There is a significant amount of success we could point to in our public healthcare system – from declining HIV infection rates and malaria control to recent confirmation that we have already met the Millennium Development Goals targets for nutrition and child health. But how do we celebrate when the system continues to fail us?
How do we celebrate when mothers are still dying under appalling circumstances and toddlers are checking in to our hospitals with what appear to be minor complaints, and are either dying or leaving with further complications? It is difficult to talk about reaching health targets when there is so much autonomy in the system and zero accountability.
We might be looking good on paper and winning deserved praises but when are we going to start talking about how poorly patients are treated in our public hospitals, and about how many families are currently demanding justice for relatives they have buried.
Healthcare is one of the most obvious indicators of inequality. In our case, public healthcare is not of the same standard countrywide and those who utilise the system are often the disadvantaged citizens, who are usually uninformed about their rights to access timely and acceptable care. And they are the ones who are less likely to get answers or seek redress when it fails them.
Most people who read the press reports about Jaden Mars – the four-year-old who bit his tongue and is now dead after his admission to the Georgetown Public Hospital for treatment – will question the system. His mother Natalie Caseley questions the system, and she too is demanding justice.
In a Stabroek News report dated December 14, 2013, Ms Caseley said that people often felt powerless because they believed they were fighting a losing battle against the government.
“It’s not about winning the government, it’s about getting justice and having them open their eyes to do what is right and pull their act together,” she said.
Indeed, we need more accountability in the system. This is not something we do particularly well in healthcare. There is lot of autonomy and hardly any mechanisms in place to hold people to account for the services they are delivering, and the system also seems to have no regard for feedback from patients and their families.
The World Health Organisation Constitution enshrines the highest attainable standard of health as a fundamental right of every human being. Equally important, is the right to ethical and humane treatment. But for years the relationship between patients, practitioners and the system here has been dysfunctional. So dysfunctional that a sick patient fell down the stairs in one of the wards at the public hospital a few years ago and he lay there for over an hour until a visitor showed him kindness. While he was on the floor, he overheard a nurse telling a colleague, “Leave him there, he done dead already.”
To be clear, the failure of some healthcare providers should not be seen as the failure of our healthcare system itself but as a manifestation of the need to change the culture of disrespect that has rotted the system and has left us exposed to a long chain of persons who operate as if citizens do not have a right to health.
One of the biggest failures of our system has been a lack of information sharing, which is crucial to delivering adequate patient care. The system has become so wrapped up in itself that patients apparently do not have a right to ask questions about their health – mothers have no business probing what is wrong with their babies. We are often denied basic information and what can be more central to the delivery of healthcare than communication?
Just ask Natalie Caseley how she felt when her son died and silence was somehow equal to an appropriate response for her questions. Perhaps we could ask Debra Archer who waited weeks before receiving confirmation that her toddler, Nicholas Cox, suffered brain damage after he was admitted to the public hospital for treatment for diarrhoea and vomiting.
Communicating with the patient and the family ought to be included in the guidelines, or at the very least, taken seriously. Sharing information with patients is the same as treating them with respect; that is, they should have the necessary information and instruction about all procedures, both medical and administrative.
But it is difficult to advocate for these changes without calling for broader reforms that will allow the sector to build mechanisms into the public health system aimed at establishing an effective link between patients, practitioners and hospital staff. Reforms must also include training for patient counsellors to help form such links.
Sometimes all that is required is a two-way conversation with the patients and ensuring that all questions are answered. The reforms have to put patient care at the heart of what they do in the public healthcare system and also examine ways as to how they could partner with patients, all in an effort to transform the care they are delivering.
Considerations must include how to get patients to be an equal part of the care team – not as people who show up at the hospital with an illness to have something done to them. Studies are now focusing on how to get patients involved in setting strategy for health facilities and how to involve them in other areas such as incidence review and quality improvement.
Whether the government will concede as much, there is a pattern of declining public support for the system and for healthcare providers. Ironically, the administration seems to have little support for the system, based on where public officials seek treatment when they fall ill. We continue to read about how much budgetary allocations have increased for health yet our leaders have little or no faith in the system.
This consideration aside, there ought to be an understanding that making the patient’s experience better translates into making the practitioner’s task easier. Communicating with patients and their families can avoid a lot of frustration and anxiety, and improve interactions and relationships.
Too often when families go public with stories the hospital points out that they have avenues for redress which are not utilized. But how do they expect people to stay silent when the system is designed to be silent and to ignore requests for information.
In sum, no matter how much we are spending on public health the system will continue to face criticisms until there is a new culture based on respect and dignity for patients. Listening and responding with empathy is an important part of the practice – something our practitioners seem to have forgotten.
While we salute the good doctors, nurses and hospital staff who commit to the profession and treat us like humans, we condemn their colleagues who have for too long been allowed to trample upon our fundamental right to adequate healthcare.
Have a question or comment? Connect with Iana Seales at about.me/iseales
