The friendly skies

We’re flying! Or did I already say that? We have resumed the flights to outlying primary hospitals and clinics so the travel time is reduced from 7 ½ hrs over rough and straight-as-an-arrow road, to 1hr 15min and we arrive refreshed. We only get to spend about 7 hrs on the ground but we go weekly now and not every three months. To think….

Tuesdays of each week we meet at the airport, make that Sir Seretse Khama International Airport, and leave at 0730 for one of three destinations. This month we have visited Tsabong in the far southwest, Hukuntsi in the far west, and Ghanzi in the northwest. Like I’ve said, Tsabong is reminiscent of the old HRMH with a ward of 30+ beds, an OR, Maternity, and a large OPD. All of the staffs are friendly and seem eager to hear our presentations.

While in Ghanzi (pronounced “hanzi”) I was leaving the OPD when a guy ran up to me and chewed me out for not seeing him and his prisoner in a timely fashion. NO ONE is seen in a timely fashion. Indeed you arrive to queue up at 0730 or earlier and then wait, a long time, wait some more, wait, watch the MO come and go for emergencies or simply to relive him/herself, one doesn’t eat including the MOs, did I mention wait?, and then are seen sometimes 4-5 hours after queuing.

So this guy was reasonably puckered. I glanced at his chart, they are all patient carried “cards”, and it looked like he was referred for “narcolepsy”. Ohhhhkay. I told him I would be back shortly as I was headed to the TB ward and would see him in ten minutes. He, perhaps rightfully so, scoffed and snorted. I told him that if he thought I was lying he should just leave but if he believed me I’d see him in 10, which is what happened.

Turns out he had fallen asleep on the job and was looking for some medical problem to legitimize this episode such that he wouldn’t be disciplined. He didn’t have narcolepsy and had simply had difficulty adjusting to night shift. “Sorry but there isn’t a disease process here.” He lit up and refused to leave until I signed a leave form.

This happens WAY too much here. It has been enfranchised so much so that on Mondays the waiting areas of local clinics here in Gabs are full of people who are hung over or have minor complaints and want “leave.” For a day--- “to rest”. Many if not all of the employers here have abdicated responsibility and have successfully placed the physician between the employer and the employee for certification of leave. As all the MOs are foreign nationals and the employers are political heavyweights, the docs feel that their jobs are threatened if they don’t give useless meds, grant medical leave, certify medical pathology when there is none, and the like. Shades of workers comp in OR. I’d almost, almost rather care for chronic pain, fibromyalgia, or chronic fatigue syndrome. Anyway this guy wouldn’t leave so I simply asked if he wouldn’t mind standing while I invited the next patient in. I ignored him out loud so he finally left threatening to see “a private doctor as he’ll give me what I need”.

And he is right. The parallel private system here is no better than the publically accessed one but as it’s private and fee-for-service, and as one has to keep ones customers happy, the private docs over prescribe, over diagnose, and over utilize. Sound familiar? God help you if you point out that the diagnosis, let alone the treatment, is bogus as it isn’t about quality as much as availability and convenience. In general you can access as capable care in the public sector the difference being you can get an appointment with the private docs and don’t have to queue with us. And by the time you see us we’re often times tired and hungry. Hell, I’d go private if I had the cash just to get out of the damn queue.

For us life continues apace. The trees are in full bloom, we’ve had relief from the dry season with some booming thunder storms (nothing worse than the Midwest in the US), and it has been a quick year. And a truly incredible and rewarding one at that.