Last week as part of our work
with those with disabilities, Mrs V and I accompanied a young woman, we shall
call her Naina, to the main hospital in Colombo South, Kalobowila. This is the hospital that those in Badowita
would go to if they required hospital treatment. I had an interesting few hours at the
hospital and rather then write it down in a narrative I thought I would think
about what we learnt from this visit.
Come prepared
Kalobowila Hospital, like other
government medical facilities, does not always have dedicated departments. For example, the orthopaedic department where
we wanted to visit, operates clinics 2 half days a week where on other days in
the same room there are clinics such as gynaecology, general surgery and
paediatrics. It is important to know
what day the clinic is held as although an appointment is not needed, it is
useless to turn up on a day when the clinic is not on. Luckily I was aware of this and had managed
to find out the correct day prior to visiting.
What I had missed, however, was that each person going to the hospital
has to purchase their own medical record book.
Many just bring a standard exercise book or you can purchase one at the
hospital for Rs20. The patient,
therefore, is responsible for keeping their medical records. Don’t expect the hospital or doctor to have
any records!
The stern ‘gatekeeper’ is stern for a reason
At the entrance to the clinic we
were met by a rather stern looking man who interrogated us about our reasons
for visit. This was quite off putting
but I realised later his manner was essential.
The sheer volume of people wanting to see the orthopaedic surgeon meant
that some were continually trying to jump the queue but with him at the door of
the clinic, none of the queue jumpers had a chance. He managed to fend of
trespassers with a mix of sternness and humour
- what a great guy!
Don’t assume a low ticket number means that you won’t have long to wait
We were assigned a red ticket
with the number 17. Great I thought, not
long to wait. This was good as the
waiting room was crowded, dim and stuffy with broken chairs so that most of the
chairs tipped forward when you sat on them. The only distraction and vaguely
new item was two big television screens playing adverts continuously.
Unfortunately I hadn’t realised
that follow up patients were given a blue ticket and these patients were seen
first. The clinic started at 12:30. By 3pm, over 100 people with blue tickets had
been seen and the red tickets finally started getting called. Throughout this time, we could see people
being wheeled in in plaster casts, then there would be a loud sawing noise for
a few minutes before the person emerged with a rather dusty leg or arm in the
place of the cast.
Make friends with a nurse!
One family did make it past the
dreaded gatekeeper earlier than their ticket and that was someone who was lead
in by a nurse who was clearly a friend of theirs.
Don’t be put off by busy doctors
When we finally made it through
the clinic doors, further chaos ensued with patients crowded around tables of doctors
giving out medical advice in full earshot of others in the room. The plaster cast removal section was in an
open cubicle; there were old bits of plaster cast everywhere and the continual
sound of sawing as plaster casts were removed.
We were guided to a desk at the
back of the room where the Consultant was clearly not impressed that Naina had
not sought medical attention before. He couldn’t
understand how someone living near Colombo had not been able to access regular
medical care previously. I stepped in at
this point and explained the extreme poverty her family lived in, that she had
never been to school let alone regular medical appointments and that due to difficult
family circumstances no-one in her family had been able to bring her especially
as it was virtually impossible for Naina to get on a bus due to her
disability. I was not exaggerating when
I spoke of her difficulties and I think he finally understood the
situation. His manner changed somewhat
and although the end result was that his opinion was that an operation would be
too risky and likely to decrease Naina’s mobility further, at least we were actually
able to establish this. Naina can now
continue to work with the physiotherapist to ensure her current level of
mobility is maintained.
Moral support helps
A chaotic hospital can be
disorientating on your own. I doubt
whether I would have endured the 4 hours we spent there if I had been on my own
looking to get medical treatment. I can
also see how families are put off bringing their children for regular medical
appointments as waiting times are extremely tedious and you have to the
confidence to ask questions to find out what medical staff have assessed and
the treatment options. I have experience
of liaising with doctors and although by no means am I a medical expert, I do
have some knowledge and have access to medical and therapy information over the
internet. For uneducated families, I can imagine that these appointments must
sometimes seem utterly pointless. Some
families who we speak with are unable to say why they went to a particular appointment
with their child; they were not even told what kind of doctor they were seeing or
for what reason. I do not wish, however,
to blame medical staff at this point.
With the severe overcrowding at their clinics I can’t imagine they have
much time for explanation.
Just having another person with you who can help fight your corner can help a lot.
Sometimes things can be surprisingly speedy
Naina was asked to get an x-ray
by the Consultant. I resigned myself to
another long wait. In fact the x-ray was
done straightaway and given to us within 10 minutes.
Come early or late
By the time we left the clinic
just after 4pm, there was hardly anyone around.
If we had arrived at this time we would have got access to the clinic
straightaway although I am not sure if the ‘gate keeper’ was still issuing tickets
at this point. Clearly lots of people
had got to the clinic at least an hour before the start time so this is another
option although hardly worth it if you are a new patient and still have to wait
for 100 follow-up patients!
What next?
So what did this experience teach
me and can it help improve the work of Asha Trust?
Most importantly, those parents who do
attend all their medical appointments for their children must be
commended. It often comes at a huge cost
for them in terms of finance (costs of transportation, lost work time) and also
causes difficulty with care of their other children and running of the
household.
There is still much work to be
done in ensuring those with disabilities get the medical treatment they need
but I think accompanied visits and possible financial support for those
attending appointments may be the best way forward.
This is the second time that we
have supported people with hospital visits and the experience has taught us some important
lessons.
Katherine
