Thursday, October 29, 2020

This is the level of preparedness that awaits coronavirus at diabetes clinic in Gaborone

A sign on the glass door of the diabetes clinic at Block 6, Gaborone, identifies this unique healthcare facility as a “centre of excellence.” A lot of people use this clinic primarily because at least in terms of conception of medical care, it is far ahead of even the private sector: a variety of health professionals from doctors to dieticians to ophthalmic nurses to provide specialised medical attention under one roof.

To the extent it is a place at which a specified activity is concentrated, the clinic is indeed a centre but “excellence” can hardly be used to describe what happens within and outside it. Contrary to what a Gaborone car dealership expresses through its strapline, Botswana is not Toyota country but long, slow-moving queues’ country. As at virtually all public healthcare facilities in Botswana, there is absolutely no excellence in the management of queues at the Block 6 Clinic – which serves the entire southern part of Botswana. Absent any official process with regard to queue management, the patients have themselves cobbled together an arrangement that is itself not working too well.

Patients begin arriving at the clinic (some as early as four in the morning having travelled all night by bus from places as far afield as Bokspits) assign themselves place numbers in the queue in terms of order of arrival. The questions that almost every new arrival has to ask are “Who’s last?” and “What number are you?” The explanation for “almost every new arrival” is that those visiting the clinic for the very first time wouldn’t be familiar with this unofficial arrangement and would thus be clueless about the need to establish what place they hold in the queue. Some people drive over as early as five in the morning and still wearing pajamas, book a place for elderly patients, go back home to return later with the latter. The place-booking happens outside the premises near a small gate that will remain locked until well after 6 a.m. after the changing of shifts by security guards. 

After the gate is opened, patients troop in to wait in the hall where they arrange themselves in a queue according to place numbers. Only then do those unfamiliar with the informal queue management system realise that they have been left out. It takes tough negotiating (or outright use of physical force) to get a place.

That government offices open at 7:30 a.m. provides false hope that members of the public will get service at the same time but that is understandably impossible. That there is having to switch on computers, pull out files, find a pen, make phone calls and do other preparatory work necessarily means that service is offered 10 or 15 minutes later. It remains unclear why 53 years after independence, the Directorate of Public Service Management can’t formally state that while government offices open at 7:30 a.m., service can only be rendered much later. In the particular case of the Block 6 clinic, “much later” means up to an hour later or more. The work day begins with a prayer service that has evidently been conceived by someone who was determined to ride roughshod over the secularism espoused in the constitution as well as over the reality that not everyone is Christian. It is also unclear why a repeat prayer service is necessary when people not only go to church every day nowadays but some do so very early in the morning.

The service comprises hymn-singing, a prayer and sermon on the odd day. There is ample evidence that the style of preaching has veered sharply in the direction of the “Fire!” church. During one sermon, a nurse-preacher sought to spice up her sermon by deploying the dramatic antics of “Fire!” church pastors.

“Turn to the person sitting next to you and say ‘I love you’ to them,” said the nurse, whom the clinic’s grapevine says has very deep “Fire!” church roots.

(One can well imagine what trouble a beauty-queen flanked by hot-blooded young men would have inadvertently put herself in by uttering those words.)

When the prayer service is over, patients register at a cubicle (wo)manned by a clerk with a perpetually surly expression and depending on the medical attention they need for that day, disperse in different directions. It would seem that there is a ticklish issue that the staff has not been able to resolve for years because every day without fail, there is a meeting in the morning which – like the prayer service, occurs during what should strictly be medical care time. That meeting has evidently never discussed queue management and the queue problem gets even more acute when one has to go for consultation at two or more offices. There is the option of booking a place in one queue – say the dietician’s – while physically queuing up in one – say to see a doctor. However, there is always the possibility of losing your place if those you booked a place with go in and leave while you are still held up in the other side of the clinic. Interestingly, there are IT professionals who have submitted comprehensive queue management proposals to the Ministry of Health and Wellness but have been persistently rebuffed.

The clinic is part of the Princess Marina Referral Hospital and doctors from the latter are rotated in and out of it. It should never be possible to compare a medical doctor to a Mogoditshane Route 4 taxi-bus (“combi”) conductor but tragically that can easily be done with some of the doctors at the clinic. One, since rotated out, was an expatriate woman (an African) one too many patients were not at all happy about her service. She lacked the full spectrum of attentive behaviours that one expects from a medical doctor and typically didn’t return greetings. One female patient tells a story of how this doctor was nonchalantly inspecting her string of pearls for a protracted period of time, neither bothering to return greetings she (patient) proferred nor attending to her even after she had sat down.  

Poor work ethic can also be observed among junior staffers, some of them interns. In one instance, a loud-voiced female clerk kept up an animated conversation with a colleague about what must have been an eventful nightclub outing.

“That gay guy can dance!” she said in between taking a blood samples from a patient and checking her high blood pressure. 

It is unrealistic to go to a government office and expect to be treated humanely but given what its purpose is, a healthcare system is supposed to function differently from the rest of the public service. With coronavirus spreading fast across the globe and having been reported as near as Johannesburg at press time, there is greater need, now more than ever, for the Block 6 clinic to function like what it aspires to be – a centre of excellence. The medical science says that people with diabetes face greater risks of complications when dealing with viral infections like coronavirus. For most diabetics in southern Botswana, the first port of call will be the Block 6 Clinic which, incidentally, is used by a lot of senior government officials. When they should be in a consultation room, patients would likely be required to sing songs they don’t even know. The entire healthcare system would do well to realise that it is dealing with what billionaire and health philanthropist, Bill Gates, has described as “a once-in-a-century” global public health emergency. 

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