Choosing your coffin hopelessly before seeing a doctor: A policy response to mitigate the sales of caskets in front of public hospitals in Cameroon

Introduction

The tenacious sale of caskets in front of public hospitals such as the Regional Hospital Buea and Laquintinie Hospital Douala, is a call for concern. Hospitals are supposed to provide a healing environment that contributes to patients’ well-being and recovery. However, the sales of caskets at public hospital entrances have continued to induce anxiety, uncertainty and insecurity among patients and visitors. Apart from the impact the site of caskets of various sizes have on acute and critical patients, others with chronic illness, pregnant women and visitors suffering from necrophobia (an exaggerated fear of death) may avoid going for routine follow-up because of the unpleasant panic attack associated with seeing coffins. Therefore, this policy brief aims to analyse the implications of selling caskets at the entrance of a hospital, a place where people go to seek medical care during times of vulnerability and distress. The paper also proposed urgent policy recommendations to safeguard the emotional well-being of patients, their families, healthcare professionals, and the surrounding communities to foster a supportive and compassionate environment within and around the hospital.

I – The healing powers of the hospital environment

The hospital environment has a nurturing and therapeutic effect, including promoting faster healing for patients and improving the well-being of their families, as well as creating a pleasant, comfortable and safe work environment for staff. The physical environment within and around a hospital significantly affects patients’ comfort and recovery. The World Health Organization defines health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity[1]. One of the most critical components of this definition is that mental health is more than just the absence of mental disorders or disabilities but includes a range of socio-economic, biological and environmental factors. Thus, the promotion, protection and restoration of mental health, including the impact of environmental factors, can be regarded as a vital concern of individuals, communities and societies globally.

The concept of a healing environment is not new and can be traced back to ancient Greece, where nature was used in the healthcare environment to positively affect patients’ recovery[2]. In the 19th Century, Florence Nightingale (1863) wrote about the positive effects of daylight and ventilation on patients’ health, demonstrating the value of the physical environment on patients’ health and well-being[3]. From a holistic point of view, the hospital environment includes the physical, social, psychological, spiritual and behavioural components of the patients, their relatives and the health care providers because they stimulate healing and achievement of wholeness. In a literature review on evidence-based healthcare design, Ulrich and his colleagues in 2008 describe that implementing the right hospital design can reduce hospital-acquired infections, medical errors, pain, stress, depression and length of hospital stay[4]. In addition, an excellent hospital environment can improve patient sleep, satisfaction, privacy, communication and social support. Apart from the positive effect of a good hospital environment on patients, healthcare providers and hospital staff experience less stress, have better job satisfaction and are more productive, effective, and satisfied when managing their patients.

II – The implications of selling caskets in front a hospital

The presence of caskets in front of the hospital disrupt healing and induces a sober and distressing element that interferes with patients’ ability to focus on their recovery and well-being, creating a state of anxiety, fear, uncertainty, insecurity, hopelessness and worst still depression among patients and their relative who are already dealing with health-related concerns. It may also evoke traumatic memories for individuals who have recently experienced the loss of a loved one, making it challenging for them to cope with their health issues effectively. For many, caskets disrupt the sense of optimism and positivity that is crucial for patients’ recovery, creating a dissonance between the goal of healing and the reminder of mortality. Being exposed to reminders of death and funerals can have a negative impact on mental health of healthcare providers, particularly those who are already vulnerable, such as those with chronic illnesses, terminal conditions or mental health issues, because it triggers or worsens symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD), including withdrawal to hospital care, missed appointment and worsening of their disease condition. Patients with a history of trauma or loss may be particularly susceptible to the emotional impact of such reminders. Also, casket sales near hospitals may create a negative perception of the quality, as some patients and their relatives might associate it with insensitivity and disregard for their emotional well-being.

Healthcare professionals, including doctors, nurses, and other staff members, are not immune to the emotional toll of working in a hospital environment where the presence of caskets can serve as a constant reminder of mortality and may intensify emotional distress that can contribute to the feelings of sadness, grief, fatigue and desensitization, leading to burnout and decreased job satisfaction. These factors can negatively affect their mental well-being, leading to compromised patient care and increased absenteeism, sick leave and staff turnover. Also, casket sales in front of the hospital may raise ethical concerns for healthcare providers and create conflicts of interest as they may feel uncomfortable with the association of healthcare services with commercial activities related to death and funerals. This can potentially impact their professional integrity and the trust patients place in them.

The negative impact of selling caskets in front of the hospital may affect school children and communities living around the hospital, especially individuals who experience necrophobia, a heightened state of anxiety and fear resulting from confrontations with anything related to death, such as caskets or coffins. The sight of these objects can trigger intense distress, panic, or a sense of impending doom that may cause the individual to engage in avoidance behaviour to cope with their fear. They may actively avoid visiting the hospital to seek necessary medical care, which may increase barriers to access to health care.

Conclusion

Selling caskets in front of hospitals has far-reaching implications for the mental health of patients, families, healthcare professionals and the community. Recognizing the emotional vulnerability of individuals in these settings and implementing appropriate regulations is crucial to protect their well-being. There is an urgent need to address this issue collectively through policy measures that establish buffer zones away from hospital entrances, including continuous public awareness about the potential consequences of selling caskets near hospitals. This will help foster understanding and empathy, encouraging individuals and coffin sellers to consider the emotional impact of their actions. Therefore, all hands should be on deck to create healing environments that prioritize mental health and comfort those seeking medical care during challenging times.

Recommendations

  • The Government of Cameroon should establish regulations restricting caskets’ sale near hospitals by defining specific buffer zones around healthcare facilities where such activities are prohibited.
  • Regional councils and Mayors should engage with casket vendors to practice their professional responsibility and relocate their businesses to more appropriate locations.
  • Security forces, healthcare authorities, and hospital administrations should collaborate to implement and enforce these proposed policies effectively, with clear guidelines and monitoring mechanisms to ensure compliance.
Dr Valery Ngo
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Dr. Ngo Valery Ngo is a Medical Doctor and a Senior Health Researcher at Nkafu Policy Institute, a think tank at the Denis & Lenora Foretia Foundation in Yaoundé, Cameroon. Before his appointment, he was a volunteer research assistant under Professor Bright Nwaru at the Krefting Research Centre in Gothenburg, Sweden, during which he conducted various researches in global health and contributed to various systematic reviews to synthesize existing evidence on major global health issues.

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