You go (nay are carried, nay rushed) to the nearest health facility. It is however only an outpatient facility that will be able to offer only an acute relief from your distress. You require more intensive tests and more importantly treatment that is well beyond what they can give here. And that right there is just the beginning of your nightmare...
You are a clinician working here and when called to the emergency room you do not expect to find smiling faces and all. It is a critical time where speed, accuracy, material resources and acute clinical skills count a lot. Here is one life on the line and you have to step up to the noble task of shoring it up to safety again. You are quite unprepared for the rough bump that your day is about to hit...
It is conventional knowledge in the public healthcare corridors that one of the truest test of the quality of care in a hospital is the A&E (accident and emergency) department. If you are not going to save lives in critical condition then what the heck are you doing in the serious business of saving lives? Our healthcare system is organized in such a way that you find an ascend in the expected scope and range of services. The lower level facilities will offer basic and less complicated services. The depth however increases as you go up the chain.
County governments have sunk a lot in the health sector. From refurbishing run down facilities to the installation of complex machines and treatment facilities. We now have some counties running dialysis centers and critical cares facilities. This is all very commendable.
There is however one stand out acquisition by nearly all the county government hospitals. Ambulances. Some bought, some hired, some as donations. But they can all be seen moving from point to the other, ferrying the very sick or critical.
Our referral system has been set up in a way that conditions that cannot be handled at that level of care are sent up to a higher level or better suited facility. But this process can be painstakingly slow and arduous. This perhaps might have informed the big investments that county governments incurred to procure these machines and vehicles. Enabling faster transfer of patients in critical states.
But sometimes a very important link in this process gets broken...
Her breath was coming to her in short raspy gasps. Visibly restless and distressed, she was in a state of progressive systemic and physical deterioration. This was clearly beyond here but here she was...
An initial assessment, propping up, intravenous access and vital basic tests. Then a protocol of jabs that will go a long way in sustaining her greatly threatened existence. All this as the referral arrangements are ongoing.
So the phone calls begin..
The first public hospital referral..
Me; hello, is that K Hospital?
KH; yes.
Me; my name is (my name) and I am calling you from (my facility) over a patient I am referring to you.
KH; yes, what is the patient's name and what is their problem?
Me; (give brief history) is in severe respiratory distress, pneumonia, could be tuberculosis.
KH; have you done a sputum test on the patient?
Me; c'mon, only done the basic tests now...
KH; what are the vitals?
Me; okay (I read all the vitals to her)
KH; what else have you done?
Me; the usual pre-referral management...
KH; but why do you want to refer the patient to us?
Me; okay I cannot offer the patient anything more than what I have done so far. Definitely requires respiratory support and hospitalized management.
KH; Sorry but I thought you had heard we are not admitting any patients...
Me; I have not heard it. Where and when did you broadcast it?
KH; we are on a go slow so we are not admitting any patients...
Me; tell me one thing though...
KH; yes, what?
Me; how is this patient to be assisted? What would you do if you were in my shoes?
KH; I don't know. Maybe try M hospital. Sorry but we can't help you.
Me; this is hard..
KH; try M hospital (hangs up)
It is Friday evening and by this time everybody is out of the facility but here you are calling up numbers.
Me; (after two cold calls) is that hospital M?
HM; yes. How can I help you?
Me; my name is (my name) and whom am I speaking with?
HM; (gives me her name) where are you calling from?
Me; I am calling you from (my location) I have a patient with this and that I want to refer to you right away..
HM; what have you done for the patient?
Me; the basic pre-referral treatment. She is not in good condition and thus the need for further treatment. That is why I am calling you.
HM; sorry but right now we don't have bed space for the patient...
Me; let me ask you something...
HM; yes. please..
Me; how are we to help this patient?
HM; try KH...
Me; I just called KH and they told me to call your facility...
HM; they told you to call here? Why can't they take the patient?
Me; damn, something about a go-slow...
HM; of course we are on a go slow.
Me; Okay, so what happens now?
HM; I don't know...sorry (hangs up)
So here stranded with the patient. The ambulance we had called is here. But what to do now? Patient can't afford private hospital treatment and even despite her very sick condition says that she will just go back to the house! That must be a silly joke...
So on a Friday evening having to call to call all these places and ending up with negative responses is just a rude jab in your face...
Your Friday can wait but what is the real meaning of this sad scenario? That we still will see more and more senseless morbidities and mortalities of this nature despite all the investments in this area?
What is going on here?
