frustration and a little rant

so back at work after a brief studying hiatus, and things seem to be getting a little bit worse, every day... to explain this post i am going to need to give a brief background about the two tiers of healthcare in this country: private care: expensive, requires a 'medical aid' (medical insurance) and top class care in hospitals that look like hotels, plentiful specialists and very little waiting lists. this level of care serves about 10% of the population. the state system: overrun, poorly staffed with underskilled nurses and doctors, rampant with hiv/aids and trauma, long waiting lists (3 -5 years for a hip replacement!) and serves the other 90% of the population, and is obviously free. (or at least cheap).

i work in the state system, in the tertiary care centre in cape town, which, on paper, has everything you could want in a hospital: MRI and CT scanners, all departments represented, including the smaller ones like rheumatology, theatres running 24 hours a day, and dedicated specialists and a lot of registrars (specialists in training), interns and medical students.

in the unit where i work, which is for acute medical emergencies, we see a broad spectrum of medical problems, everything from acute MI's to garden variety pneumonia. we have a triage system which is supposed to ensure that the most critical patients get seen first, and at least 3 doctors on duty at all times.

the problem is this: the level of patient care in this unit is unacceptably low. yesterday on the 4pm ward round, we encountered a patient see in the morning with a DKA (serious complication of diabetes), who had not received any of the meds charted for her, nor had she had her blood glucose checked since 7am that morning. a man was discovered on the same ward round, dehydrated as a piece of bark, cachectic and in pain, without any patient notes. no one was really sure when he had come in, or what his problem was, or indeed what the plan was. a patient was sent back from a referral hospital: she had a CT brain scan in the unit the day before, which noted severe hydrocephalus, and instead of being referred onto the neurosurgery team, was shunted back to the peripheral hospital. i wonder if anyone even checked her ct scan result? by the time we saw her, she was not looking well...

we routinely keep ventilated patients in our unit while they wait for icu beds. while they are in the unit, they will not get any routine obs (not enough staff), and may not even be attached to a cardiac and blood pressure monitor (not enough monitors). two weeks ago a patient went into cardiac arrest and no one knew until half an hour later as the alarm had been disabled on the monitor, and the curtain had conveniently been closed around them. is this the kind of care you would want for your family?

most of the time i can handle this kind of disaster, the persistent denial of the basic right to good healthcare, by doing the best I can personally do, and trying to forget the rest. but somedays, like yesterday, it made me really angry. why is no one doing anything about this? why has the lack of nursing staff not been raised with the nursing admin? why does no one else, especially not the consultants in charge, get angry?? everyone on that ward round just stood and shrugged their shoulders.

it also doesnt help to point fingers and blame people: there is a failure in the system at so many levels, from lack of equipment to lack of staff to simple lack of space and beds.

i know life isnt fair... but really. just because you are poor, does it mean you are entitled to lesser care than those who can pay more? back at work again this afternoon, hoping today's shift will be a bit better. thanks for putting up with the little rant.