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!
