Today I learned a little more about the in’s and out’s of
the Health Care System in the Free State. For instance, there are three levels
of Health Care in the Free State:
Level 1 includes a Primary Health Care Clinic, District
Hospital, and a Community Health Care Center. Level 2 includes a Regional
Hospital and Level 3 includes a Provincial Tertiary Hospital (I’m pretty sure
this is what Universitas is).
The hospital also aims to follow eight “Batho Pele”
principles to kickstart the transformation of service delivery:
- Consultation—you can tell us what you want from
us
- Service standards—insist that our promises are
kept
- Access—one and all should get their fair share
- Courtesy—don’t accept insensitive treatment
- Information—you’re entitled to full particulars
- Openness and transparency—administration must be
an open book
- Redress—your complaints must spark positive
action
- Value for your money—your money should be
employed wisely.
They also believe that every patient or client has the
following responsibilities (as set down by the Department of Health: Free State
Provincial Government in The Patient’s Right Charter):
- ·
To take care of his or her health
- ·
To care for and protect the environment
- ·
To respect the rights of other patients and
health care providers
- ·
To utilize the health care system properly and
not abuse it
- ·
To know his or her local health care services
and what they offer
- ·
To provide health care providers with the
relevant and accurate information for diagnostic, treatment, rehabilitation, or
counseling purposes
- ·
To advise the health care provider on his or her
wishes with regard to his or her death
- ·
To comply with the prescribed treatment or
rehabilitation procedures
- ·
To enquire about the related costs of treatment
and/or rehabilitation and to arrange for payment
- ·
To take care of health records in his or her
possession
Patients are categorized by economic status and in certain wards
they are categorized by illness. For example, in the cardiothoracic ward, the
patients who have tuberculosis are all placed in a room together in order to
decrease the risk of infection for other patients in the ward. However, should
there not be enough beds in the ward, other respiratory disease patients (i.e.
those with pneumonia or asthma) are also placed in the same room as the tuberculosis
patients.
Before delving in to everything I learned in the specific
wards today, I think that it is also important to note that none of the wards
have a room 13 because the staff and patients think that it is unlucky. So
instead, the rooms jump from 12 to 14. Also, it is unethical to indicate a
patient’s HIV status in his or her file, so staff members must read the
medication lists before treating patients to see if they are on any HIV
medications.
Now on to cardiothoracics and cardiovascular!
The dietician in charge of these units remains with the same
patients during pre-op and post-op, which I think makes it a little easier for
diagnosis and treatment. He compared diagnosis to being a CSI agent because in
the patients’ files, the doctors rarely indicate the specific illness that has
placed them in the hospital and the dieticians must put all of the clues
together to figure out what to prescribe the patients. For example, a patient
with pulmonary problems would be diagnosed with “Lung Disease” in his or her
file, but in reality, they may have pneumonia, asthma, lung cancer, etc. So the
dieticians must look up all of the medical history on the patient to determine
what their complete illness is before prescribing different diet and supplement
plans.
It is extremely important that they find out all the
information that they can on each patient because different pulmonary illnesses
require different diet and supplement plans. For example, those with COPD or
Emphysema have difficulty exhaling and the carbon dioxide concentration in the
blood increases, so dieticians must design a diet and supplement plan around
that.
Patients that have a difficulty exhaling often experience a
loss of appetite, decreased oxygen in the blood (which changes their ability to
metabolize different foods), and a change in carbohydrate metabolism (some
carbohydrates are released during exhalation and so a decreased rate of
exhalation changes the carbohydrate balance in the body).
I also got to sit in on a diet history questionnaire (in
English!), which was quite interesting. At Universitas, the diet history
questionnaire looks a little something like this:
What time do
you wake up?
What is the
first thing that you eat or drink?
Details? (quantity,
how many times a day, etc)
When do you
typically eat breakfast?
What do you eat?
How do you typically
prepare it?
When is the
next time you eat after breakfast?
Details?
When do you
eat dinner?
What do you eat?
How do you typically
prepare it?
Do you eat
anything after dinner?
How
regularly do you eat your vegetable?
Who usually
prepares your food?
Does your
eating pattern differ on weekends?
Do you
exercise?
Do you take
any supplements?
How often to
you drink water?
Other beverages?
Once we finished the diet history, the dietician counseled
the patient on how diet affects hypertension. Here’s the jist of what was said:
Increased
salt in the diet can increase your blood pressure
You can
substitute other seasonings for salt
Beware of
hidden salt in processed foods
It is better
to bake foods instead of frying them
It is
important that you don’t add extra salt to a meal
The skin of
a chicken has saturated fats, so it is important that you skin the chicken
before you bake it
Be careful with
“just add water” sauces and soups because they are often laden with salt
Always
remove visible fat from meat before eating
Fish can
help decrease blood pressure (omega 3 fatty acids for heart protection, calcium
for strong bones, and antioxidants for a “body armor”)
2% or low
fat milk is healthier than full cream milk
Always
choose brown (whole wheat) bread over white bread
Fruit lowers
blood pressure because potassium helps to lower the salt content in the body
The last
things worth noting about today are some interesting tips on how to beat
cancer. They include:
Enjoy more
fruit and vegetables
Eat more
food rich in fiber
Be more
active
Eat less fat
Avoid processed
meat like polony and viennas
Don’t smoke
or drink alcohol
Avoid contact
with poisons or chemicals
I’m hoping
to go to a Multidisciplinary Team meeting on Thursday…but I’m sure that more interesting
things are to come tomorrow!
