Hospital eyes: UWI found wanting

I’ve had the mixed fortune of my father having to be admitted to the UWI hospital again this week. He’d had a falling accident while I was abroad, and his heart rate and blood pressure had risen sharply. He was admitted early Monday morning. I got back to Jamaica that afternoon, and went to see him in the evening. Many things about the way hospitals work bother me, and frankly I would never feel comfortable as a patient anywhere but in a private room with someone right outside my door. So, some of what I observe and feel troubling, I have seen elsewhere: I spent several weeks taking someone back and forth to a hospital in the US. But, let me list some of the bothering things and maybe we can figure out if they can be fixed, easily and permanently.

  • Security and poor communication skills: In Jamaica, we have private firms who perform this service at almost every establishment; that’s how our society has developed because violence has become endemic. But, security officers have become the ‘first greeters’ at most establishments; they do what receptionists used to do. The problem is that many do not seem to have any training in essential skills for interacting with people. They often act in ways that are brusque if not downright rude. I asked the guard at the entrance to the Accident and Emergency where I needed to go to find my father, whom I had just been told by his caregiver was in a room near the entrance. I do not know the building, and I should not be expected to know it. “Where is he?” I was asked. I couldn’t answer because I had no idea of the layout; I only knew he was in a room not far away. I said that. It got me nowhere. “How many people with him?” I was asked. I guess I could have asked the person who had spoken to me on the phone if she was alone, but I had not. “I don’t know,” I replied. The guard told me that more than two people could not be with the patient, so I would need to get someone to come out if there were more than two. I was about to figure out how to deal with that, when a nurse/caregiver to my father, called to me to join her in the waiting room. Within moments, my father’s main caregiver came out to join us. She told me where to find my father and I went to take a look at how he was doing.

The simple truth is that hospitals and other organisations have derogated a certain responsibility, because they have outsourced a task and not retained much control over it, but it goes to the core of how the enterprise or organization works. I don’t want to be derogatory, but many of the security staff are not the brightest pennies in the pocket. That adds a layer of bad communication that is both avoidable and unnecessary. Economics being what it is, however, you are unlikely to get brighter pennies taking on such tasks for the money that is paid. I do not know the actual wage levels, but judging by the way that such security staff are ‘hanging out their hands’, it’s no great payer.

  • Security and cyan badda-ism: The tendency to be oblivious to surroundings is not unique to modern Jamaican society. Many of us talk about how caring the world used to be. But, one of the ways that life seems to have changed is the degree to which people seem to have little or no interest in those around them. In a setting like a hospital, this is a recipe for total disaster. One sees all manner of people in a hospital. Some are dressed like medical people. Some wear badges. Some are dressed like ordinary citizens. Some are performing tasks that seem consistent with a hospital, carry packages, wheeling stretchers, walking with files, carry meals, selling wares, etc. But, who is who? A person walking around with a stethoscope is not necessarily a qualified doctor. At best, if not a doctor, it may be a student; at worst, it may just be one of many con artists. Add to that the fact that people just do not pay attention. I was at one end of a corridor heading to the wards yesterday afternoon. I could see our main caregiver on the phone, standing next to a lady sitting down. My acquaintance then disappeared, as I turned my eyes away to avoid colliding with someone. I asked the lady sitting down if she had seen where the woman went. “Which woman?” She had not even registered the woman next to her. I said “The one who just committed a murder.” The sitting woman looked shocked. I said that if she was asked to be a witness she would be no use. She was dressed in clothes that suggested she was a hospital orderly. A passing woman said while walking “She’s not the security guard!” I retorted that we were all security guards in this setting. I went to the ward where my father was not in bed, and found my caregiver. I told her of the incident. “You mean the woman sitting by the elevator?” she asked. At least, she’d not zoned out while on the phone.

You don’t have to be a reader of thrillers to think of the many bad scenarios that could arise in such circumstances. Add to this the fact that people enter wards unchecked, with no need to present credentials or any form of scrutiny. Often, there is no one in sight to check. I walk into a ward with say 20 people and spray the room with bullets. I hear screams. I walk away, dropping the gun in a room as I walk away in the ensuing mayhem. Too easy. Oh, I shook with fear.

  • Games people play: I got a call mid-afternoon from a cousin that my father was being discharged; he’s on the information sheet as a prime contact, because he’s been doing that for most of the past 20 odd years, while I lived abroad. I happened to be with a friend in the Mona area, having a late lunch with my daughter. We had a swim meet in the evening, and I saw no need to head over the hills then come back down to get to the stadium. I quickly downed my mackerel run down and headed to the hospital. My father had been moved from the Critical Care Unit, and I looked for a nurse to guide me on what I needed to do. Another nurse told me that there was a nurse at the CCU. I told her to go look. She did. No one. A doctor came by and started telling me about follow-up appointments that my father would need on Monday. I did not get to mention the absent nurses. I heard her tell me that x-ray results had been ‘inconclusive’. I told her that disturbed me. Why? Two doctors had told me contradictory things: one that my father had a hip fracture; the other that he had no hip fracture. I think that these are each conclusive statements. Put together, they are confusing. If based on ‘inconclusive’ tests, then why make a conclusive statement. I told the doctor that I was thinking of suing the hospital. She went very quiet. I explained my concerns. I’m a stickler for some things, and doctors telling me things that are bogus is one of those things I just don’t like. Call me ‘old-fashioned’. It did not seem like what these professionals should be doing. We moved on. We talked about getting my father home. “We need to take him by ambulance. My car is small and hard for older people to get into.” Considering that my father was only a few days ago hitched to monitors, also told me that his being transported in an ambulance and by trained orderlies would be better. Add to that, his caregiver had herself just had a gynecological ‘procedure’ mere hours ago. The two of them would be better served that way. The doctor made a call. No hospital ambulance was available, but a private one could be found. I did not get into cynical mode and think that this was part of a scam that goes on all the time to get business for such firms. I took it at face value. “It will be J$8000,” the doctor told me. I said that was fine, and I would pay with my debit card. “Their card machine is not working,” she told me. I replied that ‘my ATM’ was not working either. I also did not have checks. So, debit card, or invoice, they could get paid. My funds are good. But, I understand that ‘cash is king’ in Jamaica. (In that sense, the US is extraordinary by comparison, where dirty old money rarely sees the inside of a hospital, where billing and later payment are standard.) Anyway, I headed off to find an ATM to get some cash, so that the caregiver did not have to deal with the stress of how to pay the ambulance staff. Just as I got back, they arrived, and quickly got into their routine. I checked with the doctor if there was anything else I needed to do to facilitate the discharge. She said I was good. She had called a cousin of mine who is a big honcho at the hospital “because it helps to know someone in Jamaica” to see if things could be expedited for my father’s appointment. I didn’t get into that. I let them doctor it out. I headed back to get my daughter, confident that I’d done all I could. I would expect to get a bill from the hospital in coming days.

I could go on about this episode, but I think the points are clear.

I wont attack the hospital itself, feeling that much of what I see is the result of years of struggling to perform an essential service without many of the essential pieces to make that work. But, many structural things are not right.

I wont talk about ‘little things’, such as the patients’ bathrooms that have no towels.

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Soap bar? Check. Paper towels? Unchecked

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Derailed for want of what?

I wont talk about the fact that visitors have to help with feeding patients because staff are over-extended and often just leave food to be eaten, even when patients are incapable of doing that themselves. Feeding may happen, but you better be around to help. Woe betide you if you didn’t get that memo. I wont mention the constant hand shaking that goes on between medical personnel and visitors, most of whom have just walked in off the streets. Suffice to say that I read an article last week about how this practice is the source of much transmission of pathogens in hospitals. I washed my hands on arrival. Oh, I had to find some tissue paper to dry them. I refused to shake the doctor’s hand, but explained why.

Handshake or fist bump? Pass on your germs with care
Handshake or fist bump? Pass on your germs with care

The hospital is a lively place and you can see all that is not quite right. ‘Bucks’ cafeteria is like a lively village bar. Orderlies sit in groups arguing about issues of the day. Vendors walk around selling shampoo, conditioner, bodywash–essentials that are not supplied by the hospital. I’m surprised that people have not set up stalls to sell bedding items and towels.

I know too that the longer a patient is in hospital, the greater the risk of infection and an extended stay. I’m glad my father came out yesterday. I can deal with the vagaries of our home life for his care. I’m not sure I can deal with it at the hospital. You, we, (intended pun), need to get onto this and change it.

Author: Dennis G Jones (aka 'The Grasshopper')

Retired International Monetary Fund economist. My blog is for organizing my ideas and thoughts about a range of topics. I was born in Jamaica, but spent 30 years being educated, living, and working in the UK. I lived in the USA for two decades, and worked and travelled abroad, extensively, throughout my careers and for pleasure. My views have a wide international perspective. Father of 3 girls. Also, married to an economist. :)

7 thoughts on “Hospital eyes: UWI found wanting”

  1. Wage levels, working conditions and long working hours are all dismal for security guards. That I do know.I do think it would help for them to do proper customer service training. If I come across a polite and friendly one I always make a note and usually tell them thanks… It’s a bit unusual. Recently when J-FLAG and Health Min trained public health care workers on how to deal with the LGBT community, they included security guards. We often had the same problem at the US Embassy – we always suffered for it when guards were rude to someone. As for security in the hospital, as you probably know there have been many serious incidents, because of the exact same situation you described, which is the norm!

    When my father-in-law died (in the same hospital you are talking about, I believe!) they did not inform my mother-in-law until the next day when she was getting ready to go and visit him.

    Although it cost a lot of money, I went to a private hospital to get my broken wrist fixed. I was a bit disconcerted that the nurses prayed over me before I went into the operating theater – but very happy to have them right outside my door, and I enjoyed their hymns in the morning! They were all really lovely, I felt cared for…

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    1. Thanks for the insights. I had another security guard moment at the stadium yesterday. I can’t understand why they make life difficult for want of a few signs indicating what parking is available for whatever events are on. Instead, they spend much time engaged in discussion with drivers to the same effect.

      Someone also told me of experiences with guards at AISK, who exhibit most of the best behaviour of first greeters and understand the ethos of the school. No brusque approaches. That’s training and getting staff who can apply what is taught.

      Hospitals leave me shaking.

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      1. Just a few thoughts. I do really hope your father is doing better now, though. I think security guards get on a bit of a “power trip” and also, frankly, they are not always very well educated but of course training helps a great deal.

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  2. Oh so very true ! I just got through the painful process of transferring my husband who suffered a stroke from Savanna la Mar hospital to a private facility. The methods and attitude of the Sav PGH are hair raising. All issues you mentioned about UWI hospital are doubled if not tripled at a not so ‘prestigeous’ facility such as UWI. Patients are treated as if they are cattle, no attention, patients have to wet themselves as the urinal is in no reach for patient to help themselves, nurses do not realize that stroke victims are unable to utter their desire to relief themselves and if family members beg nursing staff not to restrain the patient, they let them fall off the bed, which happened to my husband, I could add and add. Some nurses and especially ward assistants or orderlies which are not properly trained and young doctors (interns) were outright rude and showed no compassion whatsoever. It is just some sort of crisis management that goes on, giving the patient no chance of healing as their dignity is compromised to the max !! Yes, you have to know some big shot at the facility to be given some sort of attention as a family member. I am also working in the medical field, but at a nearby private Imaging facility and people should know me. I do not even want preferential treatment only because of my profession, I want to be treated like a human being as anyone should, not like a bothersome intruder. HAIL PORTIA with her expensive SUV and whatnot who provides one, yes one ! stretcher for her beloved people in PNP country Westmoreland. Oh, I forgot to mention the ambulance which is almost never available or in maintenance. Private transfers cost up to J$ 12,000. I so very much agree with almost all your blogs Mr Jones and read them daily just to confirm that I am not getting insane with my opinions and that I am not alone with my thoughts on various matters in this country. And I do not know how it all could change, as the cyaan badda attitude has become normal and standard, and old school people like me with soon pass on. JESUS TAKE THE WHEEL !
    All that said, I love Jamaica and will stay, so help me God or whoever is in charge up there …..

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    1. This is a horrible account. Have you ever made it public or offered to the hospital or ministry of health? Would you mind if I used it in a blog post?

      Thanks so much for sharing what was a touching account.

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      1. sigh, at last someone who understands. I must add that the consultants were absolutely qualified, concerned and able and had no idea what is happening outside of ’round times’. Some nurses where also concerned but had no adequate supplies to do the job. The problem is the overwhelming work for the staff, and the orderlies and ward assistants who are really not trained, they do not even know that a patient with a spinal injury must be transported on a spinal board, people are just flung on a stretcher with some sort of unstable color round the neck and that is it. When patients bawl out in pain orderlies or ward assistants will even say: Cho, mek we move yu ova deh, likkle pain muss gwaan ! Many times I have to refuse to take them off the stretcher in that condition for spinal CT scan (which is not available at the Sav PGH but at my place of employment), I have to send orderly or accompanying nurse back to get the board before I would allow the patient to be taken off the stretcher and onto the CT scanner. And all the waiting and time wasting adds to the discomfort and pain of the patient, not even mentioning dignity.

        I only made it public to one of the senior Doctors as the CMO was not available and in surgery and that poor man is also overworked I assume. The senior Doctor immediately acted on my complaint and a nurse was now placed beside my husband’s bed. (The Sister nurse though was now even more miserable when we came to visit). I have not made it public as I am now caring at home for my husband as well as working at my place of employment. By all means Mr Jones, use my posts above as you can word it much much better than I can, but would all that make a change ?? I wonder. And if Ms Simpson would have a stroke in Westmoreland she would never know what really happens as she would be flown immediately with JDF helicopter to UWI private part or straight to Florida I assume, as all our big politicians get medical treatment abroad. Just remember the late Minister of Agriculture Roger Clarke, he got is first class treatment abroad paid for by the poor taxpaying people of Jamaica who have to suffer like animals in domestic facilities. (I am assume that his bill was paid for from his salary which comes from tax-payers, unless he had some private savings acquired from non political work, maybe he did some farming himself and sold at market, I do not know… I could go on … forgive me for my anger. I am very grateful to you to take this up and just hope that I do not have to suffer any grave consequences, but I will take that chance … and thank you again.

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  3. Re. security which was really the subject of the original blog. If you get a security ‘officer’ who is in a good mood, or who you can chat up smartly stroking his or her ego, you get through with anything, or even if you wear a stethoscope around your neck to pretend to be a doctor you will get through and could blow up the whole place. Or the vendor who sells phone cards and refreshments could in theory also sell cocaine or other illegal materials. I have no objections of vendors entering the ward as everyone has to make a living and some patients will not receive visitors and have the chance to buy a bun and cheese or whatever unhealthy stuff is sold, but are they searched at all times ? I doubt it. Other security guards or officers, I do not know their ranks, will be so stern and intimidating to make one feel as one was a dangerous criminal. As petchary said: Power trip, which goes on not only in security guard environment but also in supervisory and middle management ranks in any company in Jamaica and I speak from experience. People are not being enabled, they are being kept down, outright down, no chance of development. Supervisors in private companies keep the backra mentality alive, yet they refer to any so called high coloured person as backra or rich man/woman. Is there not the provision of equality in our national curriculum ? Or are our teachers not trained to ‘beat’ that mentality out of our children ? People with dark complexion are still called black and ugly and if you dread your hair you are still a dutty Rasta in Jamaica. I done for tonight and will blast some old time music to take my mind off what the hell is going on in beloved Jamaica. (Ackee in the morning …. heaven!)

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