Zambia’s Doctors are Dying to Save Lives

Zambia's healthcare system is severely overstretched, with just one doctor serving 12,000 patients—more than twice the 1:5,000 ratio recommended by the World Health Organisation (WHO). This overwhelming workload puts immense pressure on doctors, leading to stress, burnout, and deteriorating mental health. With limited or no support systems in place, many struggle in silence, unable to seek help without fear of stigma or professional repercussions.

By Lucy Nambela

Behind the doors of Zambian hospitals, a growing crisis is unfolding. Doctors are battling stress, burnout, and even substance abuse—threatening both their well-being and the quality of patient care. The consequences are severe: medical errors, compromised treatment, and a healthcare workforce pushed to its limits.

Although the Ministry of Health acknowledged the need to enhance mental health awareness among healthcare providers, it stated that it lacks specific data on the prevalence of mental health issues or disorders, as no survey has been conducted or indicators established to track the matter.

However, a recent survey by the Resident Doctors Association of Zambia, conducted in the first quarter of 2024, revealed that a staggering 67% of resident doctors in Lusaka were experiencing burnout.

Some of the doctors who spoke to MakanDay on condition that their names are concealed for fear of losing their jobs, shared their distressing experiences that reveal a system in crisis. They described overwhelming workloads, inadequate support, and a deep sense of being undervalued.

“The system is broken,” one doctor revealed. “We’re expected to perform miracles without the resources or support we need.”

Dr. Mary Mubanga (not her real name) recounted her harrowing experience with COVID-19. Despite falling ill, she was denied testing and forced to continue working. As her condition worsened, she suffered a stroke. Her time at one of the country’s largest referral hospitals—both as a doctor and later as a patient—left her battling depression and anxiety.

“I was in hospital for several days, and the treatment was pathetic,” Dr Mubanga said. “The nurses were chatting while a patient screamed for help. Eventually, the patient died. That experience traumatised me.”

Another doctor described the overwhelming workload and lack of support.

“Unfortunately, the demand for medicine (medical care) is very high for us, and our timetable is a bit messed up,” he said. “After a 24-hour shift, we’re in clinic, seeing an average of 60 to 80 patients. It’s stressful, and sometimes we can’t do the correct thing because someone is always ready to report us (for the misstep).”

She also highlighted the lack of mental health resources and the stigma surrounding seeking help.

“We don’t have a psychiatrist here—we’re referred to Chinama Hospital. Admin isn’t actively doing anything to support us. I think it’s because the older generation believes they worked in tougher conditions, so we shouldn’t complain.”

Struggling with overwhelming stress and burnout, she sought help at Chinama Hills Hospital and began attending therapy sessions. However, her decision to prioritise her mental health was met with ridicule from friends, who mocked her for seeking help.

Another doctor shared a particularly challenging shift in which he had to make a difficult diagnosis, only to be burdened with an overwhelming amount of paperwork and bureaucratic tasks, ultimately affecting patient outcomes.

“I felt drained and defeated,” he said. “Despite my best efforts, I’ve struggled with anxiety, depression, and feelings of hopelessness.”

The doctor emphasised that the pressure to uphold a perfect public image, combined with the fear of judgment or repercussions for seeking help, can be overwhelming.

“I’ve felt like I’m walking around with a mask on, pretending to be okay when I’m really not,” he said.

The doctor noted that he is not alone in this struggle, as many of his colleagues are fighting similar battles in silence.

The stigma surrounding mental health issues in the medical profession remains a significant barrier to seeking help.

“We’re supposed to be the healers, the ones with all the answers,” he said. “But the truth is, we’re human too. We hurt, we struggle, and we need help sometimes.”

Another doctor shared his personal battle with burnout and mental health.

“As a medical doctor, I’ve dedicated my life to caring for others,” he said. “But the harsh reality is that the healthcare system often neglects the well-being of its own caregivers.”

The Zambia Medical Association (ZMA) has raised concerns over increasing stress and burnout among medical personnel, with some turning to substance abuse as a coping mechanism.

ZMA Secretary General Dr. Oliver Kaoma highlighted the need for improved working conditions, increased medical staff, and better resources to support healthcare workers. He also stressed the importance of breaking the stigma around mental health within the profession.

To address these challenges, the ZMA launched the Care for the Carer scheme, offering premium healthcare services, including mental health support. However, the initiative is facing resource constraints.

Dr. Kaoma urged the government to allocate adequate resources and personnel to alleviate the pressure on medical workers, emphasising the need for long-term solutions rather than short-term fixes.

“We need to hire more doctors, provide sufficient resources, and ensure a healthy work-life balance,” Dr. Kaoma said. “We also need to break the stigma surrounding mental health issues within the medical profession.”

The association is also collaborating with the government to tackle burnout among doctors. Dr. Kaoma emphasised the need for the government to provide adequate resources, such as equipment and personnel, to better support medical professionals.

“We must address the fundamental factors contributing to burnout—such as the work environment, resources, and social amenities,” he said. “We cannot just treat the symptoms; we need to tackle the root causes.”

Mental Health Specialist in the Ministry of Health, Gabriel Lungu, disclosed that there is no specific policy ensuring confidential access to mental health services for healthcare providers, as these services are included in the Universal Healthcare Package.

However, he stated that initiatives have been introduced to address issues related to the “care of carers,” including efforts to raise awareness about the importance of mental health in the workplace through media campaigns, presentations, community engagements, and commemorations.

“Healthcare providers are also beneficiaries of health insurance schemes, including coverage for mental health services under NHIMA,” he said in response to MakanDay’s press query.

Lucy is an investigative journalist based in Lusaka, Zambia.