Clinic visit mishaps

Arthur Pillay,
Highlands Village

There are good days and bad days. Tuesday May 23 seems to be one of those bad days. My daughter was sent home from work as she took ill with excruciating internal pains. She was in tears with pain and could hardly walk. The front desk gave her a number, 145, and she was told to wait like every other patient.

They also would not attend to her without her ID. She asked me to collect it and bring it along. I advised her to go to the trauma unit, and escorted her. After a long wait, she was told to go for a urine test.

On her return, she was politely told that she has to go back to the out-patients department as unless she has been stabbed or has a gunshot wound, the unit could not attend to her.

The administrator called numbers from 100 to 150 and told the rest of the people to come back the next day. My daughter was seen as she was number 145, but was later advised there were no doctors available, and she would have to come back the next day, which was Ascension Day, at 5am to see a doctor.

In the trauma unit, I witnessed a vagrant woman on a drip who was hit with a brick by a car-guard in Town Centre because she was collecting cardboard to buy something to eat.

She was there last week and treated for epilepsy.

She was sent from pillar to post because she did not have an ID and they could not find her folder. She was not told that she could lay a charge of assault.

At the pharmacy there were murmurs of people sitting and waiting for more than five hours without been attended to. What is a life worth to admin staff? I am aware of the nursing staff working flat out, and they have outsourced people assisting.

If the system is not streamlined, how will additional staff help? People go in desperation to this place, with the hope of being cured or brought back to health, but they seem to get more sick of depression, tiredness and frustration.

Monique Johnstone, principal communications officer for the Western Cape Health Department, responds:

Arthur Pillay refers to a situation that staff encounter at the facility on a daily basis, and that is a greater number of walk-in patients than we can accommodate. The facility has moved to an appointment system to streamline and reduce waiting times, and we encourage patients to make an appointment at the outpatients department (OPD) in the same way that you would make an appointment with a GP. In the event of an acute, unpredictable illness, as referred to in the complaint, the facility has a numbering system and they admit as many patients as possible. Clients with appointments are seen to first, unless they have a serious emergency case to handle.

For those overflow patients who cannot be admitted on the day, we have implemented a triage system in the OPD, where vital signs are checked by a clinical nurse practitioner, and if the patient is clinically stable they are deferred to another day where they will be given preference over the other walk-in patients.

Unstable patients will be sent to the Trauma Unit for emergency treatment. If patients go to the Trauma Unit on their own accord and are again triaged as “green”, meaning they are clinically stable and the illness is non-life threatening, they will be sent back to OPD and will have to go through the process described above. This is because we cannot afford to admit stable patients into a trauma unit as it is designated for emergency treatment.

There are a wide range of medical emergencies, not just stabs and gunshot wounds as referred to in the complaint, but every life-threatening case seen in Trauma require emergency treatment.

Mr Pillay also refers to issues relating to identity documents and assault charges. The facility frequently sees patients without any identification, but it is never an acceptable situation. There are many reasons why a patient’s folder should be properly identified with personal and demographic information.

In relation to an assault case, and when charges need to be made, we often have to take into account that an ID is required in case the client’s folder needs to be part of a legal process.

The client might also have to be recalled for test results.

Every citizen, if they are to benefit from the services that the state provides, needs to have proper identification.

The department can confirm that previously we had issues with our folder management system, but have drastically improved this situation through implementing additional filing space at the reception area.

The facility is responsible for approximately half a million folders, and it is inevitable that with such vast numbers folders may occasionally be manually misfiled and become very difficult to locate. But with the recent restructuring of its reception area, staff have managed to minimise the problem, although there is definitely still room for improvement and we are addressing the issue on an ongoing basis.

With reference to Mr Pillay’s complaint about long waiting times at the pharmacy we wish to inform you that chronic patients no longer have to wait at the pharmacy for medication.

These medication parcels are pre-packed at our chronic dispensing unit and is issued on a monthly basis. In April this year, the facility dispensed 21 155 medication parcels; more than a thousand every working day.

The remainder of the working day is taken up dispensing up to 2 000 items to patients in the queue, but because most of the chronic patients do not have to join the queue, the average waiting time has actually been reduced by almost two hours.

In May 2015 the Department of Performance Monitoring and Evaluation from the Presidency, conducted a Citizen-based Monitoring (CBM) survey at Mitchell’s Plain Community Health Centre to gain more information from the community and staff on service delivery at Mitchell’s Plain CHC. The survey responses were then used to compile a findings analysis report on the facility, and feedback was provided in three stages in June 2015 to the facility management team and community members that participated in the research programme. The first feedback and dialogue session was for the CBM survey feedback and root cause analysis. The second session conducted was for the consolidation of the improvement plan, and the third session was for the community feedback meeting where various commitments were developed and agreed upon and presented to the community.

Commitments made and implemented by Mitchell’s Plain CHC for this programme to the community:

The facility will reduce long patient waiting time by implementing a single service point for chronic club clients, and constructing additional filling space.

Aim to instil community and staff ownership of the facility by launching the “Proudly Mitchells Plain Campaign”, which brings various stakeholders together.

To establish an SMS client communication system for the collection of medication and appointments, as well as an overall communication plan.

Many of the issues raised by Mr Pillay requires community participation together with provincial health, to assist to provide better healthcare. If appointments are not honoured, it creates strain on the waiting times and queuing system, as the same patient would come in as an unbooked client, and would have to follow the OPD process.

Healthcare facilities like Mitchell’s Plain CHC are servicing huge numbers of people which outstrips the available resources which is why we have to have a process of prioritising the care of sicker patients over those who are less sick.

This letter has been shortened.