The Waiting Room

Something bad happened last Thursday. This event made me realize a lot about the Bolivian health care system, or at least the hospital in which I am currently working. It also made me realize that I have the responsibility to care for the patients with whom I am interviewing on a different level. I need to make sure that I fully understand their stories and that I really listen.

Here is our system of interviewing patients:

1.     Arrive at 7:45-8:00am to get situated with our surveys in the waiting room and bring out the balance to measure patients

2.     Randomly choose patients in the waiting room to interview

a.     Measure blood pressure, weight and height during the screener

b.     Continue with the survey if patients are eligible

3.     Randomly choose another patient to interview

4.     Continue until about 1:00pm, when the waiting room is empty

This is where the problem comes in. Patients arrive at the hospital around 5:30-6:00am to get in line to try and get an appointment with the doctor. Patients receive a number, but this number does not tell them what time their appointment is going to be. I frequently encounter patients who have been waiting for 5 or 6 hours to see the doctor. When the nurse steps out of the office and calls someone’s name, the patients literally sprint to the door, including older men and women and mothers carrying their babies. If they call your name and you don’t make it to the door before they call someone else’s name, there’s a good chance you’re out of luck to see the doctor that day.

I caused someone to miss their appointment on Thursday.

I was in the middle of measuring a patient’s blood pressure when the nurse stepped out and called her name. She frantically stood up and waved her arms and said, “That’s me! I’m coming! Wait for me! I’m here!” We tried to very quickly undo the Velcro of the blood pressure cuff. By the time the patient had collected her things and sprinted to the door, it was too late. The nurse said something to the patient and I could tell she was pleading with her, but the door was shut in her face. She sulked back to me, crying. I was devastated. “I missed my appointment,” she told me. “I have to wait until all of the patients have seen the doctor today before he will see me.”

This patient had arrived at the hospital at 5:30am. It was now 11:30am. Six hours of waiting, and now she had to wait even longer. To make matters worse, she was seeing the doctor to receive lab results from the previous week to find out if she had diabetes.

I apologized to her a million times and told her we didn’t need to continue with the survey, but she got her tissues out of her purse and said, “Please don’t worry, this always happens here. People always miss their appointments because they call your name but don’t wait for you. This always happens. I want to continue with the survey.”

So, we continued with the survey. Luckily, right when we finished, the doctor called her in. I was glad to have been able to occupy her while she waited even longer to receive her results, but I still felt like the worst person in the world. After she came out of her appointment, I apologized to her again. She told me she was just diagnosed with type 2 diabetes. By this time, the waiting room had cleared out, so we were done with surveys for the day. Even if the room was full, though, I was so drained that I wouldn’t have been able to enter another patient’s world.

I can’t imagine having to wait for 6 hours to receive care, and then after those 6 hours, maybe not being called in to the appointment at all. Who has that much time to take off of work or to be away from their children? What if during those 6 hours you had to use the restroom, which is very likely, and they called your name?

Many people I have interviewed have said that this is the first time they are seeing the doctor, and now I understand why. Who has the time or energy to manipulate such a system? Of course people are going to wait until there is something urgent to see the doctor. Preventive health care and regular doctor visits are just too much of a hassle.

Being in the waiting room for five hours, not even the amount of time that many of the patients are there, and interviewing patients has been such an eye-opening experience. I have been trying to really pay attention to what patients are telling me outside of the A, B, C, D answers on our survey, because their stories are so rich. Everything they tell me between survey questions leads me to a better understanding of how health care can be improved in Bolivia and in the United States.

I hope this experience never happens again, but I’m sure that it will, especially considering that this was our first full week of doing surveys. I think the best that I can do is to save these stories and experiences, share them, and hope that maybe in the future, health care access can be improved for those who need it the most.