The South African medical fraternity lost a friend and colleague this week. A young doctor serving his community was murdered in cold blood by an allegedly mentally-ill patient. This same patient had attacked a couple of nurses some years back. This event has sparked a minor outrage amongst other doctors in the public service. We all realise that it may just as well have been ourselves ruthlessly attacked in the line of duty.
A magnitude of perils face the average doctor in South Africa. The transmission of blood- and airborne diseases is a topic quite worthy of its own discussion. Simply focusing on violence in the work place, one has to mention that convicted criminals comprise a large section of the patients seen. I have witnessed, on many an occasion, the guards accompanying prisoners, releasing their shackles and leaving them quite unattended in order that they, the guards, may have a little smoke outside under a tree. This leaves the prisoners free to act in any way they so please. A young, female medical student may, in such a situation, find herself alone with the inmate. His hands are free to grab at her or at any sharp object available in a hospital room. His legs are free to carry him out the door.
When consulting mentally ill or violent patients, we are taught to arrange the consulting room's furniture in a manner that will allow the doctor to be seated closest to the door, the escape route. I've seen this rule followed only once or twice. As a matter of course, patients arrive drunk or stoned in casualties, most often on the first weekend after pay day. In this inebriated state, they are violent and strong. Not only do they show case a vocabulary that would make any sailor proud but they often lunge at one, biting and kicking.
I gather that the Mpumalanga Department of Health is implementing a number of changes in the security systems at hospitals in the province (where the young doctor was murdered). I'd like to remind us all of the daily dangers bravely faced by health care workers in South Africa and challenge the powers that be to improve the security in hospitals countrywide.
Hi Doc Guinevere,
ReplyDeleteUnfortunately these "TOP DOG" types in management who are willing to send young doctors into dangerous situations are seldom willing to expose themselves to similar dangerous situations. Young doctors at the start of their career are usually too scared to say no, worried that their careers might be jeopardized. They are also not backed up by older colleagues, who have the power to do so, but are too complacent to become involved, or don't want to create problems with management.
From personal experience I can tell you that your own life and emotional well being is worth much more than management's opinions, and that you can not look after your patients if you are not well. Your life comes first, and it is management's responsibility to provide a safe environment for you to work in.
Making changes now will not bring the young doctor back to his family, and I would not count on any changes made by management to provide for my safety, if I were you. I would ensure my own.
Hi Isabelle
ReplyDeleteFew young doctors are willing to rock the boat and oppose the system. At the university where I studied numerous injustices against med students where freely committed. These ranged from being sent into dangerous neighbourhoods without protection as I mentioned in the blog, to being exploited as unpaid labourers and made to work inhumane hours including 30hr shifts just before final exams. The chain around our necks that always prevented us from speaking out and opposing the system was the constant threat of receiving poor impression marks or failing oral exams. You see, after each over-night call, our registrar had to give us an impression mark. If he'd asked you to run any personal errands for him that day, like fetching his car from the garage, leaving the hospital to buy him
take-aways, and you'd refused, you received a poor mark. You might have done really well in managing your patients that day, but that would not count.
Oral exams were an internal affair conducted by the same professors who would make us work like slaves. The students who were made to work an over-night shift the night just before the final gynae exam asked the professor whether they might be excused from the early ward round on the morning of the exam, perhaps to sleep for an hour before the exam or perhaps to actually grab an hour's studying time. This request was met by fist slamming from the professor and a declaration that students have attended the early morning rounds for 19 years and thus will do the same that year. Were you to oppose him, he would simply fail you at oral exams. So we had to accept the unreasonable system. Predictably, the students who worked overnight shifts just before the exams, failed their exams. Each one of those students were academically strong and had never failed a block before. It was blatantly obvious that they failed because they were exhausted at the time of the exam.
Hi Doc Guinevere, it seems that systems all over the world are the same.It's one of the reasons why management like to employ young people - they are too scared, have too little power and generally are not yet assertive. Fortunately things have gradually improved over the ages, if we look at both the circumstances of workers and women....
ReplyDeleteIt seems to me though that you live ind work in particularly dangerous circumstances, and as I stressed last time, your life and health is more important than anything else. Keep safe!
Hi doctors, I guess I've been more fortunate in having a more secure environment and more liberal management in my undergraduate years, the reason being that I studied in a private college (in India). However, I had done my internship in a government-aided institution and have had some scary experiences with unruly patients. My first posting was in the casualty dept. and being already apprehensive about handling patients in general, I found it especially terrifying to treat drunken men involved in RTAs, who resist treatment and fight madly in their inebriated condition. Prisoners and the mentally ill seemed easier to handle comparatively. Following many patient/attendant-attacks on doctors, several petitions were made by the students and doctors, to the management and our Govt. about posting more security officers at the hospital at all times, to prevent such incidents in the future, but no action has ever been taken. Though all of us interns, and the residents got used to the harshness of emergency hour patients eventually, and started looking out for ourselves and trying to be safe, it would mean a lot if some official security were to be provided. It is really sad that health care providers should find themselves in such a dangerous and vulnerable situation as this.
ReplyDelete