Hospital Bathrooms and Other Public Health Beefs

We have now been working for six weeks doing surveys in the hospitals in La Paz. We've cut our survey times down in half, we're now [EXCITINGLY] enrolling patients in our automated voice response system to help them control their diabetes and/or hypertension, and we've become friendly with doctors, nurses, and patients along the way.

While we've had several engaging conversations with many of the patients and overall have had a positive experience working in the hospitals, all of this time spent in the waiting room has allowed us to see the many flaws of the health care system here. I've built in my head a list of all the things that have frustrated me the most about public health in the hospitals here, so I just need to get it all out.

Appointment Issues

• People leave appointments with prescriptions, treatment plans, and lab results and have no idea what they mean. Countless times patients have come up to me saying, "Doctorita, can you tell me what this means?" It breaks my heart that after their consultation with the doctor they are left with more questions than when they went in.
• One very sick patient and their family members were waiting for a long time to see the doctor. Eventually they went up between appointments and asked if the doctor could finally see her now, and the doctor said no. The patients in the waiting room heard this confrontation and had a fit; everyone started yelling, "Doctor, you need to attend to your patients! You need to take time to see everyone!" Patients shouldn't have to be telling their doctors that they need to care, even just a little bit.
• Patients start lining up at the hospital at 4:30am to hopefully get an appointment with their doctor. However, sometimes the doctor doesn't even come in that day and no one tells them, or the doctor runs out of time and they don't get an appointment after all. Even after lining up and purchasing a ficha to see the doctor, they have no idea when they could be called.
• After purchasing a ficha and waiting several hours, the nurse or doctor will finally call a patient's name. If the patient doesn't make it to the door by the second time their name is called, they have to wait until all the other patients are called.

Accessibility

• Today I saw a man carrying his mother in her wheelchair up the stairs in the hospital because there is no public elevator. While La Paz itself is not handicap-accessible, you would think that at least the hospital would be.

Doctor-Patient Relations

• Doctors and nurses commonly talk about patients right in front of them as if they don't exist. 
• Doctors and nurses also violate HIPAA privacy rules, such as talking about specific patients' personal information, with other people in the waiting room (and not quietly).
• There is no barrier between the waiting room and the doctors' offices. Patients commonly knock on the office door while other patients are having a consultation, begging to be seen. 
• A doctor has asked us if we could please contact a surgeon in the United States who could do a special surgery on one of his patients. Oh, and if we could figure out a way to get her there, please and thank you.

Blood Pressure Monitor Issues

• We give out blood pressure monitors to hypertensive patients enrolled in our system. Diabetic patients receive a first aid kit, which is still a cool gift, but definitely not as valuable as a blood pressure monitor. We have had some problems with this value discrepancy, with many people who don't have hypertension wanting the blood pressure monitors. Not really a health care problem, but frustrating for us, nonetheless.
• Oh, and we have the best-functioning blood pressure monitors in the hospital. So much so that the doctors and nurses ask us to measure their blood pressures.

Sanitation

• There is no fully functioning bathroom in the hospital. There is one bathroom that patients are told to use, located in the emergency department. There is no toilet seat, no toilet paper, and a sink with no sign of any faucet or water hook-up. And I don't even need to mention that there is no soap or hand sanitizer to be found anywhere. Several times I have entered the bathroom and the sink is full of blood. I hate thinking about the fact that this is the one bathroom that all the patients are using, and I doubt most of them carry their own bottle of Purell.
• Dogs frequently walk in and out of the hospital, sometimes all the way up to the waiting room on the second floor where we do our surveys. No one seems to blink an eye or try to shoo the dogs out.

Obviously I am not an expert on the Bolivian health care system or the way that any other hospitals here are run, but I would guess that many public Bolivian hospitals are similar to the one I am working in now. I will also say that being an outsider, just as in any situation, it is definitely easier for me to pick out the flaws in the system than realize the good in it. But it has become very easy to understand why it is difficult to control a chronic disease in a poor country such as Bolivia when the health care system is so inefficient and difficult to navigate. I would imagine that impoverished regions of the United States experience similar issues as the ones I am seeing here, over 4,000 miles away. It would be interesting to compare and contrast these systems and see if the health outcomes are the same.

Also... three weeks until I am home!