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.
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.
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.