2017-05-28 13:24

Picture: YouTube (a day in a life of a rural doctor in South Africa)

The Other Side

You get tired of complaining on certain days. The more managers and seniors defend the state of affairs in public hospitals, the less you discuss anything with them. That's how I remember some of my work days in rural hospitals. No one seems bothered by the paint peeling off, old buildings, dirty window panes or uneven floors. The workers are dressed to kill though. Not literally, of course. Nurses with their white or blue outfits, supplemented by make-up or weaves. Young male doctors in skinny jeans, ties and sometimes white coats. The atmosphere isn't always friendly. Some days you are screaming for assistance, on other days you find yourself doing everything quietly by yourself. If you don't know what I'm talking about, chances are you have never been to a state hospital as a patient. Or you were too sick to remember your surroundings. As a young doctor, some rural hospitals are far off from ideal "offices" you would like to see yourself in. Truth is most of us only cared about getting patients well and discharging them.

Bedside Manners

The easy part is dealing with common conditions or understanding patients. And by understanding I mean trusting patients. Not that they don't question what treatment you are giving them, but are hopeful and willing to try out what you prescribe. When faced with rare, uncommon or unusual diagnoses, one often gets a lot of pressure from both patients and relatives. In a setting where special investigations and advanced technology are miles away, rural doctors have to learn reassurance, counselling and giving patients hope. The burden of sitting with a patient in your ward because they can't get space in a referral specialist facility does take its toll on health professionals. But that's the struggle relatives will never know. When you get to the ward the following day and the day after that, you are expected to smile and wave.

Visiting Hours

As visitor, I can testify that the thinking process changes. With the white coat hanging at home and stethoscope in the bag, the visitor in me has to avoid x-rays and files. It gets harder when no ones explains anything to you. You can visit someone for days without hearing anything about their clinical progress. If you are lucky, when they get well you can forget it ever happened. If not, you wonder what the hospital staff were hiding from you. Could it be one of those doctor-patient relationships you may ask? Well, it depends. If the patient is of legal age, right state of mind and not too sick, expect updates from them (the patient). Health Professionals generally won't say much without the patient's consent.

What are your public hospital experiences as a visitor? Let me take a walk with you.


What crosses your mind when you see an unwelcoming ward? Imagine the first time ever you visited someone in hospital. What memories linger in your mind? I won't be surprised if you will fully describe the state of the ward, down to the pictures, or lack thereof, that would have served as a good distraction. You would expect to be welcomed and given "ward rules". That is in addition to the orientation to your relative's cubicle or bed. With rising medical court cases, litigation and witch-hunts, your expected warm welcome might seem colder.

The Nursing Station

Ask about orientation, you will be in their good books. Nurses seem reluctant to discuss patients' conditions with relatives these days. Most of them saying "we are not allowed to, only the doctor can give you the information you need". Partially true as that may be, just re-read what I wrote up there. For confidential diagnoses, it makes sense that you shouldn't expect anyone other than the patient to disclose. To avoid people guessing, some nurses won't give you any information for any condition, ever, at all. The challenge, I suppose, is when no one explains anything to you, about why they are not telling you anything.

The Absent Doctor

If you ever find the doctor in the ward, you are either too early or very lucky. During visiting hours, most of the ward rounds and ward work would be done. What happens if you need to know what your relative has? How about the daily update? If your loved one is in ICU or High Care, most times the doctors will be around. There will also be planned regular updates. Not only for medico-legal reasons, but sometimes the doctors will need your permission to perform risky life-saving procedures. So when you get to the ward and can't find the doctor, what do you do? Kindly ask the nurses about their house rules. The usual procedure is that you visit the hospital during week days (where possible) and see the doctor during ward rounds. For any urgent or burning issues, you can ask the nurse to contact the available doctor at that time. Good luck with that; especially if you seem threatening or confrontational.

The Update

Have you ever been unsatisfied with the doctor's answer? That's a long line of people and relatives to join. Reasons why and possibilities are endless. Some range from intra- and interpersonal dynamics, unmet expectations and bad news. People are different; and so are doctors. Everyone has their style of practising medicine. But that shouldn't mean that it should affect their work or its results. The best way to get an update if you are a large family is nominating a representative (preferably one who understands things better) and allowing only them to get regular feedback. The representative can then update the whole group. The advantage isn't only for the family, but for the health professionals too. It eliminates repetitions in a short staffed environment. It also avoids disclosing patient information to wrong family groups with personal motives. That works well if the patient isn't critically ill.

The Weekend Visit

This has to be one of the worst times to visit a relative in short-staffed, resource-poor settings. Worst time if your relative isn't out of the woods yet. With the above-described setups, nurses may not give you much information about your relative's progress. In that case, you have to wait for the busy doctor who has other emergency services to deal with. If you are very lucky, you may bump into the doctor and get an update. The best you can do is get as much detail possible when your loved one gets admitted. You can't always predict how an illness progresses. Yet, one can plan out the expected resolution of the ailment. In such cases, you will only get updates if anything changes, for better or worse.

The End

We all hope for the best. We like to think that our relatives, loved ones, friends or significant others will be discharged in tip-top condition. If all goes well, we usually have no reason to understand why they were admitted in the first place. That ignorance may negatively affect future recurrent episodes in chronic illnesses. Always remember to enquire about ongoing care and support at home. That's the good news. The bad news confronts us when the patient doesn't get discharged. It eats us up if we never got any update and things go south. One can only hope that something unexpected or unavoidable is to blame.

Are private hospitals different? What are your experiences?

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