ENTRUSTED TO CARE

In 2013, the country was shaken by a story carried in the media about a mother in Bungoma County Hospital who had undergone mistreatment while seeking maternity services. The scenario was horrifying to say the least, bringing to light the findings of a research carried out in Kenya in 2011, and published in 2013, titled “Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions”.

A few weeks ago, the press carried yet another story of a patient suing a private facility in Nairobi for using him as a teaching specimen without his permission, causing him humiliation as his genitals were exposed to female students.

The stories on social media fora especially among mothers describing their birthing experiences are heart-wrenching. Though mostly told from a humourous perspective, they do not veil the fact that many a times, as health care providers, we fail our patients at the most vulnerable period of their lives.

Stories of the maternity units are always the most hilarious. The mothers seem to carry the opinion that during labour, they are so dramatic that they court the unkind words, action or inaction that they may receive. In the heat of the moment, light humour may help the mother to get by during the intense moment. However, rude comments meant to deter them from expressing pain or shame them for having gotten pregnant are unwarranted.

Mothers in busy maternity units report being shouted at, manhandled, slapped and pinched. They are threatened with abandonment or bad outcomes for their babies in return for cooperation. At that moment of vulnerability, the power balance is skewed and the patient is not on equal footing with the health care provider.

Every patient has a right to dignified, empathetic care. This is expressly stated in the Patient Rights Charter. As the health sector gradually shifts to patient centered care, it is paramount that we leave no one behind in the quest for better health services.

To this end, it is incumbent upon the patients to know their rights. Only an insignificant minority of patients know of the existence of the Patients Right Charter, making the document redundant. The patient has a right to access healthcare; a right to emergency treatment as enshrined in the constitution; and the right to see the medical provider of their choice.

Further, the patient has a right to information; confidentiality; informed consent; and the right to refuse treatment. They have a right to seek a second medical opinion and a right to complain where they are not satisfied with their care. They also have a right to the highest attainable quality of healthcare products and services.

In addition, they have a right to access medical insurance without discrimination on the basis of their age, pregnancy, disability or pre-existing illnesses including mental illness. In the same breathe, they have a right to know the full provisions of their medical insurance scheme so as to fully benefit from it.

Even in death, the patient still has a right to be an organ donor or make any other arrangements they so wish for their bodies for example donating their bodies as cadavers to medical schools for purposes of learning!

Along with these rights, comes responsibilities that the patients must also fulfill to be able to effectively enjoy them. These include caring for and adopting a healthy lifestyle for the adults and for the minors in their guardianship. The patients need to have a positive attitude towards health and life and should therefore go the extra mile to protect the environment and at all times take heed not to endanger the lives of others.

In the event of ill health, it is important for the patient to provide relevant and accurate information to the healthcare provider so as to ensure accurate diagnosis and relevant treatment. Further, the patient should provide truthful information about their past treatments. This is especially crucial sometimes to determine current treatment.

Once, a lady from a community that frowns upon caesarian delivery, put her life at risk when she misled us in labour ward about the number of previous caesarian sections she had undergone. She insisted that it was only one so she could have the option of attempting a vaginal delivery. However, on subsequent review by a student nurse, she had a slip and said that they were three previous caesarian deliveries, which necessitated a caesarian delivery in the current pregnancy. She missed rupturing her uterus by a whisker, a situation that threatened both her life and that of her baby.

The patient is entrusted to keep their medical documents safe and to produce them when required; to follow prescription instructions correctly and not abuse their medications; honour their scheduled appointments; be aware of medical facilities in their vicinity where they can seek help; and seek care at the earliest opportunity to prevent undue complications.

In the event an adult patient is incapacitated and unable to make decisions or give consent, their next of kin should take responsibility. One is also expected to enquire about the cost of their care and make appropriate arrangements to meet these costs.

Both the healthcare provider and the patient have an obligation to ensure the interaction is pleasant and fruitful. And just as the patient has rights, the healthcare provider is also protected from abuse and harm and has the right to refer the patient to seek help elsewhere or from a different provider unless it is in the case of an emergency.

It is a delicate balance of trust that we must work to protect at all times. To this end, the employer of the health worker must meet their obligation. Ensure the healthcare providers are well equipped and with adequate supplies, have a clean and pleasant working environment and above all, are not unduly overworked.

Nobody enjoys ill health. We must strive to make it less painful at all times!