Tue | Sep 19, 2017

Anthony Deyal | Take two aspirins and call me in Miami

Published:Saturday | June 4, 2016 | 6:00 AM

A famous surgeon went on a safari in Africa. When he came back, his colleagues asked him how it had been. "Oh, it was very disappointing," he said. "I didn't kill a thing. I'd have been better off staying here in the hospital."

During my days as the media/communications adviser for PAHO in the Caribbean, I was asked to help the government of Grenada to deal with what was, and still is, a major problem with the management of health services in the region. Almost every cent of the national health budget goes to curative, instead of preventive, care, and the bulk of the money is spent on hospitals.

Despite the fact that no government ever has enough money for all the needs of any hospital, the politicians, administrators and doctors who run the system prefer to buy new, improved, fancy, super-duper gizmos that deal with a specific condition affecting only a comparatively small number of people than to spend money on what is called 'health promotion', trying to get people to help themselves to live better and longer lives. As one female doctor told me, "The bigger the boys, the bigger the toys."

While curing people after they are ill and not helping them to prevent illness when they are well is the direction in which health management continues to go, hospitals and health care are no-win solutions, especially in these days of rising pressure on the health systems and decreasing resources to manage them mainly because the major health issues are no longer 'communicable' diseases that could be dealt with by injections or tablets, but 'non-communicable' ones that are caused and aggravated by lifestyles and personal choices.

 

THAT ONE PER CENT

 

Even though 99 per cent of the people who go to the hospital may come back healthier or less sick than when they went in, that one per cent who die or whose conditions worsen while in custodial care are the ones who make the headlines and who cause the ministers of health to suffer nightmares that even the most highly paid psychiatrists cannot cure.

Even if they try what this doctor advised his nurse to do, it is still a lose-lose situation. The nurse ran into the office and said, "Doctor, Doctor, the man you've just treated collapsed on the front step. What should I do?" The doctor told the nurse, "Look, Harry, do I have to teach you everything? Just turn the man around so it looks like he was just arriving."

In fact, a 2013 study showed that preventable hospital errors are the third-leading cause of death in the United States. As the research group said, "We are burying a population the size of Miami every year from medical errors that can be prevented."

The government of Grenada, like many other Caribbean governments, was finding that the cost of health care was becoming unsupportable and decided that a 'fee' for all but the most indigent would replace the 'free' to all which was the norm.

The idea was to make the hospital a statutory authority, so it could charge fees. As part of helping to develop a plan to make this acceptable, I decided to get the views of some of the stakeholders and asked the hotel receptionist what she thought. She replied, "Statutory? But them like statue already. They does just stand around whole day doing nothing."

I believe that some kind of attempt was made, but was not surprised when it ran into problems with the union representing the hospital employees and they took industrial action, which the media reported. It seems (to make no bones about it) the majority of staff stayed home or were outside the hospital singing We Shall Overcome, while the hospital was run by a skeleton staff. I had not seen that particular group when I interviewed the employees, so I suspect they were kept in the many closets that were in every ward.

I was glad when my part of the exercise ended. Despite the many times in my life I have been in hospitals as a patient or to visit others, they are not my cup of tea, but are more like a carafe of hemlock. The smell hits me first like a blow from Mike Tyson. It is a compound of many different pheromones and causes, like stress, wounds, pain, fear, antiseptics and drugs. Then the inevitable groaning or bleeding patients and the harried nurses and staff, the security guards throwing their weight around, and more than anything else, the doctors playing God the Father, Son, Holy Ghost and Hail Mary.

Many years ago, I fell off a motorbike, and with a fractured collarbone and other injuries, was taken to the emergency department of the San Fernando Hospital in Trinidad. While I was lying on a gurney waiting to be attended to, one of the doctors, a former schoolmate, passed by, and when he heard what had happened to me, said, "At your age, you riding bike? Man, you old people should know better. You are a bright person, but you behaving stupid!"

 

LITTLE PRICKS

The news of my behaviour soon spread to other doctors who knew me, and they all came from wherever they were in the hospital to lecture and upbraid me. One of them was an anaesthetist, and when I was taken to the operating theatre, there he was with a huge hypodermic in his hand, and with a smile, he waved it menacingly and said, "Just a little prick." I replied, "I know. Every one of you."

Over the past few days, in addition to a number of little and large pricks, life has been dealing me more slings and arrows of outrageous fortune than the ones experienced by Goliath or King Harold. My mother got very ill last Sunday night. Unfortunately, Sunday fell in the middle of a five-day period bookended by public holidays on the Thursday before and Monday after. By the time my son woke us up to tell us that his grandma could not get off her bed, it was after one in the morning.

Doctors here don't do house calls anymore unless you're very rich or family. Given my past experience with doctors and hospitals here and elsewhere, and seeing that my mother, though unable to sit up in bed or walk, was conscious, I realised it would be better to see what we could do at home until about seven in the morning before calling an ambulance to take her to a nearby hospital. Our experiences later in the day confirmed that I had made the right, though painful, decision.

It was not just the many hours waiting for her to be admitted to a ward in the public hospital (after taking her to a private hospital but then advised to take her to the public hospital for treatment not available there), but the prevailing mood, tone and behaviour of some of the people, especially the doctor in charge, and security personnel. From what I heard, most of the specialists were out of town and had I tried to contact any, I would have been told, "Give her two aspirins and call me in Miami."

- Tony Deyal was last seen saying that for a headache, nothing acts faster than aspirin, so he takes nothing.