When patients bully medics inside wards

 ‘Every person has a right to the highest attainable standard of care, including reproductive health.’ ‘Every person has a right to emergency medical treatment.’

Article 43 of the Constitution of Kenya, 2010, pronounces itself very clearly, with regard to access to healthcare for all. It speaks to all health care providers, reinforcing the centuries-old Hippocratic Oath sworn by doctors and the Nightingale Pledge taken by nurses world over.

However, there are moments when the recipient of care can actually test one’s limits to the core, making it almost impossible to adhere to one’s commitment to serve without discrimination. These are the moments when a patient tramples all over the rights of the medical care team members while in their care, causing an inappropriate environment for all.

My first encounter with the orthopaedic ward as a medical officer intern was a professional lesson we clearly missed in class. 

Back in the day, orthopaedic technologies were mostly beyond reach for many patients. With the majority of patients in the ward nursing broken bones, the ward was full of young men.

These are the people who are more likely to suffer trauma from contact sports, workplace injuries, violence and motor vehicle accidents. Think about construction workers in collapsing buildings, miners, our dramatic matatu touts who jump off moving vehicles, and young revellers who are likely to get into bar brawls or drive under the influence. The incidence is greatly skewed towards young men. This has been made worse by the advent of the boda bodas.

The gold standard of care is surgery, with use of orthopaedic implants to hold the broken bone in place, to ensure healing while allowing the patient to go home early. Unfortunately, back in the day, very few patients could afford to buy these implants.

The alternative is not pretty. The patients have to spend weeks in the wards, with their broken legs trussed up in pulleys to provide traction. The traction ensures the broken bone is properly aligned and held in place for weeks, to allow healing without deformity. The average duration of healing is no less than 12 weeks.

The patients would come to hospital in a lot of pain but over the next few days, the pain would settle down and then the madness would begin. Think of a room full of young, restless, able-bodied men, permanently restrained to the bed, unable to attend even to the most mundane tasks.

They are confined to taking bed baths and using bedpans because they cannot otherwise get up; and unfortunately, with the limited resources in our public facilities, they cannot even attend to these functions in private due to lack of curtains.

Even worse, they cannot even attend to a call of nature whenever they feel like it. They must learn to school their body systems into a timed schedule. I was shocked to learn that the joke on the corridors about the orthopaedic ward nurses having a medicine administration round, and then a bedpan round, was an actual reality.

These young men cannot just take a stroll outside to soak in the sunshine or take a breath of fresh air. They are in prison. Even worse, their confinement is not just to four walls but to a three-by-six bed. They are stripped of their fundamental tenets of dignity.

To be reduced to this level, right from a previously independent and highly active lifestyle, is enough to send one into depression. Even worse, the long durations in hospital tend to wear out friends and family, who visit less and less often, leaving them feeling abandoned.

These patients, with otherwise intact faculties, must find ways to cope in this physical asylum they find themselves in. 

They would listen to their little transistor radios, keeping abreast with current affairs, especially politics and football. They would occasionally break into arguments that could easily degenerate into all-out verbal wars. They would have friends sneak in cigarettes for them, playing hide-and-seek in the dark at night because, again, nicotine patches are a luxury in hospitals in our part of the world.

Ultimately, they would turn their attention to us, the care providers, and not in a positive way. 

They would tease, cat-call and downright bully especially the female staff without a care. We were easy targets for venting their frustrations. The nurses in the ward were battle-hardened and were immune to this but as interns, we were particularly vulnerable. 

They would comment on everything, from one’s body, to the clothing, to the gait. It would boil down to outright sexual harassment.

Surviving the first day was a nightmare. No one prepared us for this and literally, there was no recourse for their actions. We had to spend every day and some nights in the ward, when we were on call. The wards were packed, with the beds close together. Working at the bedside doing procedures in the first week should be listed among the 1,000 ways to die. You did not know what to expect or how to handle it. There was no manual.

We were in these wards for only six weeks, and just as we were beginning to grow thick skin, gain some respect or learn to ignore this, it was time to leave. The patients would gleefully welcome the next lot. 

Most of the consultant orthopaedic surgeons at the time were male. They mostly couldn’t relate to our woes. Further, they were hardly in the wards, spending long hours in surgery, so they didn’t really see the extent of the experience.

It was a relief, thanks to the just-folded National Hospital Insurance Fund, that most patients were able to access the prohibitive surgeries and go home before they literally lost their minds.

Further, the Patient Rights’ Charter, not only spelt out the patient rights but also their responsibilities, which includes respectful relations with the medical providers who attend to them. 

Otherwise, once the patient’s condition ceases to be an emergency, a care provider does have the right to hand over the patient’s care to someone else due to their psychological incapacity to provide impartial care.

We have come a long way; and just to appreciate how far, we celebrate the orthopaedic specialty which now boasts several female surgeons!

The writer is an obstetrician/ gynaecologist