Sequel to Jacob’s Story…
The medical and health sector in our dear country is faced with a great challenge of human resources asides the challenges of structure, warring factions, equipment and funding.
Generally, doctors are over worked worldwide. However, in developed countries the work load on doctors has been reducing with time. The World Health Organisation (WHO) standard has been revised down progressively, and is currently at a ratio of one doctor to 600 patients. Great Britain, the world’s first industrialised nation is a sovereign state, with a monarchy and parliamentary system of government. She has a physician/patient ratio of 1:440 which exceeds WHO standard (Nigeria’s poor ratio of 1: 3500 reduces the quality of care expected to be given).1
If left to go at the pace and intensity it is moving, the health sector will undoubtedly implode, undergo apoptosis. The story of brain-drain in the Nigerian health sector is no longer news. In fact, it is one of the fastest growing ‘organizations’ as we speak. If I had my way already, I would have become a full member myself.
The story earlier told (read here) is grossly fictional but representative of the regular daily dealings in most government hospitals in Nigeria (note that I have tried to water down how bad it can really be, because trust me, Jacob was really lucky to have left that early if you ask me). Some people have had worse experiences than that, and of course there are a few good stories too.
The question that will already be hovering your mind space right now will be “who is to blame?”, “what is the way forward”? Who is responsible for all the mess we have found ourselves in? Doctors? Nurses? Pharmacists? Paramedics? Government? The patients themselves? Permit me to say we are all responsible for the mess. I do not have enough time and space to distribute the cake of blame equally, so I’ll just skip mostly to the way forward.
The patient comes to the hospital because s/he needs to get better, or sometimes because s/he needs to find answers. If they knew what to do exactly, and could do it themselves, they wouldn’t show up. Every health worker needs to know and internalise this fact. You’ll agree that patients sometimes find it difficult to even explain what exactly is wrong, you’ll find out most for yourself as the professional, this alludes to the fact that they really do need your help. Also note that you’re in contest with many external forces – pseudo experts, your one time patients, grandparents, who would have offered counsel, remedies and several varying nuggets which you may first have to format from your patient’s hardware, before you infuse your new data. There comes the greatest challenge – time. You need enough time per client to be able to complete such tasks successfully! Formatting itself is tedious, and most health workers just proceed to uploading new information.
I also wish the patients coming to the hospitals would understand the predicament of those attending to them. Generally patients have no idea what your schedule looks like or why you have to rush through most of your tasks or why you do what you do. Some will even pick fights with you when you ask them certain questions in a bid to help them find answers to their puzzles of complaints. I have received several facial expressions in response to questions like, ‘when was your last period, what was the cause of death of your grandfather, can you sustain an erection, how many pregnancies have you had, to mention a few.’ If only the patients knew the import of these questions whenever they are asked, they would gladly respond. On a clinic day for example, a patient is likely to wonder why the doctor resumes so late and closes so early. At least that’s what they think. If they knew the doctor may have been on duty the previous night, plus s/he has to do a quick round on in-patients every morning, or attend some clinical meeting/presentation before resuming at 10am in the clinic; leave clinic at 2pm not to go home but to return to ward activities or perform procedures or even go to the theatre to close much later in the day, if they knew all these, maybe they wouldn’t be so vexed. But all these are very avoidable if the doctor-patient ratio was ideal. There will be less call duty per head, division of labour would be possible and so on.
I have not even begun to tell you about how defunct our Primary health care system is. Had we gotten things right at that level, the crowd at the secondary and tertiary levels of care will drop drastically. I am only speaking for doctors, right? Well, I know what it feels like for them, other health professionals also have their schedules and peculiarities, details of which might be alien to me in terms of personal feel and experience.
We have a lot to do, as a country, as professionals and as recipients of care. As a recipient for instance, don’t take shortcuts by visiting quacks and ‘middlemen’ and only present to the hospital when things get out of hand. You may say but we don’t get enough attention or care when we do, but remember it is your body, when the complications arise that finally warrant an hospital visit, it’s not the doctor or nurse that will bear the bodily pain and afflictions. Seek help, on time and from the right quarters.
Well, for the doctors and also other health care professionals, we may not as a matter of urgency be able to fix all the problems and challenges of the health care system, but there are a few things we can do right to salvage the situation. I will expatiate on these in these stories that follow.
I am working in a school health centre as the medical officer and some weeks back I had a patient, Simon**. Simon is 26 years old and is a ‘sickler’ (colloquial term for people with Haemoglobin SS genotype who have sickle cell anaemia). He had a painful crisis, and was admitted. I saw him through the duration of his stay, he was transfused twice among other treatment that was administered. We suspected 2 of the common complications in ‘sicklers’ and had to investigate. He spent about a week with us and he spent quite a sizeable amount of money. A week after he was discharged, he came to my office in the clinic for check-up as advised. His file had been taken to another consulting room where he had already been attended to, but he waited to see me afterwards. This time, he was looking much brighter and livelier. His earlier lemon-coloured eyeballs were now milky and almost white. Recognising him in that moment, I thought he was yet to be seen and asked for his folder but he told me he had already been attended to. He had come by to just say thank you to me because according to him, “in the past 20 years since I have had to go to the hospital, no one has really taken time to treat and explain my condition to me as you people here have done for me last week”. I was glad to hear and also a bit sad. Sad because I had admitted this same patient about a month earlier, only for a few days though but we didn’t have much time to talk as we then did. I was also part of those doctors who had seen him before and didn’t have enough time to counsel or explain things, we just treat and when the patient is well, we discharge.
Well, in my defence, I didn’t have much time, I daily have more patients than I can successfully see comprehensively. How do you describe seeing 100 patients upwards per day in clinic – that is not considering the in-patients and other emergencies that will show up. But this particular admission where we took time to explain and treat, 2 new doctors had just been employed so I could really take my time to do a comprehensive ward round before joining them in clinic. After this my defence some of you are still judging me, I know. Continue.
I went ahead to give Simon a comprehensive explanation of why he has sickle cell anaemia, what things to avoid, what drugs to take regularly, how to prevent crisis and possible complications to look out for. He was particularly happy about the colour of his eyeballs, he said “my eyes have never been this clear before”.
Simon eventually left my office about 45 minutes later, and I don’t know who was happier, him or myself. I felt like I just averted Third World War. Truly, the satisfying feeling is indescribable. However, a few glances at the faces of the other patients who were waiting to see me said it all, they wondered why it took me so much time for just one person, who had even been seen already by another doctor. It dawned on me that we cannot save them all, and whenever we as health care providers give all that is needed to a particular patient, it would be at the expense of some other patient. Tough choice! For every patient that leaves your office happy, fulfilled and much better, there is one or two others outside who feel frustrated already.
There was another patient that same week, Donatus**. Donatus is 7 years old, and he is also a ‘sickler’. He did not look happy at all, there wasn’t much I could do in his case, he wouldn’t even talk to me after gulping down my bottle of soft drink (real name withheld, I’m so not advertising for any bottling company). While on admission, the mother and father had arguments and the frustration on their part too was palpable. The next day I invited them to my office and we had a long talk about the boy’s condition. By the time they were to leave, they could almost kneel and prostrate in appreciation for all the explanations. They finally knew why Donatus was different from his other 3 siblings. By the time they were leaving too, I got those familiar glances and warning looks from the crowd of witnesses who were waiting to see me.
Truly, we can’t save them all, but we can try.
We can get out of this predicament if the ratio of health care providers to patients improve significantly. But while we seriously hope for that to happen, and while we are still here (my membership form for the brain-drain association is still in transit remember) we can do a little. Talk to your patients, ask them questions, answer their questions, listen to them. If your schedule is too tight and you have to rush through work, come back on your day off to visit and counsel. Trust me, it is not only the patients who will feel better, you will too! Especially for those patients whose conditions have no particular remedy, whose cases are complicated, who wear long faces while you do your thing; talk to them, or just listen.
Long live Nigerian health sector, and if my membership form gets approved soon, it will be ‘hello from the other side’. But while I am still here, I will keep talking to you and will listen.
So talk to me, will ya?
** real names withheld
- Albert Oyedokun: Guardian News….www.medicalworldnigeria.com
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