Monday, March 8, 2010

Adventures in Health Care

Last Friday, one of the participants at a seminar on our Centre, a man from Togo, got ill with severe abdominal pains. It was the middle of the night and he was staying in one of our Centre guesthouses, so he got up and woke up a colleague. Together, they went to the night guard for help, who in turn phoned the assistant Centre manager because he lived nearby. The assistant manager managed to call a taxi at 3 o’clock in the morning (not an easy feat in our area of Ouaga in the middle of the night!) and took the Togolese man to a clinic. There they gave him something for the pain and told him to come back later in the morning when more personnel would be on duty to do tests (good thing it turned out not to be appendicitis or later in the morning would have been too late!)

So, after several hours of drug-induced sleep, he was taken back to the clinic for tests. They took some blood, did an ultrasound, and told him to come back again the following morning for the results, sometime after 8 a.m. He was also supposed to bring a urine sample.

Since the next day was Saturday, I took him to the clinic myself. Upon arrival shortly after 8 o’clock, he presented his urine sample. The doctor on duty, a young lady (the same one that had seen him on Friday), refused to take it. She said too much time had elapsed between when he had given the sample and when he had brought it to the clinic. He needed to bring the sample for analysis first thing in the morning, around 7 a.m. So she asked him to bring another sample on Monday.

The man looked disappointed and I was none too happy myself. It’s typical of medical personnel here not to tell patients what they need to know or even to explain things to them. Just thinking about this and the amount of time and money that patients, many of them with extremely limited resources, waste because of this put me into a slow burn.

I asked the doctor why she hadn’t explained this to the man. He had no medical training, so could not be expected to know this unless someone told him. She said that he didn’t need medical training to know this. It’s just common sense that biological samples would deteriorate rapidly in the heat of Burkina. I shook my head and told her that in my opinion, she had not done her job properly. She should not assume that ordinary people know things like this. She should take care to explain it to them and not waste their money and their time.

Of course, the lady immediately got huffy. You don’t tell doctors in Burkina how to do their job! In a very tight voice, she told the man to go home and bring another sample back on Monday, but earlier this time, with as little time elapsed between giving the sample and bringing it to the lab. Then, turning to me with an angry look on her face, she said, “And yes, I should have explained it to him yesterday, and I didn’t! I’m sorry!”

Well, she didn’t sound sorry.  She sounded like my kids used to when I'd make one apologize for doing something nasty to the other.  But I realized that in her present state of mind, this was probably as close to an admission of not having done the right thing and an apology as we were going to get. Will it make any difference with her future patients? I don’t know. I hope so. Most Burkinab√® wouldn’t have said anything to her. You just don’t question the doctor, even if you’re not happy with what he or she has done. But unless someone says something, things will never change. And since I’m not Burkinab√®, I figured that someone might just as well be me.


Laura Dun said...

well done - that's such a typical attitude.

Mike Steinborn said...

Yeah, that's also why we need someone like Kathy to advocate for our folks here and teach them to advocate for themselves too!