Quality of care issues in tertiary hospitals. Are we caring for people or giving pills and injections?
Antonyamma, fondly known as Antu is our key community health worker, our anchor in the IPH urban health operational area of KG Halli. On Wednesday afternoon, Munna and myself went to her house to spend some time with her after hearing of her mother-in-law’s passing on.
It had been some months since we had been hearing of her mother-in-law’s “heart problem”. Evidently it was of long standing, some interventions in the past, and then status –quo for a number of years, when the good lady had been an exemplary grandmother, the person that Antu’s two boys could expect at home with a hot meal ready when they came from school.
About three months ago, there was news of her being shifted to KGF, where her daughter, Antu’s sister-in-law stays. Then within a month she was back, her condition worse, breathless on exertion and now confined to the home. She had been on medication for some time, but these seemed less effective as the days passed. Now, when she looked ‘serious’, the family rushed her to Bowring hospital. From here, she was referred to Jayadeva a superspeciality cardiac hospital, apparently the condition needed treatment there. In Jayadeva, they were told it was not a cardiac condition at all, and now shunted to KC General hospital. Antu, by this time, tired, angry and unhappy with the treatment of the staff there, brought her mother-in-law home. She still did not know what the “heart problem” was.
Now came a month, fraught with difficulties. Antu holds a full time job, and seeing her burning the candle at both ends, her 66 year old mother chipped in to help. Evidently , as with all bed ridden patients there was endless work – special food ,sponge baths, disposal of wastes, all to be done in a tiny two room space, with the now expanded family and constant visitors. A point came when the patient demanded to go to hospital again….. a now- tired Antu took her to the tried and tested Bowring hospital. She lasted a week, and the day before she died, the family was told to transfer her to NIMHANS , this because she could no longer connect to her surroundings.
On Monday morning, Antu called us, her colleagues and friends to break the news, it was understood that she would not work for the next days. When we visited on Wednesday afternoon, after the burial, it was intended as a condolence visit. And we listened….to stories of the soul departed and the family dynamics common to all such events. In words (translated from the Tamil) “ We sent her back to the mud she came from ”……. The candles lit before the large cross in the corner of the room reminding us of the fleeting nature of our lives.
And I wondered, what did the phrase “quality of health care” mean to the soul departed? To the family left behind? To the tertiary care hospitals that shunted them from pillar to post? What could I learn from the death of a 76 year old woman who died of heart disease – so she no longer becomes a statistic in the register of births and deaths?
