Day 80, Referral

Day 80, Asking someone for their help seems a simple enough idea. It is particularly a good idea when you know that the person helping you has more knowledge or more resources to find answers to your questions. Of course if the reasons are genuinely unselfish then there should be no reason to be obstructive, should there?

In the medical world asking for someone’s help is known as a referral. It is almost a special skill in itself because despite it being a completely rational thing to do one will be made to question their very existence in order to carry one out successfully. Of course this is not confined to Mseleni hospital and its various referral centre located miles away in towns that can be reached in a mere 8 hours, if waiting for an ambulance is concerned.

During my time in accident and emergency in the UK referral was an art form. You feel like partly like hostage negotiator and partly like a used car salesman. The aim was to get your patient across to the appropriate intake team and their objective was to stop you. It was almost a game where we argued semantics over a patient lying on a hospital gurney.

Like everything in Mseleni, the principles are the same but the execution is that much harder. To make a referral here your first hurdle is to get the switchboard to agree to putting your call through. Even though the eventually always will, you still have to dance the dance of outlining who you are and what your purpose is. They will then try and put you through to a relevant hospital switchboard who will in turn connect to a department. That department will tell you there are no doctors available and ask to call back to their switchboard. They will give a mobile number for the doctor and I will have to ring through again via the same rigmarole, this time through the shoddy connection where I struggle to hear over the din of the OPD. If the process takes less than an hour you can consider yourself a real charmer

Once through to the actual doctor the real hard sell begins. Back home it is tough enough and can take a considerable length of time and if your skills are good enough they will yield. In Mseleni even if you can talk your way into your colleague agreeing to accepting an obviously sick patient under their care, they will then turn around and explain they have no means to help them and to ring back in a month. While the month passes, often so does the patient.

To my surprise, probably owing to some cosmic alignment I was unaware of, this week I spent a mere fifteen minutes before speaking to a consultant rheumatologist who entirely agreed with my assessment and wanted my patient over in Durban ASAP. Alas she had no one to look after her children and I had to relinquish her bed and hope that when she returns I, and she is equally fortuitous.

It is sad that being able to essentially ask for someone’s help to try and get medical attention to the very sick becomes a series of negotiations. But I suppose I would be naive to think that it would be any different simply because of altruism. That doesn’t really change whether your patient lives in Mseleni or Manchester, only the scale differs.

www.youtube.com/watch?v=uWhkbDMISl8