Throwback: Roadtrip Through History

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I wrote this post as a note on Facebook exactly five years ago, 6 July 2010. I’m often ashamed when I read my past writings, but this isn’t one of those times. I’ve left it exactly as is. I’m not sure how much sense it will make to people who are not familiar with South Africa, but I decided to share it here in any case. I’ve hyperlinked some things for comprehension’s sake.

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The extravagant price-increases as brought on by the hosting of the FIFA World Cup recently necessitated a 12-hour road-trip to Cape Town, as opposed to the usual 90-minute flight.

A cold and dark 05:00 morning progressed just as we progressed through the land of memories.

Memories of debating trips – so many debating trips.

Here we debated.

Here we lost.

Here we won.

Here I learnt that the line between conviction and contradiction truly is a fine one.

On this road four of us shared one iPod with t.A.T.u.’s Malchik Gay blaring, egging us on to speak a battle; afraid of our beloved coach’s wrath.

Here a new team stood for hours at roadworks.

Here we bonded.

Along this way my family rushed to each other one tragic Spring morning. Oblivious to the fresh beauty around us, our hearts were black that day.

In this little town we sought the history of the orphaned child who would later become my father.

Here, my friends and I mused over the dusty beauty of Ms Martins’ artwork.

Here I rummaged through the ruins of Saint Matthew’s Mission, trying to understand the concept of Shades – both theirs and mine.

Past these dilapidated houses we drove one early morning to a karate competition. There I got my first gold.

Over this bridge walked my mother and her sister to school every morning.

Grandpa built that church’s roof.

Ouma worked in that hospital.

Here my parents met.

Here, Mom supported Dad while he earned his degree.

Here I was born.

In this settlement along the road I learnt what poverty meant. There too I learnt the value of community and service.

Here we travelled, my family and I. Here we quarrelled about the middle seat. This view we enjoyed.

This trail we walked. It was muddy and Dad who can’t see was in tow, but walk it we did.

On this field, battles took place.

Here, nature claimed lives.

Here, once, the last of a species walked.

As the landscape changed, the mountain came into sight.

Once I hated this mountain for being flat, for being an autocrat, for not being the rolling hills of the Eastern Cape.

But this mountain has consoled a broken heart.

At its foot arrived my ancestors, nearly 150 years ago.

Here the Call to prayer – virtually unheard where I come from – enabled my tears to come.

Here I have loved and here I have lost.

Here I have made memories and I have made friends – some for a lifetime, others merely for a while.

On a recent trip abroad I met amazing people. I saw beautiful scenery and experienced amazing things not found in South Africa. It was safer there. In many aspects, it was more efficient too.

But home is still on this little Southern tip of Africa. I pray that my country will remain safe for my people and for the generations to come.

Truly, this land is embedded in my soul. This is the place of my Shades.

Ownership of Medical Data: A South African Anecdote

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There is a worldwide, profession-wide debate about the ownership by patients of their own medical records. Eric Topol deals with it in his book The Patient Will See You Now and in April this year the New York Times published a piece about The Healing Power of Your Own Medical Records.

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Only twice have I ever had access to doctors’ notes about me: after I got the Paeds Sick a few years ago, I was provided with a duplicate copy of my notes. I didn’t request them, or need them, but I liked having them. And when I was diagnosed with subclinical hypothyroidism I was provided a copy of my blood results, so that I could show them to whichever clinician I happened to visit subsequently.

But in South Africa there is one piece of medical data that is always available to its owner: the maternity case record. Every pregnant woman is provided with a maternity book, containing information about their previous pregnancies, their family history, their HIV-status, and every antenatal care visit they attend. This case book also contains a partogram, space for notes about the delivery or C-section, and for puerperial notes. It’s not really revolutionary in that these kinds of records have always existed, but now, much like a child’s Road to Health Chart, they are standardised around the country (in the public sector, at least).

Women can go to any antenatal clinic in the country, and their provider will not only know what to do, but have access to the notes any other provider made about the patient. It sure isn’t electronic, but in a system where many clinics don’t have working, connected computers, it does the job. I am certain the document was devised to assist with the problem of an extremely mobile South African patient: today they are in their hometown, tomorrow they have traveled 300km to their ancestral village for a funeral.

In general, our patients don’t lose these records. I’m not saying it never happens, but usually by the time these moms deliver, their maternity records are so tattered from carting it around to their antenatal visits.

I’ve seen some instances of women purposefully losing these records: invariably because they realised that their HIV status was included in the record. I’ve even had a patient request that I leave that section of her record blank. It’s a very difficult part of this system, and I’m not sure what the solution is beyond education and elimination of stigma.

What struck me was once, while rounding on my antenatal patients in a high-risk ward (women with pre-eclampsia, placenta praevia, gestational diabetes mellitus, and so forth), I noticed that every time I finished with a patient and walked to the next, she would lean forward, take her maternity record and read what I had written.

I loved it!

These are patients who often have not finished high school, and who often don’t have a firm grasp of English; and whom the world stereotypes as “not caring” about their health: and they wanted to read what I had written about them! I can’t describe the excitement I felt. Not only was it affirming to me, but it made me HAPPY to see patients take an active interest in what I wrote about them.

I’m not sure what the situation is like in other countries, but in my training, patients being able to read what I write has never really been a foreign concept. We leave patient files at their beds (with the exception of psychiatric patients), and when they are discharged they walk with their own files to the dispensary where they finally hand it in. So the possibility that a patient might read their notes has always existed.

But why have I never SEEN it done before? Why, during anaesthesiology and orthopaedics, do I not see my patients reading their notes when I leave their bedside? My only guess is that pregnant women feel as though they truly own their records, and have been told how important their records are: and so they not only feel free to peruse their notes, but they also begin to take an interest in them.

In this way, access to one’s personal medical records is not only healing, as Steve Lohr writes – it is also empowering. And empowerment is something our patients direly need.

The more I think about it, the less I understand why doctors do not want their patients to have access to their own notes. We are trained to be professional, and as medical notes may be scrutinised in a court of law they should always be written in a professional tone. So why would one write “++fat!” when you could write “BMI = 36″? Why would you write “difficult patient” when you could write “has many questions, unwilling to commit to treatment currently”?

If a doctor fears that a patient reading their notes would lead to litigation, then they’re probably doin’ it wrong.

Medical litigation is not as big in South Africa as it is in the USA, but the incidence certainly is increasing. A nasty phenomenon has emerged where nurses at some primary hospitals were found to sell patient folders to lawyers. Although it is certainly a multi-faceted problem, when a patient feels their doctor is keeping information from them one is asking for trouble. So why bother?

I want my patients to read my notes about them. I want them to be fascinated by their own health and disease, and I want them to ask me if they don’t understand what I wrote. I want their interest to hold me accountable.

When I realised how my antenatal patients perused their maternity records, I started writing them instructions. How often do we not feel swamped by all the information a doctor gives us, and then forget half of their instructions? So I wrote to them, “Remember to take a walk around the block!” or “Cranberry juice!” or even, “Have you felt your baby move today?”

So why not?

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Extra Reading:

Medical Records in South Africa: An MPS Guide

Assessment of the use of the new maternity case record in improving the quality of ante natal care in eThekwini District, KwaZulu-Natal; Sibiya, Cele and Nxongo; International Journal of Africa Nursing Science; April 30 2015

Doctoring in Heels

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GeekBoy is really good at foot massages. You know that good-painful type where one squeezes all the knots from a persons feet.

I discovered this because I needed a foot massage after work today. For some reason I thought it wise to work in heels for close on ten hours.

via Deviantart Kiba-Kun1289 (click for link)

via Deviantart Kiba-Kun1289 (click for link)

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Top Ten Reads of 2015 So Far

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Hurrah for a Top Ten Tuesday – and one where I’m not working, to boot. I had no idea what to expect of my reading this year. On the one hand: no more formal studying! On the other hand: real-life doctoring with long calls and boring admin. But it has gone well – in fact, as of 18 June I was done with my 2015 reading goals (namely to read 30 books). Not, you know, like that is going to STOP me or anything.

I’ve read some great books these six months! And… some awful ones too. But we won’t dwell on those. Here are the top 10 I’ve read so far. Continue reading

My Booming Frontal Cortex

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Unborn Ideas by Catrin Arno

Unborn Ideas by Catrin Arno

I remember it clearly. I was twelve years old and one day, without any precipitating events, I looked at the world as if with new eyes. I felt as if I had been living in a bubble, and suddenly the world was big and I wasn’t a child. Or I was, but I didn’t want to be.

It was my first experience with “growing up” and I can only postulate that as it was roundabout the time that I hit puberty, my frontal cortex was busy myelinating like crazy. I of course believed that my brain was fully developed and that old people who claimed it was still developing were, well, old – but what would a twelve year old know, right?

It wasn’t so rapid this time but I think I may be having a similar experience now. I have been trying to put it into words but having largely neglected any kind of writing besides the odd blog post, that hasn’t gone so well. It started with a feelings of disconnect and then intense reconnection; and a lot of confusion about my role in society as a doctor, a daughter, a sister, a partner, a citizen. Continue reading

Top Ten Top-Tens

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Happy fifth birthday to Top Ten Tuesdays! I first did a TTT in November 2010, but TTT debuted in June 2010. In celebration, this week’s TTT is about our ten favourite Top Ten Tuesdays. So, here you go! Each time I will link to my post and also to the link-up on The Broke and the Bookish.

1. Top Ten Bookish Memories | My Post | TTT

I’m very proud of this one because I did it for a freebie on 10 July 2012, and then it was chosen as a topic for 5 February 2013. Also, I got a lot of interaction on this post and it made me happy.

memoriescollage Continue reading

Sometimes It’s Attitude

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I hate platitudes. I hate when people say, “You can get through anything if you have the right attitude”. It negates the fact that sometimes, circumstances are atrocious. It puts the onus on people to grin and bear it, instead of on the system to change.

I’m not saying I’ve changed my mind, but I noticed something recently. I’ve met two community service doctors who were both placed in departments where they REALLY did not want to be. The nature of your community service year is that you get placed where you are needed and not necessarily where you want to be.

via @bunnybuddhism

via @bunnybuddhism

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