Tasks and Tickboxes: a broken care system.
Last year was a roller coaster of a year and it made me reflect on how i can be more intentional with what i consume all round and not just food but also digitally. I focused alot on my health, getting relevant checks and follow- ups as well as my mental health. As someone with a long term health condition and getting on in age, i needed to stay on top of things. My cholesterol levels have been high for awhile but not of much concern as my good cholesterol was higher than the bad, so that bought me sometime in terms of cardiovascular disease risk.
This has been the healthiest eating combined with fasting that i have done in a long while. I was also conscious of how perimenopause was playing havoc with my body and hormones and no matter what i did, i could not shake the belly fat and the creeping weight gain. Anyhow, i ploughed on and even got joking with the family about how my Doctor will tell me my cholesterol levels have gone up despite all my healthy habits! Come the new year, i had my half yearly check and bloods and was very confident that even though my weight was still on the high side, my cholesterol levels would at best decrease or at worst stay the same.
I get the call from my consultant and everything is fine except the bloody cholesterol and the levels mean that a recommendation will be made to my GP to consider starting me on statins after having a discussion. I am not a fan of statins or regular medication especially if other options are available, so while i waited for an appointment from my GP to discuss my options,as had been suggested by my consultant, i drew up a list of questions and concerns i had.
A week and a half later i get a call from the GP surgery and it is the pharmacist calling to discuss my high cholesterol levels, if the hospital had given me any statins and if not then which ones she could prescribe. she then asked a series of questions about my activity levels and diet with the offer to send me a link to healthy eating. She checked which pharmacy i collect my medication from, informed me that i would experience some side effects when i started the prescribed statins but not to worry. I was then to have repeat blood tests in 6-8 weeks and did i have any questions? To say i was stunned into silence would be an understatement.
I was mad and disappointed, not at her but at the system that is broken and has been reduced to a task based and tickbox service where the whole sum of the person and their circumstances and views are not taken into account or made space for, when their care is being decided. I know the days of having a meaningful face to face conversation with your GP who had all your records at hand and had known you for years are over, but i had at least expected to have a face to face appointment to discuss this life changing event and explore other options available. That i would be given the chance to make an informed decision instead of the decision being made for me.
So for now i have a prescription waiting for me that i am not keen on picking up any time soon. Meanwhile i am intent on pursuing those alternative methods like exercise and diet and see what results i get when i next have my blood test. What is it they say? You are more likely to look after your health if you are involved in the decisions about it and are invested in it. Please talk to and with patients and not at them. When patients feel they have a say in their health and care they are more likely to be receptive to suggestions made and not balk at them.
Racism and Inherent Bias in Health: A Patient Safety Issue? Navigating healthcare while Black: Part 2
Snap shot of racism issues raised in the last few weeks.
Growing up, going to hospital was a very serious affair. It often meant that one was very sick or that something was very wrong. You would often get people going to visit relatives or friends to check on them because they heard they had gone to hospital. I have often joked that we Africans only seek medical help or go to hospital when we are dying ie when things are serious! Other times we relied on herbal medicines and remedies or over the counter medication and just got on with life. I had not realised that this ideology was deeply rooted in myself, why go to hospital when a paracetamol here, an ibuprofen there, a little Vix/Rob could help ease the pain, plus there are more sick people in the world and so long as the pain was bearable, life went on. In fact I took pride in the fact that i was not a frequent visitor to the GP and surely that alone must have earned me brownie points and that if I finally came in for a consult they would look at my records and see that I had not been in to see them for near on 11 years and that for me to have come in, means things were serious- the dying African analogy thing! I mean my work sickness records matched my not visiting GP records, if that earned you brownie points at work surely it applied to my GP as well? How deluded i was! But before i explain my delusion and crash to earth moment, i need to highlight another issue that in my opinion is a huge determinant in the quality of healthcare we receive as Black and marginalised communities. These are my observations and experiences through the years and by sharing them i hope i start a conversation where we as individuals can look within ourselves and check our biases and maybe we can understand that sometimes the system is stacked against certain individuals making them invisible and that by the time they become visible, it is not because they were neglectful with their own health or that they did not try hard enough, it just got too exhausting trying to get the help they needed and finally they gave up and that those racist views and practices at the top that we constantly deal with at work, school, in life, have a knock on effect that then affects society as a whole.
Before moving to Birmingham in 2005, we lived i a quiet mainly white neighbourhood within a small town. The GP practice was a small family practice with a handful of doctors and a lovely pair of receptionists who even while talking to you in person or over the phone, getting more information before sign posting you to the right service, did it with kindness and patience more often than not. You always felt welcome, never rushed and every concern was dealt with in house or via referral. Slowly the town started to grow, the independent shops were knocked down, a huge Tesco was built and new apartment blocks started springing up and the GP surgery got busy. The town was growing and changing, a natural progress. The area we moved to in Birmingham and indeed Birmingham as whole was much quieter and laid back than London, the traffic was almost none existent, it seemed like by 12 midday, especially on weekends everything just died, it was way to quiet but on the up side we could afford a bigger house with garden and the neighbours seemed nice. We registered with the local GP surgery, which was almost like the one we had left in London, despite the incident with the practice nurse or occasional gaffe by one of the GP partners who upon seeing the children during a consult said: “ what fat children! Very different from the ones I have been seeing in South Africa this last month” ( She had just come from a volunteering programme in South Africa), overall you felt heard and more importantly you saw your named doctor and the continuity of care was there. The receptionists were kind and you could walk in to make an appointment . The streets were clean, we knew the local street cleaner and would stop for a chat once in awhile. A year in we started to notice for sale signs cropping up, the white folk in the neighbourhood were moving out. Not long after, the local street cleaner left, said he was retiring and for a week a two we had a replacement and then nothing and they would be cleaned as and when. The area started to look neglected and derelict. Various take away shops started to crop up. Our corner part of town was changing and growing and not for the better it looked and the GP surgery was not spared this growth. We were getting an upgrade, a bigger and better service, it looked like but looks can be deceiving and not all change is good, especially when an area is changing and becoming more derelict and unkempt and phrases like ‘ deprived area ‘ start being banded around. When an area is now mostly inhabited by marginalised communities and it looks like the local council has all but given up and services such as litter picking, rubbish collection, housing and the community surroundings as a whole take a back foot, you start to realise how all this connects to healthcare provision, schooling, policing and life in general. A two tier system comes into play.
A year after my life altering surgery, i was back at work navigating the pitfall that is the extreme sport of nursing while black, especially in a new town, environment and work culture and all the changes going on withing the neighbourhood largely went unnoticed or took awhile to notice as most of my time was spent at work and the only time i went to the GP surgery was to take the children for their immunisations etc. I had been told at my hospital outpatient follow up after the surgery that i would experience some lower abdominal pain which was normal due to scaring and so i managed my pain when it became unbearable by taking paracetamol and ibuprofen and occasionally buscopan. My local pharmacy was great and between myself and the pharmacist we always managed to puzzle stuff out which meant i was helping the GP service as well as the hospital service by not using up time that can be used by more urgent cases. Years went on and the pain slowly got worse but i put it down to scaring and work/ family pressures. More and more people were coming into hospital and complaining about their GP’s and access to services, from rude receptionists, seeing different doctors if you were lucky to be granted an audience and no continuity of care, it was easier to come into A&E. One chap had been to his GP ( one of those mega practices) several times complaining of chest and joint pains and each time his was given pain killers, then stronger ones which were eventually on repeat prescription! After a year of frustration and increasing pain and breathlessness he turned up in A&E and was diagnosed with TB. Another elderly chap had to go into A&E at the request of his GP’s receptionist at the frustration of the A&E doctors. His old GP had retired ( White Exodus) and the surgery had been taken over by another GP ( South Asian ) who only operated on a Thursday and worked the other days at his brothers practice in Solihull. This meant that his patients could only book appointments to see him on the Thursdays otherwise if they fell sick outside of that given day, then A&E was their only choice! He finally had to change GP’s to a bigger practice, when it took almost 4 months to fix a medication error with his diabetic medication, where he was previously on a combined tablet of Metformin 850mg/ pioglitazone 15mg but later changed to standalone tablets but with Pioglitazone at 30mg, when this error was later highlighted to the surgery( taking months to sort out) , the only explanation was that the standalone tablets were cheaper than the combined tablets! No recognition of the drug error/ potential harm caused to patient nor an apology. This is what care in a so called ‘deprived’ area had come down to!
After more than 11 years since my major surgery and managing the related pain on my own, it got to a point where the pain was massively affecting my quality of life. So i decided to seek the services of my GP to help find out why the pain was getting worse and also why it was mainly on the left side and not the right where the Fallopian tube had been taken off, also why i was needing to empty my bladder more often. My GP practice had under gone a huge change and had become one of those major practices with around 8-10 doctors. It was a mission getting an appointment and i was informed that i would see a duty doctor as opposed to my named GP as that would take weeks of waiting. So i turned up for my appointment with my husband ( he was not letting me go to hospital alone ever , since i almost never came back last time he did) , the doctor asked why wanted to see him, i told him i had given all that history to the receptionist but i could tell him again, so went to explain why i was there to his completely disinterested self. He then asked what is it i wanted him to do? and that i had been dealing with it for 11 years, so what did i expect him to do? I was stunned into silence, i tried to explain that yes i had been dealing with the pain for that long but i had come in for help because it was getting worse and affecting my quality of life and my work as well and that something didn’t feel right and that if he looked at my records he would see that i was not a frequent visitor to the surgery and that the fact that i had come in meant that i was not coping and needed help. He casually googled the medical term for ovulation pain, then proceeded to tell me that i was suffering from that and that i should would write me a prescription for Ibuprofen which i should try and that would sort out my pain and that i can not expect him to help me when i have no records and do not seek help and that if i need help i should fight for it and bang the door more and then i would be taken seriously as they would then wonder why i was frequenting the surgery and was not getting help/relief from interventions prescribed and so would take matters further. in other words, i had to be a problem patient to be taken seriously! I was gobsmacked and just sat there starring and not believing what i was hearing. I could see that if i stayed and continued arguing my point the situation would escalate into something serious, so we left. I don’t know who was more livid between myself and my husband.
I could tell you how after weeks of banging on proverbial doors I finally got an ultrasound and MRI scan, which showed fibroid growth and bulging disks, further banging led to useless misogynistic gynaecological referral and a most eye opening Orthopaedic appointment where I was being warned to look out for signs of Cauda Equina and to get myself a female gynaecologist. At this point I was just tired 😫. Not that the story ends there nor does my experience of bad healthcare even after changing Gp's ( still same area with super surgery ) and i’m sure mine is not the only story of struggle in getting proper healthcare as a black person not to mention as a woman ( indeed the black practice nurse at my new surgery was leaving due to racism at the surgery! Not to mention that a serious drug error almost occurred because my records had zilch on them, no one had bothered to populate my online GP records! Being a nurse saved the day.)
Historical and all through colonialism with attitudes that still extend to this day, Black people have always been at the bottom of any hierarchical structure, our value and worth was and is still considered below that of the Whites and South Asian and these biases exist in everyday lived lives of Black People no matter your standing in life. How many black Owned and led GP services are out there? I am yet to see a black doctor at a gp surgery! Maybe if there were it would at least be a start in evening out the playing field of healthcare navigation for black patients? Just a thought. All I know is that i’m tired of constantly fighting to live while Black, be at work, I'm school/University, access to healthcare not just bare minimum healthcare and tired of being blamed as a whole for health outcomes while the system is verily rigged and stacked to the rafters against any positive outcomes.
Meanwhile, when you see me at the hospital looking alot worse for wear with conditions that could have been treated had they been caught earlier, please don’t fall into that judgmental trap of “ why are these people so neglectful with their health while it’s free” ! Try to listen and get their story, you maybe the only one who cares enough at that point!
Independent Patient Safety Organisations:
Plan4ZERO- Patient Safety Movement: https://patientsafetymovement.org/product/plan4zero-pin-magnet/
Patient Safety Learning Hub ( U.K based ) : https://www.patientsafetylearning.org/the-hub
Courtesy of the Lansing Injury Law News ( available on the Patient Safety Learning Hub.
Lets talk about Allergy!
Lets talk about Allergy!
Looking at allergy and some of the most common allergens.
If like me you are constantly sneezing, almost gorging your eyes out and constantly apologising ( especially in this Covid-19 era!), or have to mind where you get your take out, or are constantly reading ingredients at the supermarket or shops when buying packaged food or skincare products, then you understand the frustrations having an allergy can bring.
Allergies are caused by allergens - which is defined as “a substance that causes an allergic reaction” ¹, and can be roughly broken down into 5 categories: Eczema, Rhinitis, Asthma, Food and Anaphylaxis. We will look at briefly, a list of the most common allergens for each category, and what services and help are available ( some will be UK specific) to help identify what is causing your allergy and how to manage it.
Gathering at a Barbecue
So what are the most common allergens?
ALLERGIC RHINITIS ²
Furry animals like cats and dogs, Mould, Pollen and House dust mite.
ASTHMA ³
Furry animals like cats and dogs, Mould, Pollen and House dust mite.
ECZEMA ⁴
Milk, Wheat, Soya, Peanut, Eggs, Mould, Pollen, Furry animals like cats and dogs and House dust mite.
FOOD ⁵
Children: Tree nuts and peanut, Wheat, Soya, Milk, Eggs.
Adults: Tree nuts and peanut, Shellfish and Fish.
ANAPHYLAXIS ⁶
Latex, Drugs, Fruits, Milk, Fish, Shellfish, Eggs, Tree nuts and peanut and Insect stings.
IS IT ALLERGY? What happens next!
Most mild allergic reactions can be treated with a dose of antihistamine, bought over the counter like Cetirizine, loratadine or if the allergen is know, for example if its a food stuff then avoidance measures can be used, life threatening allergies with likely hood of causing anaphylaxis may require one to carry a precribed adrenaline auto-injector( Epi-pen, Jext pen, Emmerade). Best practice is always a referral to an allergy clinic, where detailed clinical history is taken, and a range of tests can be carried out like Skin prick tests(amongst others) of suspected allergens, specific IgE blood tests for suspected allergens combined with exposure reduction advice to all sensitised allergens, like removing carpets and replacing them with wooden floors to reduce prevalence of house dust mite for house dust mite allergy or avoiding all shellfish for shellfish allergy. The severity of the allergy and potential risk is also accessed and advice and treatment is prescribed accordingly. It is especially important to attended an allergy clinic if there is increased risk of ANAPHYLAXIS or a suspected case of ANAPHYLAXIS has occured. This is because anaphylaxis is a medical emergency that can end in death and the sooner the causative allergen is found or not and preventative measures are put into place, the chances of not dying from anaphylaxis are improved.
REMEMBER: Use your adrenaline auto-injector as instructed ( if you have one) and call an ambulance or rush to the hospital if you experience any of the following symptoms immediately or within an hour of coming into contact with a suspected allergen.
feeling lightheaded/dizzy/ collapse
throat closing up
shortness of breath
facial swelling( eyes, tongue, lips etc)
All over body itch with hives
REFERENCES:
Lexico online dictionary: https://www.lexico.com/en/definition/allergen [Accessed June 2020]
NHS Rhinitis: www.nhs.uk/conditions/allergic-rhinitis/causes [Accessed June 2020]
NHS Asthma: https://www.nhs.uk/conditions/asthma/causes/ [Accessed June 2020]
NHS Eczema: https://www.nhs.uk/conditions/atopic-eczema/ [Accessed June 2020]
NHS Food: https://www.nhs.uk/conditions/food-allergy/causes/ [Accessed June 2020]
NHS Anaphylaxis: https://www.nhs.uk/conditions/anaphylaxis/ [Accessed June 2020]
USEFUL LINKS:
Anaphylaxis Campaign: https://www.anaphylaxis.org.uk/
Resuscitation UK: https://www.resus.org.uk/anaphylaxis/
EAACI: https://www.eaaci.org/
The British Society for Allergy and Clinical Immunology: https://www.bsaci.org/index.htm
Allergy and Immunology West Midlands: https://allergyandimmunology.heartofengland.nhs.uk/
Thermo Fisher Scientific: https://www.thermofisher.com/diagnostic-education/hcp/wo/en/allergy-autoimmune-diseases.html
Allergy Society of Kenya: https://www.allergysociety.or.ke/
Allergy tests- Kenya Paediatric Assosiation: http://www.kenyapaediatric.org/wp-content/uploads/2017/05/Allergy-test-their-Application-in-Clinical-management-Dr.-Priya-Bowry.pdf
DISCLAIMER: This article is not a substitute to seeking professional medical advice nor should it be used in place of medical advice.
WORLD ALLERGY WEEK 13th - 19th JUNE 2021.
This year’s focus is on Anaphylaxis: how to Spot. Treat. Prevent. A handy info graphic has been produced by World Allergy Week Organisation and you can learn more at:
https://www.worldallergy.org/
The NHS is returning to ‘normal’. Backlog and patient safety
Putting patientsafety at the front ,back and center of every decision as the NHS tries to deal with the huge backlog of cases as it tries to return to 'normal' #effectsofcovid19 #patientcare #covid19uk #healthcare
Click on the link below to read a brilliant piece by Patient Safety Learning on concerns about patient safety and the backlog of cases that face the NHS as it tries to return to normal post Covid-19
Telemedicine in Kenya - 5 years on!
Telemedicine was meant to revolutionise primary health care delivery in Kenya. Five years on, has it?
Technology can play an important part in healthcare, as is currently evident in the role it has played in the fight against Covid-19. Indeed early this year in March, Kenyatta National Hospital (KNH), launched a telemedicine technology center for the detection of Coronavirus, touted as the first of its kind in Africa. Telemedicine allows healthcare professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology.
A quick google search on telemedicine in Kenya, shows that its not a new concept in Kenya. In fact 2015 saw the launch of two telemedicine schemes, that were meant to revolutionise healthcare delivery to Kenya’s rural poor and marginalised communities. The first scheme was a collaborative venture between German based Merck group and the Ministry of Health, that provided a platform which enabled both patients and healthcare providers in rural areas to interact with Kenyatta National Hospital health experts via video conferencing. The second scheme, Sema-Doc was launched by the First Lady Margaret Kenyatta and for monthly fee of 300 Kenyan shillings you would get access to medical doctor plus a whole range of other services by dialing *220# on ones safaricom line. There also exists a whole host of privately run telemedicine schemes like Connect Med (mDaktari) by Access Afya, which aim to offer affordable convenient access to primary care.
Five years on and with the devolution of healthcare coupled with little or no change in primary healthcare delivery services especially in rural and marginalised areas, we would like to know of your experience of telemedicine and if it has truly revolutionised primary healthcare delivery for the rural poor and marginalised communities as envisioned. Have you heard of these schemes or even used any of them or any other form of telemedicine? If so, what has been your experience and what if anything can be improved upon?
Please let us know via the ‘your health matters’ page on the website.
Useful reading:
Nakweya,G(2015) Kenya launches telemedicine initiative for the poor- https://www.scidev.net/sub-saharan-africa/medicine/news/kenya-launches-telemedicine-initiative-poor.html
2. Wanyonyi,P(2015), Telemedicine is here ,but more needs to be done . Nairobi business monthly https://www.nairobibusinessmonthly.com/telemedicine-is-here-but-more-needs-to-be-done/
4. Kabia, J (2018), Technology expert says Kenya is the ‘promised land’ of telemedicine. Health Business- http://www.healthbusiness.co.ke/2015/technology-expert-says-kenya-is-the-promised-land-of-telemedicine/