My day as a detective

The health system in South Africa seems pretty convoluted. On Monday I was sent on a mission to track down a file for a patient. She was paralyzed with obvious surgical scars but no medical record of the procedure and very little understanding of why she had surgery. My partner in crime is David, a dead ringer for Willem Dafoe, who is interning with Oxfam at the respite unit. Often when I find myself running errands with David I feed the need to re-enact the scene from Boondock Saints; run my fingers through my hair screaming “There was a firefight!!”…but David is Australian, I am sure has never seen the movie and would think I was completely insane. So, we set of for R.K. Khan. Which is a huge public hospital in Durban. This place was a mad house and there is no parking on the premises. So we have to squeeze into a strange lot across the street and walk.
Inside the hospital outpatients hand in a card to a nurse to proceed to queue for hours until their name is called. At which time they proceed to another queue where they wait to retrieve their outpatient record. Once getting that they must pay 10rand to carry the file from that room to another queue where they wait to see a doctor. The sing on the wall in that room says the wait to see a physician may be +/- 4 hours.

We bypass most of this craziness as we are not trying to see a dr. although there is a small hitch in the fact that we have no written permission from the patient to see the file and cannot remove files from the premises without serious consequences.

We hand in a card and wait for 2 ½ hours. Finally we get called by a man who brings us into a file sorting room and he pulls our patient info. Once getting this file David looks through the pages searching for a clue about the mystery surgery. It helps that David (willem) is a 4th year medical student and can decipher most jargon. After sorting though the paper work we find there is no diagnosis written. Just notes upon notes of random maybe this maybe that and on an order for a head ct with no results.

Now we are on a detective mission and we have to sneak over to the physician’s office to try and get some face time with a doctor. We find a helpful nurse who corrals a doc into seeing us with no wait. He was kind and very helpful but also he could not place a diagnosis. Her file was horribly handled and she had no discharge summary. The doc wrote us a permission slip to seek out further files. We went back to the file room where the workers disagreed over where to send us for several minutes before telling us to go to the info booth down the hall. The info person directs us to the basement. Which is def as creepy as is sounds. The man there reluctantly connected us with our patient’s inpatient file. And we searched again to no avail.

We head to ward 1, the women’s medical ward. This was basically one large room with around 60 beds. Each lined up to the next with no sense of privacy during examinations. We asked around and found another helpful doc. He deciphers the 2 files to conclude that the surgery did not take place at that hospital but another one in the city. We were disappointed for a few moments until he offered the hospital phone to get the verdict.
A 5 min conversation later we found our patient was paralyzed by a cyst that was growing on her lumbar vertebrae. They had been able to remove it but nerve damage was already done. This meant we no longer had to worry about TB of the spine or something called transverse mylenation (both req different meds) and now we could focus of her ARV treatment. After 4 ½ hours we returned with a small victory.

All of this made me realize that even with the crack in our healthcare system we still appreciate a small sense of continuity of our care. Our doctors talk to one another, we have patient histories, a lot of the time our files will at least have a diagnosis and informed consent. I know things like this happen in the states but this what every patient here has to go through to get medical care. Its nuts! Thanks to the brief kindness of a few people we were able to close that gap, but oh it was a learning experience!