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. 

My heart is broken today

This morning I learnt of the passing of the son of a staff member of ours whom we have had for years. This little man was only 4 yrs old. His father has pictures of him on his phone/facebook showing a wide grinned little boy with a spark in his eye. Someone you can just hear people in the village say "o le ulavale ia" referring mostly to his overabundance of energy and knack for life.

2 weeks ago, our staff member  brought this little man to me with his wife. It only took a first glance to see that he was pretty sick, looking very thin, gaunt and breathing very rapidly.   He was admitted to hospital that day and after a prolonged admission finally was deemed better enough  by the drs there at the time to go home. In that time, we had discovered that the little guy had acquired an illness that had caused his heart to swell significantly. I had done a bedside scan on him trying to find answers to our questions  and could tell right away that his condition was quite bad. I refrained from leaping straight into giving him a terrible prognosis as I don't feel I have enough experience to know with his illness, whether he was past the point of no return or whether there was a chance things could be improved. When it comes to kids, my heart is fragile and I only ever want to give good news. The bad news is so enormous when its a little person who hasn't had the chance at  life. Actually I think Im like this with all my patients. Just never rushed to give bad news unless Im sure we have exhausted all possible help, drugs, meds, investigations, expertise.  In this little guys case. His heart was very sick. Meanwhile, we don't have a heart dr to consult on at the hospital, and in particular a paeds heart  dr was who we really needed help from  (or childrens heart dr) so everything was going to be a 3 step process of trying to contact overseas specialist, send them reports/images and await a reply.

We did this. But the replies were not good. My heart always sinks when I get a reply which starts with. "this is very sad" because I feel like this summarises the whole outlook right there. What I didn't expect though was that this kid would go so soon. I had thought he would have more time, at least a year or two of back and forthing to the mainland , to see visiting specialists, even if he were deemed unfit for surgery I thought there would be a palliative pathway he would go down. But no. Literally within 2 weeks of his illness coming to light, his heart gave out and he has taken his last sleep. Im not sure if this was better or worse. I think either way is pretty sad but perhaps more time ?although always the question of quality of life :(

His father rang me to tell me he couldn't work this morning . I asked first if they were being transferred to the main hospital in Upolu  for his sons treatments - knowing he was pretty sick? When he told me what had happened, I could hear him choking back tears in his breadth and so did I . I had to run away to the privacy of our bathroom to escape the morning rush of people in our house and have a little cry . Kids getting ready for school, sitter just arrived,  manager from hotel coming to update tasks of the day, housekeeper from hotel wanting to know how to use her timecard...my heart is breaking just a little bit and I want you all to go away :(

I thought about this kid a lot today. What a gorgeous little man he was. How his parents loved him so. How much my kids mean to me. How terrible it is to see your children suffer. How parents are meant to cope with this. The fairness of it all. Our staff member came over later, and sat at the foot of our door. He looked like he did not have the strength to even breath.  His eyes blood shot from obviously being up all night and for the river of tears he must of shed. His English is not very good, my samoan aint that flash either. The hubby is in Pago for a faa'lavelave. Where are his wise Samoan words when I need him. I'm no good at providing comfort or counselling in Samoan, and I doubt me doing it in English would be very good either. So I stumbled through some "I cant think of anything that will ease the pain you are going through now" (in my broken Samoan ) and some "be strong for your wife and kids, so you can get through the next two weeks" I didn't feel it was enough but all I could muster while trying not to be a ridiculous bag of tears.

Of all  thing things in life I am grateful for. My childrens health is  one of the most important . Despite all the challenges and hardships we face, that is the one hardship I am glad to not have. The pain of suffering and health issues.  Today I will hug my kids a little harder and pray for this families pain.

2019

Ive neglected my blog for a year just about. I looked back at my sad blog site and wondered why. Writing used to be such an outlet, a tool to keep my sanity. From the dark and tiresome hours in Wellington hospital, to the move back home, through kids, and through adjusting to a rural life. It was always my replacement for not being able to go out for a coffee with friends or yarn with a relie;)

I realize that it sort of came to a slow crawl after some worries got  under my skin that people or persons or communities (ie the village or the workplace etc) may actually be reading my blog. Har har. Heres to me thinking I was more popular then I probably actually am :) But in all honesty, I just didn't want to offend anyone with anything I said. One year, I wrote a blog about how terribly under resourced my workplace was and of the things we needed. A great organisation (through a friend who reads my blog) picked up on this and did some amazing gathering of forces and actually brought alot of donated goods across to Savaii. Unfortunately in this process I learnt that officials in my workplace did not receive this charity so graciously, and when had heard of this "much needed list" were out to head hunt the person who dared put it together (apparently making them look bad etc and not doing their jobs etc) It was really deflating to learn of this, to the point where I actually did not participate in the receiving side at our local hospital (which I would've really liked to because I just wanted to be part of the recipients side, expressing the joy and love I felt that someone cared enough to put these things together for us). It also reinforced the frustration I've always felt with working in this public service  where despite that fact that we are so poorly resourced and lacking in many things ....someone in an office somewhere is more consumed by how this plea makes them "look"" ( ie forget the patients right ?)  and used their precious energy to attack something so useful as donating goods to our local hospital. Go figure.

Meanwhile, life goes on without  crying  me a river. Fast forward to 2019. I've now lived in the bush for 11 yrs  and life has been so full of surprises. 2018 brought tears and new beginnings. It started with my 90 yr old grandmother developing a lump in her jaw. Ultimately this led to an operation in NZ, suffering complete paralysis of the right side of her face, eventual decline in her overall health - spread of " cancer" and becoming a palliative patient.

My Supermom and Superaunty becoming her fearsome full time caregivers/nurses/drs/ and me trying to fill in the gaps for palliative care dr as there basically isn't such a thing or a service in Samoa. My grandmother passed away at home surrounded by Mum and Aunty . It was a tough  time for our family as my grandmother had always been such a headstrong person, a leader of her family for many many years after my grandpa died. And always been in pristine health, heck she had a double total hip replacement done after she was 80 much to everyones surprise:)  Her advice and talks were always full of gems for anyone, set with her lifes lessons. Always being able to share 90 yrs of experience - how through determination and perseverance navigated her family through tough times post world war,  both her and my grandfather always holding jobs and having 8 kids to raise, managed to establish their business build their own houses help 8 of their kids succeed and just manage to live a fullfilling and rewarding life, no easy feat for sure.

 There were few times in my life that I could recall ever seeing my grandma weak or sad. Even when she was down with a flu or an infection, getting out and doing her stretches and exercising and making some home made brew or broth using every part of the cow (ie tongue hoof tail etc lol) was always part and parcel of her recovery. When she began to lose her strength to her recently diagnosied cancer , her body only failed while her mind remained a bright as anything. Despite losing control of her body she was certainly still very much in control right up until the end.

Not long after a loved Uncle also went through the same process and it was a double whammy for our family having 2 loved members pass away of cancer. Funerals for some reason are always a contrast of suffrage but also an overwhelming outpouring of love. I cant say one ever looks forward to these events, but I am glad to have seen cousins I havent seen for ages, and spend time with the whole aiga is always nice.

This year, for fear that my brain was turning to mush, I found a really awesome course finally available by distance - Rural and hospital medicine, something I had been eyeing for a while but had always required in the past for people to go and live in nz, not an easy choice for me. So when I discovered they were allowing it to be done by distance I jumped to the opportunity. Albeit with a bit of hair pulling and panic attacks at the start  (ie remembering feeling completely burnt out from studying 14yrs ago hehe) and then realising I was doing it again , but with 2 kids and 2 businesses to run ...hmmmmm...yea anyways. How do women do it ? we just do...its the subconscious auto-pilot switch I swear...thats how lol. Anyways, back to school I think has been the best decision I have made x 100 and as hard and stressful as it is...Im loving it. I just wish I could find some local scholarship to help cover costs but apparently what I am doing doesnt tick any boxes of any government scholarships these days, and there are no sympathetics votes for lonely one man band drs in the bush hehe. Anyways, Im tired of waiting for handouts so am self funding(scrounging)

And then , after 9 yrs , found out I was preggers in November. Weeehhheeewww. The plan had always loosely been to have 3 or 4 kids...and that came to a halt in 2014 when I was diagnosed with some weird eye thing that i had to take a drug which you are forbidden to fall pregnant on (terrible for unborn babies) only came off it a couple of years later and since then, hubby an I have been pointing fingers at each other as to why it was suddenly so hard. Anyways, long story short, hallelujah. I am now in the throws of nausea and lethargy and just hoping it will all dissappear soon jammit. I dont remember ever feeling this yuck in my previous but know they can all be comepletely different. Now, Im looking at other mums with young babies and thinking yay that will be me soon - look at how cute bubba is and then - daaaannngggg, she just said she didnt sleep til 3am this morning and had to wake up with the baby at 6am awwwaaaaaaatt??? Im too old for this hehe!! lol

So moral is enjoy them naps now while I can right ? before its all over lol. So , heres to a hopefully great 2019. Bring on the bubbs bring on the bush and its krazy ways, bring on the books  ! Will try to not neglect this blog again...cause realistically I probably have 2 readers so who really cares? lol

And another

Here is another thing that I cant get over. The number of job applicants  who
- submit all their school certificate  year 13 certificate  which CLEARLY say they failed half their subjects (like seriously, english 28%, maths 32% etc)  and in their cover letter go on about how well they did at school ??????????????????????????????? unfortunately...the one I read today even had a school award (from their own local school) for top in maths for the class....but their SC mark was a big fail hmmmmmmmmmmmmmmmmmmm....not good for the look of the school right ? But where and when does it calculate in their own minds...that a 32% fail is not something to gloat about ? like seriously...it does NOT work in your favour in your job application where staff are expected to do simple maths :(  I would have just left that off my CV and talked about things I am good at in the community/society etc

and  also
-the number of cv cover letters that sound like this 
" I am a friendly and driven person with ambitious goals for the future. I am punctual committed and hard working. I am an honourable and intelligent person, who will ensure that my contribution to the workplace will lift the level....bladibladibla" my point is...oka oka gi big words about what they are...ae gagu mai le kagaka makuia LEILOA....who is to blame? that cousin from overseas who said they would write their cv for them (mate...a nice sounding letter is not a winning ticket...you may think its some sort of 'ticket in' but once the letter and the person are viewed as non symbiotic....makuia igoigo lava le mea lea e kokoe). Also, there are now people 'selling ' CV services in APia and will write your CV for a fee....what a joke when it is not a true representation of this persons attributes:(

faiaku ai foi