Nurses Coping with Patient Loss

Good Grief: Nurses Cope With Patient Deaths

Rowena Orosco, RN, BSN, had been working at Johns Hopkins Bayview Burn Center in Baltimore for three years when a family with seven children was brought to the hospital after a fire destroyed their home. The one survivor, a 7-year-old girl, was transferred to the burn center with burns over 70% of her body. As the medical team worked desperately to save the girl, Orosco sat with her, crying and holding her hand as she died. This moment haunts the nurse 15 years later.

“I got through that day, but after that I thought about quitting,” Orosco says. Instead she attended a debriefing, exchanged many tearful hugs with colleagues in the halls, talked a lot with a co-worker and kept working. “You kind of put your emotions aside because there are other patients waiting for you.”

Nursing students might learn how to help family members grieve, but seldom learn how to deal with their own feelings of sadness or loss. Research about how nurses cope with patient death is scarce and mostly anecdotal. But what studies there are suggest nurses go through a unique grieving process when patients die, and how they manage this process is important to their well-being.

Only Human

“We feel that when people die, it doesn’t affect our care, which is absolutely ludicrous because we’re human, too,” says Tina Brunelli, RN, CSN, MSN, ANP-C, a nurse practitioner with Novant Health in Kentucky. Brunelli, who has worked in oncology, hospice and critical care, wrote a concept analysis as a graduate student, published in Nursing Forum in 2005, about how nurses cope with patient death.

Stifling personal emotions about patient death has been equated with professionalism for nurses and physicians. “These fields evolved from the military and there are still feelings of, ‘Suck it up and move on,’” says Robert S. McKelvey, MD, a professor of psychiatry at Oregon Health and Science University, Portland, who wrote a book titled, “When a Child Dies: How Pediatric Physicians and Nurses Cope.”

But in interviews with nurses and physicians about the subject, McKelvey found “nurses, on the whole, did a better job [of coping]. They were more open to talking about these things than their physician colleagues.” Those who allow themselves to go through a grieving process seem to be healthier, McKelvey says. Those who hold it in, he says, “pay a price by not being able to deal with their feelings at the time and place.” They may feel reluctant to get close to other patients, have difficulty with personal relationships or have trouble sleeping or eating properly.

How a nurse responds to a first death — and whether he or she is supported by colleagues and supervisors — seems to affect how that nurse reacts to future losses, says Lisa Gerow, RN, MSN, a doctoral candidate at the University of Kansas, Kansas City, and associate professor of nursing at Tulsa (Okla.) Community College. She is the lead author on a report, published in the February 2010 Journal of Nursing Scholarship, which uses interviews with 11 nurses to describe the grieving process after a patient dies.

Nurses may be especially at risk for problems in coping with patient death if they believe they had some responsibility for it or didn’t do enough to save the patient, Gerow says. Many ICU and ED nurses become angry and upset after seeing very sick or elderly patients die in pain after extreme and futile treatments to prolong their lives, says Catherine Miller, RN, MSN, CCRN, clinical education program manager for the ICU and special care units at Howard County General Hospital in Columbia, Md. They might feel they didn’t advocate enough for the patient to experience a “good death,” she says.

Self Care

Some coping strategies, developed over time, nurses say, include: rituals to help the patient and family feel better, such as bringing the family food; attending funerals or posting obituaries; and praying or drawing strength from spiritual beliefs. Some nurses use exercise and relaxation therapies, such as a hot bath, to help ease stress caused by patient death. “The nurses that care for themselves will grieve better,” Miller says, especially if they recognize their limits and turn down extra shifts or working with insufficient sleep. If they don’t care for themselves after a traumatic event, she says, they put themselves at risk for eventual burnout, compassion fatigue or moral distress.

Nurses often use humor to deal with death, though they must take care not to use it inappropriately, especially in the presence of family members, says Terry Foster, RN, MSN, CCRN, CEN, a clinical nurse specialist in the ED at St. Elizabeth Medical Center in Edgewood, Ky. “Ask any nurse, the most pressured laughter they have ever heard is in the presence of a dead body. Because it’s so awful, but there’s something funny that goes along with it.”

An ED nurse for 35 years, Foster has given many clinical lectures, but the most requested, he says, are those dealing with nurse humor, including humor about death. “Sometimes it’s just the way you maintain your sanity,” he says. “This is just one way that someone can channel the anxiety and stress.”

Talking with co-workers is probably the most helpful coping strategy in getting through a difficult death, nurses say. Spouses and family try to be supportive, but they can’t know what a nurse goes through, Brunelli says. “The people who don’t talk about it with their co-workers probably don’t survive in the long term. It’s unbelievable how much people can suffer before they die. If you’ve never seen it, you can’t understand it.” Hospitals and supervisors can be supportive just by acknowledging that patient deaths affect nurses, she says. Just giving nurses time to talk to one another would be helpful, she says.

Some hospitals hold voluntary debriefings after difficult deaths. McKelvey says people who have gone through traumatic experiences may be better able to express themselves in private counseling sessions or meetings without administrators present. “They really have to feel safe to grieve and talk about what is on their minds,” he says. He thinks hospitals should make one-on-one support available to those who want or need it as soon as possible after a traumatic death.

Some nurses in Gerow’s study said they wished their hospitals had supported them more during difficult deaths, or they had learned more about the grieving process in nursing school. But they also talked about how patient deaths, though upsetting, changed them and helped them to grow.

Foster vividly remembers an ED patient who begged to see his daughter. Foster brought her in and watched the patient tell her he loved her, minutes before the man unexpectedly died. “I am so glad I brought that daughter in,” he says. “I think, ‘Who am I to keep people out of the room.’”

Miller has a letter on her wall from an angry, difficult patient who came to her unit with advanced pulmonary disease. Two days before he died, he wrote to his caregivers, praising those who showed passion and compassion in caring for him and helping him overcome his fears. Thanks to them, he wrote, “I have become ready to march on.”

For Orosco, a turning point in her career — which made her decide not to quit her job — was a thank-you letter from a relative of the girl who died holding her hand in the burn center. “Even though we didn’t make any difference [by saving her life], that moment was a big thing, that she didn’t die by herself,” Orosco says. “Since then, I have never let a patient die alone.”

Cathryn Domrose is a staff writer.

To comment, e-mail editorNTL@gannetthg.com.

Kenema Hospital Fire-Culled from Standard Times

Fire Disaster Wrecks Kenema Hospital….Matron, Doctor And Others Arrested
Posted by Fayia A Fayia on Feb 21, 2011, 19:29




Kenema Hospital on Fire....Youths trying to put out the fire
The Internal Affairs Minister Hon. Musa Tarawally was on Friday 18th February, 2011 ordered the arrest of Dr.Jemisa, Matron Stevens, Hospital Secretary of the Kenema Government Hospital, Pious Saffa, and Mr. Thomas all senior members of staff of the hospital, following a serious fire disaster that left the Maternity Unit and other divisions of the hospital completely burnt down.

The decision of the minister of internal affairs came when the various hospital authorities had made to the minister and his entourage conflicting statement with regards the inferno.
The Minister and the Chief Fire Force Officer, Mr. Kamanda Gbongay and entourage were left with no option but to order their arrest after listening to pieces of evidence from the various hospital authorities. The Minister and his team discovered that they advanced conflicting pieces of evidence relating to the cause of the fire disaster, which led to the suspicion that the disaster was an organized incident.

Youths including bike riders and the Members of Republic of Sierra Leone Armed Forces –(RSLAF), it would be recalled did their best on Thursday 17th February 2011to put the fire under control but only succeeded in preventing the fire from transferring to other buildings .

Sand and water were used to put off the fire but their efforts did not prevent the building that housed the offices of the Matron, Medical Superintendent, Store, Labor Room, from burning down completely.
Patients and their relatives were rescued from the burning building by youths and Military Officers but their personal belongings, drugs and other Medical equipments were burnt, but no life lost.

Irate youths in Kenema vented out their grievances at the late arrival of one of SALCOST water bowzer and the fire force team from Bo, thus denying them access to enter the hospital compound Report states that the Hospital Management and other stakeholders were in meeting at the same building when they were chased out by the fire.

Meanwhile observers have linked the fire to electrical problems. It could be recalled that the Maternity Unit was reconstructed and furbished by UNICEF, IRC and other development partners under the Emergency Obstetric Care Program

Gaddafi's Rambling Speech

The King of Kings' speech
Al Jazeera's senior policy analyst says Gaddafi's threats were no different from those of any foreign occupier.
Marwan Bishara Last Modified: 22 Feb 2011 22:19 GMT

Gaddafi has ruled Libya for the past 42 years with an iron fist, but insists he has no official role [EPA]
Muammar Gaddafi is dangerously in denial. Alas, he's been that way for a long time.

Gaddafi has ruled Libya for the past 42 years with iron fist, but insists he has no official role and therefore couldn't resign. Otherwise, he would have done that long ago!

He thinks of himself as Zaim - a guru leader - or the king of kings of Africa as referred to himself repeatedly the last couple of years.

How do you resign from greatness, he wondered! After recounting his heroism, sacrifice and courage over the last few decades.

In reality, he wasted his country's fortunes, misused its sources and violated its people. He misspent hundreds of billions of dollars in revenues from oil.

He commands the state budget along with his family, and yet he insists he has no money, no fortune and no belonging to give away.

Why would he need any of that when he de facto had claim on the whole country.

One is speechless listening to him telling Libyans: Go ahead take back your oil.

Like father like son

Gaddafi senior, like Gaddafi junior before him on Monday, went on rambling endlessly in Tuesday's televised address, with little coherence, many threats and more political blackmail.

Speaking to both domestic audience and Western decision makers, he raised the spectre of civil war, bloodbath and the threat of al-Qaeda takeover in various parts of the country.

He warned he would use all or any means to prevent the breakdown of Libya.

Over the last few days, his regime has killed hundreds and reportedly using his air force to bomb Libyan cities, but insists he hasn't ordered the use of force yet.

But he did threaten to kill all those participating in the ongoing upheaval, in accordance with the Libyan law, as he put it.

Worse, he threatened to burn the land, behaving as if his rule was a foreign occupation.

For many years, Qaddafi, his family and tribe have maintained their rule through the maintenance and deformation of the very tribal order he's been warning against.

He's used political blackmail and financial bribes and unveiled threats of force to stay at the helm of the regime.

In the process, much of the country's wealth was wasted. And so was any chance of development as his dictatorship suppressed pluralism, creativity and freedom of expression.

Meanwhile, unemployment in this "rentier economy" has shot from one-fourth to one-third unemployment year after year.

Gaddafi has turned a country rich in oil to a poor country in more than one way.

Dangerous call to arms

While Gaddafi admitted that the police has refused to confront or shoot at the demonstrations, he called on his loyal and violent "popular committees" to defend his "revolution", either individually or by joining forces with members of their tribes.

Certainly, the most deadly and dangerous force in the coming days will be those popular committees and their association with the private militias of Gaddafi's regime, his sons, cousins and tribe.

It seems that these well-armed and well-financed militias have been carrying out the worst violence against the peaceful demonstrators. Possibly aided by mercenaries from various neighbouring countries.

Unless the Libyan army puts an end to the violations and violence of the militias, the ongoing confrontation might continue to escalate.

Alas, there is little information as to today's relationship between the army and the militias, but one suspects it shouldn't be a good one as the militias have been used primarily to keep the army in check.

That's why Arab and international decision makers must try and deter the escalation of violence by making it clear that those committing the crimes against the Libyan people will have no future in their country, but would eventually be punished for their crimes.

And that the army has a responsibility to protect the people and the unity of the country.

Source: Al Jazeera
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US concerned about Situation in Libya

February 20, 2011
U.S. ‘Gravely Concerned’ Over Violence in Libya
By ERIC SCHMITT
WASHINGTON — The Obama administration on Sunday condemned Libya’s use of lethal force against peaceful demonstrators, pointing to what it said were “multiple credible” reports that “hundreds of people” had been killed and injured in several days of unrest.

In the administration’s strongest statement on the escalating violence in Libya, the State Department said that it was “gravely concerned” about the reports and that the number of deaths was unknown because of a lack of access to many parts of the country by news organizations and human rights groups.

Philip J. Crowley, the State Department spokesman, said that the United States has raised “strong objections about the use of lethal force” with several senior Libyan officials, including Musa Kusa, the foreign minister.

“Libyan officials have stated their commitment to protecting and safeguarding the right of peaceful protest,” Mr. Crowley said in a statement. “We call upon the Libyan government to uphold that commitment and hold accountable any security officer who does not act in accordance with that commitment.”

The impact of the administration’s sharp criticism of Libya’s firing on demonstrators was unclear, and stood in contrast to how President Obama’s strong criticism of the use of force by security forces in Bahrain appeared to have pressured its government to withdraw police officers and troops from the main square of that country’s capital, Manama.

On Friday night, Mr. Obama spoke to King Hamad bin Isa al-Khalifa of Bahrain, leaning on the government to show restraint, especially against peaceful protesters, and pressing for meaningful reform. The next day, Mr. Obama’s national security adviser, Thomas E. Donilon, telephoned the crown prince, Sheik Salman bin Hamad al-Khalifa, to underscore Mr. Obama’s message. Mr. Donilon praised the prince’s orders earlier in the day to withdraw security forces.

Administration officials said Sunday that the tough line with Bahrain, home of the United States Navy’s Fifth Fleet and the center of American efforts to contain Iran, had been effective. “We’ve been very clear with our partners in Bahrain that they ought to exercise restraint, that there is no place for violence against peaceful protesters there or anywhere else, and we’ve condemned that violence,” Susan E. Rice, the American ambassador to the United Nations, said on “Meet the Press” on NBC.

As it did with Iran and Egypt, the administration has responded in different ways to the embattled governments in Libya and Bahrain. “Each of these countries is different,” Ms. Rice said. “Each of these circumstances will be decided by the people of those countries. We are not pushing people out or dictating that they stay.

“What we’re doing is saying, consistently across the board they are universal human rights that need to be respected.”

Senator Lindsey Graham, an influential Republican from South Carolina, offered support on Sunday for the administration’s dual approaches. “We should have a policy of urging old friends to do better and replacing old enemies,” Mr. Graham said on “Meet the Press.”

“I’d like to see regime change in Libya,” he said. “I’d like to see regime change in Iran. I think we need to be tougher on companies that do business with Iran. But, generally speaking, the administration, I think, has handled Egypt well and is trying to stay ahead of this when it comes to Jordan, Bahrain and Saudi Arabia.”

Meanwhile, Adm. Mike Mullen, the chairman of the Joint Chiefs of Staff, arrived in Saudi Arabia on Sunday for a previously scheduled weeklong trip to the Persian Gulf region. His scheduled stops also include Kuwait, the United Arab Emirates, Qatar and, possibly, Bahrain.

Capt. John Kirby, his spokesman, said in a statement that Admiral Mullen would meet with his counterparts in each country and would “make clear his desire to see that peaceful protest be allowed to continue without threats or violence from any quarter and that restraint is shown by all sides in these disputes.”

Middle East security experts say the United States has greater influence over allies like Bahrain than countries with which relations are more strained, including Libya, even though full diplomatic ties were restored in 2009.

In Bahrain’s case, the administration is also balancing the interests of Saudi Arabia, another monarchy, which is connected to Bahrain by a causeway. Senior Saudi officials have expressed displeasure that Mr. Obama has allowed the protests to continue, and even grow, by espousing political and economic reforms in the region.

Throughout the region, Ms. Rice said, “there are conditions that are inherently unstable — a youth bulge, high unemployment, a lack of political openness — and we have pressed publicly and privately for the kind of change that is necessary.”

Senator Richard G. Lugar of Indiana, the ranking Republican on the Foreign Relations Committee, said that in most of those countries, an aging autocratic leadership was confronting the realities of a youthful population eager for social and economic changes and connected by social networks that were not broadly in use even a few years ago.

“They know they are not getting their fair share, that life is not going to be good for them,” Mr. Lugar said Sunday on “State of the Union” on CNN. “As a result, given hunger problems, other economic difficulties, they have come to the fore.”

Mr. Lugar continued, “The question is, will, as in the case of the Libyans, the protesters simply be shot?”

Gaddafi's Son Warn Protestors

Gaddafi's son warns of civil war
Appearing on Libyan state television, Seif al-Islam Gaddafi said his father is in the country and backed by the army.
Last Modified: 21 Feb 2011 01:42 GMT

Libyan leader Muammar Gaddafi is confronting the most serious challenge to his rule in 42 years [Al Jazeera]
A son of Libyan leader Muammar Gaddafi has promised a programme of reforms after bloody protests against his father's rule reached the capital, Tripoli.

Seif al-Islam Gaddafi also hit out at those behind the violence. He said protests against his father's rule, which have been concentrated in the east of the country, threatened to sink Libya into civil war and split the country up into several small states.

Live Blog
Appearing on Libyan state television early on Monday morning, Seif al-Islam said his father is in the country and backed by the army. "We will fight to the last minute, until the last bullet."

He said his father was leading the fight, although he added that some military bases, tanks and weapons had been seized.

"We are not Tunisia and Egypt," the younger Gaddafi said, referring to the successful uprisings that toppled longtime regimes in Libya's neighbours

He acknowledged that the army made mistakes during protests because it was not trained to deal with demonstrators but added that the number of dead had been exaggerated, giving a death toll of 84.

Human Rights Watch put the number at 174 through Saturday, and doctors in the eastern city of Benghazi said more than 200 have died since the protests began.

'Desperate speech'

Marwan Bishara, Al Jazeera's senior analyst, termed Seif al-Islam's speech as "desperate".

"It sounded like a desperate speech by a desperate the son of a dictator who's trying to use blackmail on the Libyan people by threatening that he could turn the country into a bloodbath.

"That is very dangerous coming from someone who doesn't even hold an official role in Libya - so in so many ways, this could be the beginning of a nightmare scenario for Libya if a despotic leader puts his son on air in order to warn his people of a bloodbath if they don't listen to the orders or the dictates of a dictators."

"It's also fascinating how he threatened the West with chaos in Libya and then threatened Libyans with Western intervention, because as he put it, that would turn Libya into a decentralised country allowing various Islamist groups to take over which the West would not allow," Marwan Bishara said.

The younger Gaddafi offered to put forward reforms within days that he described as a "historic national initiative" and said the regime was willing to remove some restrictions and begin discussions for a constitution. He offered to change a number of laws, including those covering the media and the penal code.

He said the General People's Congress, Libya's equivalent of a parliament, would convene on Monday to discuss a "clear" reform agenda, while the government would also raise wages.

After Seif al-Islam's address, Najla Abdurahman, a Libyan dissident, told Al Jazeera: "He's threatening Libya and trying to play up on their fears. I don't think anyone in Libya who isn't close to the Gaddafi regime would buy anything he said.

"And even if there is any truth to what he said, I don't think it's any better than what the people of Libya have already been living with for the past 40 years. He promised that the country would spiral into civil war for the next 30 to 40 years, that the country's infrastructure would be ruined, hospitals and schools would no longer be functioning - but schools are already terrible, hospitals are already in bad condition.

Protesters 'shot dead'

His address followed reports that security forces had shot dead scores of protesters in Benghazi, Libya's second largest city, where residents said a military unit had joined their cause.

There were also reports of clashes between anti-government protesters and Gaddafi supporters around the Green Square.

"We are in Tripoli, there are chants [directed at Gaddafi]: 'Where are you? Where are you? Come out if you're a man," a protester told Al Jazeera on phone.

A resident told the Reuters news agency that he could hear gunshots in the streets and crowds of people.

"We're inside the house and the lights are out. There are gunshots in the street," the resident said by phone. "That's what I hear, gunshots and people. I can't go outside."

An expatriate worker living in the Libyan capital told Reuters: "Some anti-government demonstrators are gathering in the residential complexes. The police are dispersing them. I can also see burning cars."

There were also reports of protesters heading to Gaddafi's compound in the city of Al-Zawia near Tripoli, with the intention of burning the building down.

Tribes 'revolt'

Meanwhile the head of the Al-Zuwayya tribe in eastern Libya has threatened to cut off oil exports unless authorities stop what he called the "oppression of protesters", the Warfala tribe, one of Libya's biggest, has reportedly joined the anti-Gaddafi protests.

Speaking to Al Jazeera, Shaikh Faraj al Zuway said: "We will stop oil exports to Western countries within 24 hours" if the violence did not stop. The tribe lives south of Benghazi, which has seen the worst of the deadly violence in recent days.

Akram Al-Warfalli, a leading figure in the Al Warfalla tribe, one of Libya's biggest, told the network: "We tell the brother (Gaddafi), well he's no longer a brother, we tell him to leave the country." The tribe lives south of Tripoli.

Protests have also reportedly broken out in other cities, including Bayda, Derna, Tobruk and Misrata - and anti-Gaddafi graffiti adorns the walls of several cities.

Anti-government protesters in the eastern Libyan city of Benghazi have reportedly seized army vehicles and weapons amid worsening turmoil in the African nation.

A local witness said that a section of the troops had joined the protesters on Sunday as chaos swept the streets of the city, worst hit by the uprising against Muammar Gaddafi's 42-year old rule.

Mohamed, a doctor from Al Jalaa hospital in Benghazi, confirmed to Al Jazeera that members of the military had sided with the protesters.

"We are still receiving serious injuries, I can confirm 13 deaths in our hospital. However, the good news is that people are cheering and celebrating outside after receiving news that the army is siding with the people," he said.

"But there is still a brigade that is against the demonstrators. For the past three days demonstrators have been shot at by this brigade, called Al-Sibyl brigade."

The witness reports came on a day in which local residents told Al Jazeera that at least 200 people had died in days of unrest in Benghazi alone. The New York-based Human Rights Watch on Sunday put the countrywide death toll at 173. The rights group said its figure was "conservative".

Source: Al Jazeera and agencies

African Leaders' Letter to Ex Tunisian President.

Africa’s despots write open letter to Ben Ali,
Dear Ben Ali,

We have learnt with profound shock and sadness the news of your forceful departure from Tunisia, apparently at the behest of angry, unemployed youths. We are all quite surprised at the speed with which you were willing to break our Code of Conduct by actually listening to and accepting the will of the people.

Your decision to listen to, rather than shoot, beat, teargas, arrest, torture and murder those unemployed cretins that flood the streets has set a dangerous precedent that, you must be aware, has now spread to Egypt, forced a cabinet reshuffle in Jordan, and sown seeds of discontent in Yemen, Libya and elsewhere.

We were under the impression that Comrade Robert Mugabe has set us all a useful example of how to ignore public opinion and economic collapse to stay in power. You are aware that reforms in countries like Ghana, Malawi, Zambia, and Liberia have left our club with fewer members. The cruel hand of death has robbed us of Comrades Mobutu, Sani Abacha, Gnassingbe Eyadema and El Hadj Omar Bongo, among others.

Similar reforms saw us lose Comrade Moi in Kenya but we believed we could bludgeon our rivals to a draw and remain with a fighting chance to share power. It is this new survival strategy that Comrade Gbagbo is applying in Ivory Coast and one we believed you had at your disposal. If push come to shove, as it did in the streets of Tunisia, we expect that you would call out the boys in the uniform and teach those demonstrators some lessons in physics (the velocity of bullets), biology (the disintegration of bodily parts that come into contact with said bullets), and chemistry (the effect of teargas on unemployed demonstrators).

That you allowed the media to remain active were others have been quick to shut down radio stations and newspapers was a surprise and unfortunate miscalculation, as was your decision to offer concessions, when you ought to have appeared on national television to stare down your rivals, promise new laws to keep them in check and throw a few cents and districts, or biscuits, into the hungry and angry crowd.

With the benefit of hindsight, maybe it is our fault, as members of the club. We assumed, after you cunningly got rid of former president Habib Bourguiba by declaring him senile, and then winning several elections by landslides, that you were actually popular or had built a well-oiled pipeline to supply the taps of patronage.

It is ironic that your successful efforts to help the UN declare 2010 as the International Year of the Youth have returned to haunt you in this manner. Ungrateful, unemployed bastards! As you can imagine, we are all watching Comrade Mubarak try to weather the storm in Egypt and have advised members to announce promotions and pay rises in their armies, just in case. We are urging democratic and electoral reforms only as a last resort.

We hope your beautiful wife Leila has been able to pawn some of the 1,500 kilogrammes of gold she withdrew from the Central Bank to take care of your financial needs and that it will not be taken away from you. You must recall how we looked on helplessly as the Swiss handed back to Nigeria money that Comrade Abacha had diligently saved in their banks, in total disregard of the welfare of his orphaned family.

While in Riyadh, look out for relatives of the late Comrade Idi Amin who might offer some local knowledge and assist you settle into desert life. We doubt it is the first place any of us would choose for exile but please identify some well apportioned plots of land (preferably near oasis) for some of us, just in case this bloody thing you started keeps spreading.

Until we meet,
Your old friends in the African Despot’s Club.

The New African Trend-Lose and hang on.

There is a brand new variant of democracy sweeping the African continent, which basically runs like this; the ruling party holds multi-party elections, after immense pressure from donors and/or western governments. If by any chance the ruling party wins, the results are accepted with much fanfare and there is an elaborate presidential re-inauguration and a resumption of the status quo. Things go back to basically how they were before the elections with some new minor new appointments and a recycling of the old power brokers. The opposition makes feeble attempts at crying foul, the international community basically describes the election as largely free and fair, election results are appealed in courts by the opposition, which litigation they invariably lose and everybody waits for the next four or five years to repeat the same process over again.

In some cases, the ruling party may suspect that even with election rigging, manipulations and intimidations, there are enough opposition votes to make the outcome unpredictable. In this case they may do the following; cancel the election outright before the results are announced and denounce the whole process as being corrupt and influenced by evil factors within the country, the Algeria Style.

In the Zimbabwe style, perfected by paranoid strong man Robert Mugabe, the government delays the announcement of the results and manipulates of the process until a way can be found to announce a narrow victory margin in its favor. In the meantime, opposition strongholds are attacked and the supporters maltreated so severely that they go into hiding until the government announces the results. If there is still considerable resistance, swift talks are held with the opposition to form the sham known as a unity government in which the ruling party enters into a power sharing agreement, keeps the vital ministries of defence, finance, development, mines, and foreign affairs, and cajoles the opposition into accepting ministries such as social welfare, gender affairs, and in some cases education. The opposition leader may be made prime minister, a largely ceremonial post stripped of many powers and ruling party members told not to listen to him, as the largely symbolic role of Morgan Tsvangirai in Zimbabwe shows. The Mugabe variant may also paint the opposition as agents of neocolonialism who want to take the country back to the colonial past.

The Mwai Kibaki variant is similar to the Mugabe Mugabe case, but in this more sinister variant, the element of tribalism is introduced. Members of certain tribes are are eventually convinced, through a deliberate process of misinformation, disinformation, prejudicial statements and appointments, that the destiny of their particular tribes, and the welfare of their tribes, can only be maintained or enhanced if the ruling party is kept in power. In this more effective variant, the voters, who in most cases are mainly illiterate view the election not in terms of opposition parties trying to oust the ruling party in a democratic process, but an attempt by other tribes to dominate and control them. When the ruling party or opposition are able to rally sufficient tribes to their camps, their work becomes easier and the need for spending money on individual campaign is minimized and replaced with efforts to promote tribal divisions, discord and disharmony.

In the Lauren Gbagbo version, the opposition is branded as mostly foreigners who want to control the real indigenes of the country. Laws are promulgated to discourage people of foreign descent from taking part in the politics of the country, though their forbears may have been in the country hundred of years before the country even attained independence. If the last name of candidates can be found in another country, then of course they must truly be from that country. Alassane Wattara and even people like Kenneth Kaunda have suffered from this variant. If this strategy fails and the electoral commission announces the opposition as winners, the government takes the results to the supreme court full of ruling party cronies who find loopholes that will enable them overturn the results and declare the ruling party winner. If the international community cries foul, hunker down and do not give in and wait for calls to form a unity government, and then adopt the Mugabe pattern.

In the Mubarak variant, perfected by the Egypt strong man Hosni Mubarak, arrange regular elections to satisfy western donors and regular arrest and accuse opposition activists of crimes ranging from threatening the security of the state to easpiona and in extreme cases treason. Ensure that by the next electoral cycle most of the main opposition leaders are either mostly in jail, in hiding or self imposed exile. Hold elections every four or five years and win 90% of the votes.

In the more honest Qaddafi version, hold no elections at all, convert every citizen to revolutionary loyalists, line the coffers of foreign pro-democracy activists, clamp down on the media, and close your country to the outside world. At least you are not a hypocrite.