What sort of people go to hospitals?
Sick people.
But what happens if the hospital falls sick?
I was confronted with this unfathomable concept a few months back. Two of our consultant specialists had to leave our hospital due to unignorably urgent needs back home. Suddenly there was a murmur going around the hospital and everyone from the sweeper to the staff where talking about it in hushed tones. Our hospital was going to become a ‘sick unit’ they said, ‘Salary time se nahi milega! Patients ka load decrease ho jayega!’ And from the way it was talked about, it was awful thing to be. I had never heard of this terminology before, but then again I hadn’t been working in a mission hospital for very long.
I turned to a few sources to ask them what in their opinion a sick unit was. Google baba went first and said, ‘Sick (industrial) unit is defined as a unit or a company which is found at the end of the financial year to have incurred accumulated losses equal to or exceeding its net worth.’ I spoke to a few seniors - some say it is a term essentially describing the financial status of the hospital – ‘Used to refer to a hospital which is not doing well financially, usually in debt.’ Others said, and I quote, ‘I believe it is the state of the people in the unit rather than the infrastructure or finances or human resources of the unit. If the people in the unit are ‘alive’ the by-products like infrastructure and finance cannot be far behind.’
A lot our patients believe in ‘tatkal ilaaj (treatment for the time being)’ and we seem to have taken to the concept quite happily ourselves. Our current medical practise is very happy to treat symptomatically. Very happy to put some micropore on the tap but not fix the leak in the tank. Very happy to prune the hedge but not water the roots. Very happy to treat the X-ray or the raised counts but not look for the cause, take a detailed history and dig out the pathology.
When filling out a death report there is always a direct cause, something acute which led to the person’s death. However, there is always an underlying cause, something vague and long standing that we refuse to make the effort to hammer out and treat. Because as we all know such causes take time, effort, consistency and some amount of hit and trial to figure out. The same analogy can be extended to hospitals which are considered sick. Maybe something acute (consultants leaving) may lead to death (shutting down a hospital) but what is the underlying morbidity?
This brings up two questions, both of which I have very inadequate answers for. Firstly, Why does this happen? And secondly what do we do about it?
Is it enough just to have doctors fill an empty OPD chair every two years? Is it enough to ensure than there is someone manning emergency every night? Is it enough to downscale and lay low till things get better? When does one make the decision to pull the plug? Or do we keep running on ventilatory support and inotropes?
During student years we hear of how one person started a one man clinic and turned it slowly into a hundred or two hundred bedded hospital. How the dedication of a few, changed the lives of many. We place these people on a pedestal and expect to find such powerhouses fuelling missions in India. Then we actually start working and get a close look at the real challenges Christian missions in India faces today. For how long can lone people charge and run a hospital? For how long and indefinitely can a few people surrender all, while others watch? In the end we find ourselves inadequate, inept and unwilling even to consider that the same could come of our efforts.
Someone asked me a very apt question recently, what is the purpose of what you are doing? It took me a while to form a coherent thought on that. Why is that? Are we just working without a specific end or goal or vision? Or have we along the way, lost sight of it?
What determines the ‘health’ of a hospital? Is the number of surgeries we do? Is the number of beds we have? The doctor to patient ratio? The amount of money we make? Is being able to pay salaries on time? Is it having more modern equipment? Or, is the happiness of the people who work there? Is it the impact we have on the community? Is it the transformation we see in our own hearts and lives? Is it kinder doctors, nurses and staff who live together with a common goal?
In the end I have many questions, and very few answers.
Hey! thankyou for pointing this out. I was confronted with the same question which was partially a reason for me to take up Hospital Administration. Many of our mission hospitals are actually sick because they are people dependent. or rather clinician dependent. there will be a couple of doctor families who have committed their lives to that particular place but except that the remaining crowd of doctors and other staff is a floating 1 which comes and goes every couple of years. And most of the mission hospitals are actually focussed on providing subsidised care rather than on quality. if we compromise on quality naturally patient load will decrease. and ultimately it is patients who bring money to a hospital. the goal should be on equating quality with affordable care. Another thing that I feel is that all the mission hospitals should come under 1 umbrella so that optimal sharing of resources will be there. Just some thoughts :)
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