I open the next outpatient card. It is Thursday evening and I am on call in outpatients. My heart sank as I arrived – there were at least 40 people still waiting. Some had been there since 8am. The card I have opened has a piece of paper inserted. It is headed “Waiting time survey” and is all part of the entertaining clash of first world standards and third world communities, resources and managers.
Let me describe a typical patient journey:
Week 1
Monday – goes to clinic with cough for 3 weeks. Clinic gives amoxil and takes sputum.
Friday – patient goes back still coughing. Result lost - clinic repeats sputum.
Week 2
Wednesday – patient goes to clinic. Sputum negative for TB but still coughing so told to go to hospital.
Friday – gets up at 5am having found the money from a friend for the journey. Arrives 5 hours and 2 taxi journeys later. Sits in OPD for 6 hours. Seen briefly by stroppy doctor at 4pm who wants an X-ray. X-ray has just closed. Sleep on the floor overnight with 30 other people using mattress carefully impregnated with urine and lice.
Saturday - get your chest X-ray. Seen at 2pm by stroppy doctor who loudly complains that you are not an urgent patient and “why have you come on a Saturday for a cough that has been going on for weeks?” Started on TB treatment and told to register at the office. Pharmacy has just closed for the weekend. Office closed til Monday.
Making piles always helps. I divide the cards: non-urgent compassionate see (15 patients - e.g. joint pains but been waiting for 12 hours), non-urgent won’t see (4 patients - e.g. chronic cough arrived at 4pm), urgent must sees (15 patients - acute breathlessness, vaginal bleeding etc.).
I could just see the urgent “sick” ones – it is not as if people can go home until the morning anyway – but I have still not been able to shed the “responsibility guilt”. One colleague commented regarding it that I “seemed to spend rather more time feeling guilty than a protestant Christian is supposed to.”
Bastard.
Let me describe a typical patient journey:
Week 1
Monday – goes to clinic with cough for 3 weeks. Clinic gives amoxil and takes sputum.
Friday – patient goes back still coughing. Result lost - clinic repeats sputum.
Week 2
Wednesday – patient goes to clinic. Sputum negative for TB but still coughing so told to go to hospital.
Friday – gets up at 5am having found the money from a friend for the journey. Arrives 5 hours and 2 taxi journeys later. Sits in OPD for 6 hours. Seen briefly by stroppy doctor at 4pm who wants an X-ray. X-ray has just closed. Sleep on the floor overnight with 30 other people using mattress carefully impregnated with urine and lice.
Saturday - get your chest X-ray. Seen at 2pm by stroppy doctor who loudly complains that you are not an urgent patient and “why have you come on a Saturday for a cough that has been going on for weeks?” Started on TB treatment and told to register at the office. Pharmacy has just closed for the weekend. Office closed til Monday.
Making piles always helps. I divide the cards: non-urgent compassionate see (15 patients - e.g. joint pains but been waiting for 12 hours), non-urgent won’t see (4 patients - e.g. chronic cough arrived at 4pm), urgent must sees (15 patients - acute breathlessness, vaginal bleeding etc.).
I could just see the urgent “sick” ones – it is not as if people can go home until the morning anyway – but I have still not been able to shed the “responsibility guilt”. One colleague commented regarding it that I “seemed to spend rather more time feeling guilty than a protestant Christian is supposed to.”
Bastard.
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