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Mauritian Health Care: Don’t spoil the ship for a ha’penny worth of tar!


by Lindsey Collen

While the USA’s disastrous health services become known to the world as President Trump dismantles the small gains made under President Obama, I begin to realize just how remarkable our health care service is. Working class people of Mauritius have waged long struggles to force the State to provide good, free health care for all, and have risen up against attempts at privatizing it. It is free. It is thorough. It is efficient. And it is generally caring.

 It is in the context of my appreciation of health care service that I write about the service a friend received at Hospital recently. Her case also reveals one of the systemic flaws – one that has potentially disastrous effects and which is yet easy to prevent. It is a case of the proverbial: Don’t spoil the ship for a ha’penny worth of tar!

 But, my motivation is deeper. There are very strong vested interests that run a non-stop campaign against public health care. Behind the media campaigns are:

 - private insurance

- private clinics

- specialist doctors who work both in hospital and privately

- pharmaceutical companies that prescribe non-generic drugs

- the importers of all manner of hi-tech machinery for health care

 All these different vested interests benefit directly from disaffection with hospital services. Some are in a position to cause the hospital system to work less well.

 Anyway back to my friend’s case. She recounts: “A few weeks back, I had a superficial pain in my right chest/breast, which I thought was probably muscular but, when it persisted, I went to outpatients at Jeetoo Hospital. The doctor prescribed, correctly, painkillers (paracetamol), an anti-inflammatory and I think a vitamin supplement, and I was given an appointment for a fortnight later. When I went back, the pain was less, but still there. The doctor took a family history, noting that my mother had died of cancer. He referred me for a cancer screening by mammogram at Candos, and also for ultra-sound at Jeetoo.”

 This is free health care of an outstanding quality. I doubt it exists anywhere else in the world. It may, if anything, in this case even err on the side of being over-careful, or trigger-happy with tests.

 Let me make a minor deviation. Assuming she dared to seek medical attention in the USA, what would this ultra-commercial dysfunctional system charge her, assuming she wasn’t insured? The internet gives an idea: $102 for the mammogram, and $116 for the ultra-sound, plus $102 for each of the three doctor’s appointments. That’s $524 or over Rs17,000, not counting the medicines. That sum is twice my friend’s monthly wage. It would be half the wages of a quarter of people in the USA.

 Here it is all free. As well as the excellent hi-tech service, my friend says the staff at both Jeetoo and Candos Hospitals were helpful and pleasant. A nurse even joked that she’d just had her birthday. Waiting time was reasonable, too. She chatted to people in the waiting rooms, and so on.

 It was a perfect service.

 Or was it? There was, right at the end, a sink su missing that ruined the famous rupi ron. There was the ha-penny worth of tar missing. And this is what is so infuriating about our health care system.

 When she went on her rendezvous for her results three weeks later: they had not yet met up with the rest of her dossier. This is one of a kind of problems that goes under the general heading of “dosye perdi”. It is not probable that both sets of results had been delayed so long. They had probably just been misplaced.

 And this dosye perdi is something one is always hearing – from friends and on radio phone-ins. That day my friend saw two other people with similar problems with files.

 It is such a relatively small investment to sharpen up the Records Section. The solution is probably simple: get senior staff to re-think the processes that dossiers go through as they move, organize advanced training in accuracy and speed for existing staff, recruit a top records officer to do trouble-shooting, and take on new junior staff who can begin by putting existing records into thorough alphabetical/numeric order. There is only one place for a dossier to be, after all, at any one time. In a filing system, there is only one correct place for a dossier between two others. Staff must be able to put their hands on it at once.

 The second problem, linked to this first one, was that my friend was then given an appointment in four weeks’ time. The missing test results are so seriously “lost” that a month is needed to locate them. A trouble-shooting Records clerk should be able to solve this by telephone on-the-spot in fifteen minutes.”

 In LALIT, when the Ministers and PSs get to read this article, we hope they won’t come up with a silly reply like “once it is all computerized ...”. Computerized systems are only as good as what goes into them, as they well know. We believe that both the Dispensary and Hospital systems would be greatly improved by getting the “retrievability” of the Records System up to scratch.

 If the Authorities answer is that my friend should have made a complaint. Our answer is that, on our advice, she did. She went back to the Jeetoo Hospital and tried to discuss her complaint with someone. She was sent from pillar to post, eventually told that she had to phone. So, she went outside and phoned. They then said she can’t make a complaint by phone. She had to come in person. So she went back in. She was given a form to fill in and leave with a security guard! Which she did. On 16 August 2017. So, there is another section that needs to be put in order:  complaints!

 But the ending is happy. She received a phone call on her mobile phone to call at Jeetoo on 22 August, that is to say today, for her results. So, the complaint form worked.

 And this brings us back to the question of those little sink-su that prevent us enjoying the rupi ron of one of the best health care services in the world. The small dysfunctions can have extremely grave consequences sometimes, and are often merely a question of the will to run the service well. But the will to run a service well includes the will to oppose the campaigns run by vested interests against the health care system.

 In LALIT, we also call on trade unions and associations that group doctors, nurses, records clerks and so on together, to develop programs that include making the health care service work well. The recent corporatist stand of hospital doctors was not a good one. Nor is it in the interests of health services for nurses’ unions to collaborate with the State to send nurses to Germany. But, a good program that seeks excellent work conditions and an excellent service for all, is the way to help build an alliance between health workers and patients.

Lindsey Collen