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When we talk about healthcare systems, providers, professionals, paramedics, diagnostic technicians etc., our entire focus is on patients, and rightly so. What we do not talk about is that in all healthcare facilities in Pakistan, the patients are required to bring attendants with them to take care of them. Except for ICUs in selected hospitals, the healthcare facility requires the presence of at least one attendant who must stay in the ward with the patient. This is necessitated that none of our hospitals is designed to take care of the patients independently. It means they do not have enough support staff to take this responsibility. Secondly, the healthcare is not provided free of cost from the government, thereby necessitating the presence of attendants.
True, that our social system and our thinking also makes it compulsory to have multiple attendants with the patients. The nature of relationship with the patient matters, and so do other social considerations.
In this post, we shall see a few aspects related to attendants of patients who come to Emergency and Public Hospitals.
I came across a study published from Karachi, Pakistan about satisfaction level of attendants who come to the emergency department with the patients. [Satisfaction Levels of Medical Attendants at a Pakistani Emergency Department – PubMed (nih.gov)]. Patient attendants were asked to fill a simple questionnaire which were then analyzed to measure the satisfaction level. Study concludes that most – about 80% – were ‘satisfied’ or ‘very satisfied’ with their experience at the Emergency Room – ER. It is rather pleasant to see such results because when patients are brought to ER, their attendants are anxious, stressed and agitated. Even slight delay from ER doctor or paramedic staff is taken very seriously. The emotions rise with the condition of the patient. The entire environment of ER is stressed. We understand it becomes difficult for the staff to work under such heavy scrutiny of attendants, but we also know that they generally do quite well.
For several years, the good development has been that the attendants are not asked to run every few minutes and bring some new medicine. The ER keep stock of most medicines which they use and charge the patient later. For some time, Punjab public hospitals provided all medicines at the ER and did not charge anything.
Patients who come to tertiary care hospitals in large cities like Karachi, Lahore, Rawalpindi, Peshawar, are from large adjoining geography. They may cover couple of hundred kilometers, if not more, to reach the hospital. They are always accompanied by not one, but several attendants. It is not just for social reasons; it is necessary to take care of many needs of the patient.
The hospital either does not have any place for them or offers an extremely insufficient facility. Most of these families have limited financial resources and that is the reason they come to public hospitals; to seek free of cost treatment. Their attendants cannot afford to stay even is small hotels near hospitals. They are therefore forced to dwell at the footpaths, corridors, lawns, and wherever they could squeeze into. Because they are encroachers, therefore the hospital administration does not treat them well and keeps harassing them.
This is a chronic situation, which has been around for as long as we know.
As mentioned earlier, the hospital does not take entire responsibility of the patients. They require attendant(s) to be present at all times for things such as:
- Bringing medicines
- Running for lab tests
- Taking care of patient hygiene
- Taking care of patient personal needs
- Running after doctors and paramedics, if needed
- Signing consent forms when needed
This are some major things-to-do; there are many more errands to be run.
The sum up is that the attendants are absolutely necessary in the healthcare system. The problem is that no hospital recognizes this issue and therefore does not address this elephant in the room.
A respectable solution would be providing for at least a shed where patient attendants can respectably and safely stay while their patient is being treated. The hospital does not have to provide them food or extra facilities, but at least basic facilities like a covered place and toilets/showers should be made mandatory.
The patient attendants are also a source of spreading infections in the hospitals. They come from far and wide, with variable degree of hygiene which is further compromised due to poor shelter with no cleaning facility. They may be a source of catching old and spreading new infections.
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