The "we'll call you back " phenomena

My journey and time working in our health system back home has been a bucketful of mixed emotions and experiences. Alot of challenges and alot of lessons learned.  It definetly took me a few years to adjust to working in our "lots to be desired"  health system. Ive had to  become more resourceful, lower some of my expectations while raising the bar on what I could do for patients with what was available. A whole lot of embracing rural health and rural people and removing my preconceived/naive " how could they do this to themselves" way of  thinking to understanding why our health is the way it is.

If theres one thing I did not see coming, it was the development of  a passion for rural medicine. Practicing medicine in a rural area has  been one  of the toughest most nerve wracking things I have done but at the same time truly  rewarding . I certainly now appreciate that people who live  in some of the furthest corners of our country are some of the happiest  and healthiest too, and they want to stay in their homes. Their villages, their land...they want to reap and sow the plantations handed down by their forefathers and we all could learn alot from their humility and outlook on life. However it has been my most burdensome grievance, that when these people need something from our health system, that it is often placed so far out of their reach, so many difficulties, challenges, costs, human error and human slackness resulting in negligence and  eventual distrust. One honestly can not blame the people sometimes. I do realise that our health has had advances and things to be celebrated - certainly we have acquired new skills and thus new services over the last 10 years, more technology and more human man power. However our health system still falls flat on some basics. Its like  teaching someone how to speak spanish (or french or latin or whatever) when your english is still poor to begin with ....

I often come across this phenomena in health, that I have to warn people about. It rears its ugly head in various situations and torments the lives of poor patients. I dont think the bearers of this phenomena actually realise the anxeity and grief this causes, and if only one could audit and measure the amount of emotional stress associated with it. This phenomena I call the "call you back " phenomena.

In this day and age of technology, of Microsoft work and excel, of phone text messages, to group chats viber messanger whatsap, to online organisers google calender, cloud, dropbox, trello, etc etc etc. Surely there must be a way our health can be held accountable for the promises it makes its patients. Time and time again I have patients who come in to see me , often very unwell after a ridiculously prolonged period since last seeing a health professional who say "I saw them (specialist/doctor/nurse/ whoever) and they said- sei faakali bla ba bla(some reason person/investigation/team from overseas/test to go overseas/lab reagent to be back in stock/radiology machine to be fixed etc etc)...and they will call me back " and then they wait. They wait and they wait. They wonder how long they are meant to wait and whether their ongoing weightloss is meant to be of concern?. They go back to the hospital but when telling the new face young and freshly rotated Dr there that they had the "call me back phenomena" they are promptly told to go and wait again. That the first issuance of the "call you back " ticket surely means youve made it past round one (which is where the new dr now sees himself/herself) and you need to go wait as youre currently suspended in round two of this phenomena. And surely Drs/health professionals are good people, theyll follow up on their promises.  A year goes by and they are far worse. finally they decide this is ridiculous and come back to see someone else. (me) to be fair, on the odd occasion, people have changed phone numbers/lost their phones. Which isn't unusual in Samoa. Thanks to ridiculous rivalry between the two giant phone companies constantly trying to outdo each other, customers are constantly being lured to come in exchange their sim cards and get a free amount of X credit etc etc etc....annoys the crap out of me because this is what happens. Everything registered to their life with that number, does not cross the minds or cares of the phone company and often the customer is ignorant to the fact that youd need to go change all those registrations (and often wont do anyways) and so...that call back phenomena gets worse.

Anyways. Then, even overseas visiting teams have the same effect . Although they come from health systems which are highly refined and scheduled and manned and held legally accountable ie someone could go to jail should it fail, not a single hair out of place on that head .When they come to our shores, they suffer the same sloppiness. I dont know if they see us do it (issue the call you back cards) and think thats what they should do, or they just dont realise the effect they will have or how much work this action actually entails, and dont realise the slim chances of this even happening,  but we even have visiting teams of specialists who go around and see people, and then lo and behold give them the same phenomena...they tell them things like ...something is wrong, but we/or someone " will call you back" sei lipoki aku le falemai and then they will call you back, they promise.Once their findings are handed back to the Samoan health system, even if its Bob Smith the data entry clerk at office/building 102 miles and miles away from the acutal hospital, who'll just file their forms...surely, theres someone sitting somewhere who will ring these people back when I return to zimbabwe.

My problem is, 1) the hospital landlines cant even call a mobile phone so how are people meant to be called back on their mobiles (ie this leaves the caller with no credit phenomena to ensue) then 2) who is doing the calling? if the actual health care people are operating/working in clinic/ resuscitating people - who sits down and calls everyone up?Although I really hope and root that my fellow brothers are...I often find the patient who did not have this luxury. Unlike other fancy overseas health systems where all specialists and departments in hospital have receptionists and secretaries who are responsible for spending a good amount of their days organising these, in Hamo-land we dont.  3) what are they using to remind themselves to call people up? often the call back phenomena is seen accompanied by 'scribbled my number on a piece of paper' phenomena...surely there must be a more robust system of capturing these lifesaving details and prioritizing /remind the caller? We must all remember that we are only human and our brains are not endless gigs of data...we too will reach a point of maxing up...and surely there is some software we can invest in to do the reminding? some people we can invest in to do the calling?

 I think this terrible phenomena is not solutionless. It really just needs smarter solutions and I really feel it boils down to 2 things -Technology and manpower. Better systems, that are smarter then us, that wont fail or forget or lose details or that piece of paper.   Some sort of technology (and surely you can pick from hundreds of free tools available on the internet/computers) to capture peoples details and plot dates and reminders for follow ups, and a dedicated person ot do the calling. Full stop. In other countries, this is called a secretary (or medical receptionist) or ward clark or personal assistant, and the other is called a computer and a phone.  The two need to go hand in hand and weak points identified. Ie what happens when a follow up date goes by and the person doesnt show? then the human power looking at this must have the dedication and belief in their purpose to ensure the person is hunted down by all other means (thats why you normally should always provide 2 numbers, a next of kin, next contact, your wife husband father mother, faifeaus number along with your own) to ensure the person is indeed located and not left  behind to become one of those " lost to follow up " statistics

Unfortunately, my brothers and sisters in the rural areas suffer most from this glitch in our health system as travelling often to the main hospitals to try to get answers is financially burdensome as well as time costly as well. things they dont have lots to spare. Samoan Fofos are far more accessible and often people will resort to seeking fofos in the interim for prolonged periods , sometimes to their own demise.