My practical venture, ideally the taste of reality began when I stepped out as a fresh graduate embarking on a journey to minus insult to injury, joining a government hospital as per PMDC requirements for a stretch of 12 months. A new graduate sticks out like a sore thumb and so did I. After braving the series of delays in the entrance exam, I was finally handed out my choices for the year.
Ideas of lending a helping hand to help fill the void and several other encouraging designs were running through my veins. At the time, I felt like a ninja, perhaps a doctor without a border. With most of the government vainness out in the open, how vulnerable was I? Highlighting a series of events and outcomes, I have divided the government setting into 8 subcategories, each with its own surprises.
The Parfait Healthcare Delivery System:Hospital and hygiene go hand in hand. The sanitary situation in every department lacks even the generic rules of waste disposal method. Beginning from basic techniques, there lacks a concept of waste segregation.
The containers are not color coded differentiating them from sharps and other forms of risk waste which burdens the waste management plan. The risk waste like pharmaceutical, genotoxic and chemical waste fall into the same bin which is mishandled thereby adding to the health risk. The ambulating services within the hospital responsible for moving patients from one unit to another don’t meet the standards as quite.
The vain chain to making a request via land line towards the main office to the arrival of the ambulance is enveloped in endless delays pushing caretakers to take charge and conduct the patients to the desired destination. Often, there were several intensive care patients within the unit required shifting with oxygen; sadly, both the nursing attendants and oxygen showed no avail. Patients referred from the main emergency to the corresponding department are seen stretching across the hospital, braving the heat and confusion.
The blood bank and laboratory are perhaps the only operating units with order. However, collection units servicing the admitted patients in every department had been closed a year ago due to which all samples are directed to the main laboratory by the patient/patient’s attendants, even an arterial blood gas sample dipped in ice-cold water. According to a local perspective, the laundry and food services have little to offer too.
The Individual Unit: A doctor too is a human being you know, and hence a potential candidate entitled to safety, security, privacy and well-being. Through the course of my rotations in the major departments, there were no private rooms assigned for interns, let alone for boys. We either shared a room with the members of the opposite sex or didn’t have a room at all and therefore took shelter in the nursing staff’s shack where we were not welcomed.In the brighter cases where we had a place to settle down after prolong duty hours, the restrooms were devoid of a necessity called water (I didn’t complain of the hygiene at all at this point). Moreover, the rooms often became flooded with the senior on call duty doctors with the juniors compromising their happy hour or adding to the pile. Attacks on personal lockers and unrestrained theft were next that rocked my world.
The Nursing Posse: Here I would like to speak of “some and not all” nursing staff who fail to deliver nursing care and indulge in illegal practices of selling off the healthcare goods to make a handsome living. Every department is allotted a budget that covers certain departmental expenses. Some turn over their departments into a new system, others drive the budget into their pockets. Mostly, I was requested to return used voiles and document disposables consumed at a duty the next morning to a senior staff member. The staff member at various events refused to handout important healthcare materials deemed necessary for post-operative patients and insisted they be ordered by the attendants of the hour. Ruckuses were often sparked following an ample spending on their behalf which was totally justified. On the flip side, some staff members remained true to their responsibilities and did more than their capability to offer help.
The O.T Blues: The sketch of an operation theatre felt like a blue area, highly disinfected, with limited personnel and a protocol that followed. If you should know everything, the theatres were often crowded with interns more than desired. Moreover the practice of proper theatre specific attire including a foot and head gear, scrubbing details and bringing unauthorized personal articles were far from supervision. The advent of disposable gowning and draping is a dream which is yet to come true. Given the resources, I believe the hospital still makes the most of it. However, the smallest details of observing proper measures before, during and after a procedure need a reality check. In the unlikely event of an instrument/machinery running out of order is only followed by a feud and the blame game. Also, patient privacy is still misunderstood and incompletely sought after and the concept of medical ethics in the OT has a supporting role to play.
The E.R Bloom: The emergency from a distance gave me the chills. It’s been updated into a new building, with central conditioning system instated, separate areas of major trauma departments including a resuscitation room, emergency serial reporting and a theatre. I believe the ER should be a place with absolutely no shortcomings. To begin with, the patients and scores of attendants scramble and split to locate stretchers to put them out of their misery. In case you require wheelchair, you would have to ambulate at least 10 times to find the right person to reason with. Once in, the patients meet their amateur interns and are treated in accordance with the emergency decrees and senior reporting.
In the morning when most seniors and head staff report to duty, things maintain order. However, as the sun dusks, the ER becomes an independent entity which has rendered the ER helpless and in-efficient. The freedom proceedings range from disappearing from duty hours, making medical supplies in need unavailable, illegal medico-legal practices, misguiding the patients in terms of remote access and pharmaceutical crimes. Not to mention the security of the healthcare workers which often falls into great danger when important personnel, drunkards or criminals arrive for healthcare delivery in the wrath of night. The security officials allocated for their purpose are found napping and sipping in their booths. Obviously, surveillance and profiling hasn’t worked.
The Secret Society: This society only comes to being in events of an emergency. By that I mean foreigners touring for funds/donation, senior accountability, employment/sacking, greetings from highlife, and… can’t think of anything else.The patient welfare fund doesn’t approve of your poverty unless the secret society authorizes. Serology, MRI, thyroid/bone scanning and others forms of expensive reporting harbor bad news to the unfortunate masses. Also, in the event of a mass/multiple casualty when reporters gather around for scoop, the personnel arrive for a routine visit touching only the outskirts of the area. To my surprise, there were more than single units reserved for mass emergencies. These rooms were equipped with automatic monitoring systems, in-built laboratory, quick serial assessment structures and restrooms. I discovered this mode of personalized care when it played host to an official who presented with a low blood-sugar level.
Us: Speaking so much of the bitter truth, I have thought of nothing positive except the doctors. Because doctors do not discriminate, healthcare belongs to everyone!
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