Bereavement is not an illness. It is an experience.

In the early 1990’s after some 14 years of Nursing principally in Accident and Emergency units;with close links to colleagues in the Johannesburg Fire Department, it became apparent that too often, little or nothing was being done for the surviving family of the acutely-dying patient.

Parents and siblings, whose lives had been irrevocably changed by something I had had to tell them, were merely being offered a sleeping tablet, a cold shoulder and the front door.

Compounding this situation for a lot of the parents was that they did not speak English as a first language (and often not at all); and that the medical and nursing staff  at (white) hospitals pretty much only spoke English (or Afrikaans).

So it was often a cleaner or ward clerk who was called upon to translate for the parents.As a result,they had little real understanding of what had happened to their child or indeed what was about to happen.

And, a lot of the patients and their parents lived in sub-optimal housing, with no electricity or running water – certainly no television.The culture shock of seeing modern EMS embrace their dying child was unfamiliar and thus doubly overwhelming. They took absolutely nothing positive away from the event or the subsequent interaction with the staff.

As the political violence worsened and more children sustained collateral injury it also became obvious that the staff working in these high stress areas were experiencing profound “burnout”.

Amongst other signs then being exhibited were:-

• Depersonalisation of the patient, reducing him-, and by extension the staff themselves-, to mere physiological entities;
• Inappropriate coping mechanisms, including extreme “black humour” and generalised dissonant emotional responses to stressful situations;
• The development of a “them-and- us” worldview, where “they” (the patients) were intrinsically less important/valuable/human than the staff.The uniquely exacerbating issue of Apartheid just heightened the alienation. “Black” patients were later to tell me that they thought that “white” nurses and doctors would not even try to save the life of their 'black' child.
• High substance abuse and a marked inability to sustain a nurturing relationship
• The high staff turnover in most Emergency medicine services.

Aggravating this situation was that most hospitals tended to be very compartmentalised, with professional lines jealously guarded.

For example, at that time (and still where I work today in the NHS) Social Workers would not be pro-active and seek to share their skills with Casualty Staff-who anyway did not believe that mere Social Workers could actually teach them anything or offer the patients any “take home” benefit!

The fact that a lot of mental-health-protocols are predicated on the belief that patients are only in need of help when they self–identify that need; or that a mental health intervention is always linked to “illness”, further muddies the water.