Sunday, September 2, 2012

How not to capacity build - a second perspective


In 'how not to capacity build', 'the week before & the week after' & 'say it with bananas' I described one incident with the staff on ICU medicine & its ramifications, but below is my lovely VAs interpretation of the events. Sometimes it's really good to have an ally. 

Reflection in case of Meningitis patient
Description of the event
On Wednesday my boss and I went to check up patients in ICU Medicine ward as usual as around 9o’clock in the morning. We always visited interesting patients each room. But when we arrived in the room 6, we noticed there is a remarkable young female patient who is around 25 years old with suspected meningitis was a back-bend patient. After questing with her mother about her history of illness and complaints, we learned that this miserable girl, who had been treated as the typhoid fever in health center and not yet improved, was referred from the health center far away where she lives. Also, she had been staying in the hospital for five days. She still got the high temperature including abdominal pain as before. Suddenly, my boss examined her throat and abdominal. She thought that maybe she had malaria because she lives in the malaria place. Then she went to check the doctor document and knew that there is no malaria test in blood test which they need to diagnose it when patients come from the malaria location. So my boss asked Dr.V to do blood test with the malaria test again. For the result, we had to wait until tomorrow.
On Thursday at 9 am, we went to ICU Medicine ward to see the result. The result showed there is negative for malaria. Immediately, my boss went to check up the patient. She examined her throat, abdominal and took pulse. Then she thought that this girl probably has meningitis. After examination, she told Dr. V about her ideas and recommended him to change specific antibiotic early as well as do the LP test for making sure that she has meningitis because the previous antibiotic was not respond to her daughter disease for five days, according to her mother. He agreed her decision and would change it later. That sounded so great that he listen to us. However, Doctor asked a nurse whose name is P to do it. But she yelled at us that “I was pretty busy with my paper works- the medicine papers and I didn’t have time to do it”. And I wouldn’t do it until I completed this.My boss and I felt very frustrating to get that response which is not appropriate for being nurse. She said to her that “in role as a nurse, you need to put patient first not your paper work. You need to change to specific antibiotic early as soon as possible, otherwise patient would be died soon because you’re carless and laziness-you are not busy. You kill patient“.  As a translator, I had to interpret it in diplomatic way by changing that” you didn’t have time to do it, so can you ask someone to do instead of you?” Dr. V suggested the new qualified doctor to do LP test. However, thing did not happened due to this nasty nurse. She said that she did not have time to prepare the LP equipment for new doctor and told him not to do it. We told the qualified doctor that “when you do LP test, we can help you.” After that, we left the ward to calm our emotion down; then we went again and something came up with interesting. We saw invoice on the patient’s bed. The invoice was about two compress steroids purchase. The doctor asked the patient to buy because they run out of compress in their medicine store. But it is not right for patient with PFD. Immediately; we came to Sry P to confirm about that. She really shouted at us and said that it was out of stock. We decided to see pharmacy to make sure whether it is true or not. Exactly, it was no more inn pharmacy, according to medicine workers. Then we told the sub-director M about and asked him about PFD patient (patient has equity card) problems. Dr. M said that he would solve this problem himself in order to avoid the conflict between staff and u. He went straight to ICU Medicine ward and worked that out. After this, we went to see doctor to make sure that the antibiotic has change. Nevertheless, a nurse told us that there is no antibiotic in their medicine store; hence they couldn’t do it today. There was nothing being done on that day until tomorrow.
On Friday at 8:00am, we checked up the patient and knew that the new antibiotic which had been changed since yesterday afternoon responded to her disease. We were so happy to see that. One week later, she was improved and discharged from hospital.
Two week later, the mother of meningitis girl came to meet us and gave us a lot of bunches of banana, and a bunch of Longan fruit for saving her daughter’s life. She was very thankful and grateful to us, especially my boss. We felt very happy to see and hear that. We think we have done the great job today. This is the great success for us.
Feelings and Thoughts
At beginning of the event, I felt very sad because doctors didn’t treat the patient correctly, as pointed out by Dr.Esther. They did not observed the patient whether she was improved or not with their treatment. Absolutely, they just did it to show that they already completed their duties. I thought they are definitely not doctors but they are killers. After seeing and arguing with the doctor and nurses, I felt more frustrating and upset what nurses did on patient. They didn’t put the patient first instead they thought their paper works were more important than patient’s life. It seemed that they did not know their basic duties or they were lazy to treat the poor patient because there was no bribe for them, so they did not look after the patient properly. For another thing that caused me felt more aggressive   and pity to patient is that they did not control well in medication as well as medicine store.  They should have kept all materials, especially antibiotics and compress all the time. If they don’t have that stuff, the patient will die because they delay treatment until they have it. It showed us that they are careless as well as laziness. However, at the end, I felt happy to see that patient get the correct treatment after this big argument. I think my boss did the great job and cheer the patient up by concentrating the doctor and nurses to do the right things. Her works was served the patient’s life. All in all, I feel very impressed with my boss’s work, but I feel very upset and frustrated with nurses and nurses due to their bad works and behavior.
Evaluation& Analysis
Through critical thinking, I can explore some good and bad experiences as description below:
·       Well done:
-       Patient and illness observation: Dr. Esther observed patient’s illness from day to day until get the correct treatment. This really helped her disease improve and get better from time to time.  As result, she recovered from the illness and discharged from hospital. So following up the patient is a key to obtain the right treatment.
-      Hard-working of Dr. Esther: Dr. Esther parts were really changed the situation more actives. And her work made the patient get the correct treatment and recover from meningitis. Patient felt very happy. So her assistance brought the new life to patient.
-      Struggling with nurses even in hard-time:  Even though Dr. Esther and I confronted with lots of problems such as verbal abuse, ignoring from them, etc., we still keep going on to see the doctor and nurses’ works to the patient. Also still continued to argue with them and recommended them to do correct treatment to the patient. This struggling made them more concentrated on the patient, so she could have proper care from them as the result showed. Therefore, our attention on the patient put the pressure to staff there.
-      Appropriate authority: When the Dr.M took part with those problems, we noticed that staff in ICU ward paid more attention and active in this patient. It means that his position is more powerful than us which can put more pressure on them. His present in this problem can give us more authorities because they might listen to Dr. Esther, the professional doctor in order to avoid another problems, otherwise they will get trouble with Dr. M who is sub-director of hospital later. This points out that when we have similar case, we should tell Dr. M in case that they are so stubborn with us.
-      Diplomatic interpretation: Diplomatic translation helped the argument get a little better. It assisted my boss speech to become slightly negative to staff when the staff felt very aggressive to us. So it could lead situation less tighten.
·       Bad done:
-Poor pharmacy management: Antibiotic and compress are very important in each ward, especially ICU medicine. They should have them in their store room all times, or they will kill patient who were waiting them because Ward has to delay treatment until they get them from Pharmacy. So pharmacy needs to check their inventory such as medicine, compress every week to know the inflow and outflow of these. They can control inventory flows and know the amount of inventory left. Therefore, all of medical equipment or medicine will be ready for ward needs.
-Poor ICU Medicine management: There were no the antibiotics and compress in their medicine store which are needed to be there all times, for they are ICU ward. They have to treat the patient in time, but they didn’t have one, so the patient was dying to get their service. Therefore, they should check it every day to make sure there is enough material for treatment.
- Doctor and nurses Ignorance:  Doctors and nurses didn’t observe the patient. The patient was not improved due to their ignorance. They thought she was a minor life that no needed to care. As the result, she got worse from day to day until the argument came. This made the patient feel very miserable and angry. They should have treated her early not waited until the argument took place, then started to concentrate on patient. So they have to treat the patient correctly as they are the health staff. Their caring to the patients will improve condition in ICU ward.
-Verbal abuse &-Laziness of nurse: Sry P, a nurse in ICU ward, did not behave well   to patient and us who cared the patient‘s life. She yelled loudly at us when we tried to tell her to do something for patients. She always said she was busy and did not willing to do it .In fact, she was not busy but she was definitely lazy. Her attitude made the patient feel very upset and scare to death. This is the cause of death rate in ICU increase from day to day. In role as a nurse, she must have looked after all patients and offered the good service all the same level. She must have put the patient priority –not do the paper work. This is the basic of nurse duty. Also she should behave well to patient and people who care patient and accept the good recommendation from Dr.Esther.
Conclusion
After observation this situation, I could see that the great help from big argument between us and staff. I also know how nurse should react to patient, how to treat patient correctly, and how to interpret in argument. The nurses and doctor should have treat patient correctly with their well- behave. This has taught me to how to get involved in the argument and how can I help poor patients. I could see that i can help them through my diplomatic translation in argument. Moreover, these problems have given me more power to confront with the bad health staff .So I have to ask my boss to see the patient often. This is what i can do as translator.
Action Plan
This is an action plan that I have to change myself to encounter this event against in the future in order to get the situation more successful:
-        To control my feeling when we have this argument again. I am not too aggressive, but I have to be calm down and try to find the way to talk to those people more effective in order to put them the pressure to do it.
-        To build up more strength to confront with those bad staff.
  

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