a secretary and a Peace Corps volunteer. Sixty years later, it has grown to 13 employees, including Williams-Hemmings, herself a trained clinical social worker, and 11 other staff members and a secretary.
She stressed that they are overwhelmed, “but we are mindful of the situation that we have, not only within the hospital but throughout Jamaica, and we do the best we can with the resources that we have.”
However, she noted that they are “lucky” because UHWI has more medical social workers than any other agency.
Wide range of services
“Similar to social workers employed by departments such as the Department of Social Security, whatever the complaint is, it is usually based on some psychosocial issues. Unlike the PATH workers, they will receive help through grants to improve their financial situation – we do some of that in liaison with partners in other departments – but our main focus is to ensure that their health issues are addressed by addressing their psychosocial situation,” Williams-Hemmings explained.
She said MSWs sometimes work with school officials through the Child Guidance Clinic, Addiction Alert and Pediatrics. They help patients islandwide through referrals. She said in some areas the heavy caseload is cyclical, while in others it is consistently heavy.
“We have an HIV management area which is always overcrowded. The facility has two social workers. Some areas of the hospital only have one social worker and you can imagine that if there is an influx of patients, that social worker can be overwhelmed. But we work as a team and we try to solve the problem as best as we can,” she explained.
She noted that the number of AIDS patients did not grow significantly because some died and others were transferred to other institutions. In some cases, when hospitals had no room to accommodate patients, social workers had to act as “brokers” to connect them with social programs at government agencies.
“Ideally, we ask for 50 cases per person. If we want to have a realistic patient load, we want at least four people in the (HIV) unit because on average, more than 300 patients are seen there per month. So, if you do the math, we can’t see everybody. But not everybody needs to be seen every month,” Williams-Hemmings told The Sunday Gleaner.
She noted that some people are able to manage their affairs, but many who are struggling often have to make difficult choices between food and medicine.
“We have set up a lot of networks, working with government or non-government entities (and) charities to help patients through social surveys to see if employers or former employers can provide some support. Does the MP also have facilities or resources to help? So, it’s basically trying to explore and exhaust all possible avenues of assistance,” she said.
MSW relies heavily on Food For The Poor for nutritional support, and other private partners, especially when someone gets sick because the fire destroyed all their belongings. She said housing assistance is coming slowly but must be understood because it is island-wide support and land ownership issues must be considered.
She also noted that relatives often brought patients to the hospital, and medical staff had to provide these patients with basic personal care items.
Williams-Hemmings hopes to offer play therapy — a form of treatment for childhood trauma — in the near future, but notes that it would require someone with more specialized training.
She also hopes the hospital will have more space for MSWs to perform their duties and see patients.
UHWI chief executive Fitzgerald Mitchell acknowledged that space is a current challenge, but expressed hope that with the hospital’s planned expansion, room could be freed up when some areas are relocated.
Mental loss
The rigors and inherent tedium of this work place a severe mental strain on UHWI’s MSWs.
“We are trained to understand human behavior. Our training educates us on the evil that humans commit against one another. However, being there is not the same as reading about potential scenarios. That’s why we do our best to debrief and provide ourselves with support because there is something called secondary trauma or vicarious trauma, which occurs when you are traumatized by the trauma you are treating,” Williams-Hemmings told The Sunday Gleaner.
She said the entire team celebrates patients’ successes and pledges to work harder for those who are still struggling.
“We work as a team, we use our own time to debrief and vent, do our own case discussions, see if there is anything else we can do, and of course if we find that our consultations are not having the desired effect, we seek help from other disciplines. So we are very aware of our limitations. That’s why we have both internal partners and external partners,” she said.
Williams-Hemmings said more social workers are needed across the island, especially in schools, and more rehabilitation facilities are needed to better meet the needs of those in need.
“If we fail to help those who are hurting, then our society will continue to be paralyzed,” she said.
It is not clear how many social workers there are currently across the island. However, it was said that as of 2018 and 2019, each health district was short of social workers, when there were approximately 3,000 social workers in the public health system.
In March this year, Social Security Minister Dr Norman Dunne said demand for general social workers had surged to unprecedented levels, which he said reflected the important role they play.
This demand also exceeds the number of graduates from colleges and universities each year. However, many social workers have complained in the past that it is difficult for them to find jobs despite the shortage of social workers, and many want to work overseas.
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