Incompetent Ministries: A Case-In-Point – M.O. Health.

As social animals we possess intuition to recognize intent from behaviour and it pleases us to know someone is looking out for our well-being. Empathy empowers compassion and a trustworthy atmosphere. And I should add catalyzes healing and recovery.

The moment you step in Salmaniya, in contrast, you no longer feel safe; anxious with a sense of impending doom. It has cultivated a reputation for distrust and a popular local opinion is ‘one gets sick visiting the hospital’. It is understaffed and overworked because according to one practitioner, “the ministry wants to provide healthcare for everyone without having enough resources.” The demand and supply curve shifted to the left some 15 odd years ago thanks to this state’s failed policy of naturalizing citizens and from ineptly regulating labor laws, flooding the market with deprived workers who are exploited and at risk of health hazards. Inadequate improvements were introduced to meet this demand for healthcare so the tendency is to accomplish as much work before the shift-ends, jeopardizing quality (life).

The main entrance or emergency is where chaos is on exhibit, where the notion of functioning with limited resources is abused. There is insufficient time to build rapport so doctors hope that patients will be complacent with their curt and abrupt effort. After all they are under real stress so if it’s not worth the stretch to 'entertain' patient concerns entirely in relation to getting the job done, then be it, straining whatever undamaged integrity left of Salmaniya’s rep with their unaccommodating attitude. It adds to the skepticism and patients wait in suspense for their “incompetent” doctors who are heckled and liable in a frenzy that inevitably breeds mistakes.

Briefly serving as an intern, I was excited for the opportunity to belong and work with this community of health-care providers, hoping to possibly alleviate some of the stereotypes and God-willingly gain experience. Although interns are advised to actively participate (they say the onus is on us to find our place around the busy doctor), in practice, doctors appreciate our compliance more than our active involvement because our nascent skills is a risk that can potentially encumber them, or at worse endanger patients. So the frantic system sidelines us into awkwardly waiting for instructions, cautious not to inadvertently say or do anything that reveals more ignorance than our disposition already parades.

We quickly learn to redeem their hesitation by faking enthusiasm for any administrative duty – admissions and discharge, calling for consultations, writing round notes, assisting however possible. At my lowest, I was assigned to count staff at the clinic and get them doughnuts. Of course we endure this with the optimism that our tracks serendipitously educate us with an occasional courtesy exposé.

During the three months that I rotated in Salmaniya it became clear their training is the capricious legacy of attenuated doctors who have come to accept the ubiquitously poor standards. The pressing crowd spins everyone into a current leaving little room for moral reflection and conscientiousness. Their forced brevity and meager supervision compelled me to tense more about not embarrassing myself with silly mistakes than about medical or moral wisdom. This arrangement restrains attention on trivial matters away from considerate planning for patient well-being, so the toil that consumes most of our energy in this framework is meaningless. Standing around a firm during rounds, or in a crowded clinic waiting for an opportunity to learn by observation is the best you could hope for. Which most of us don't mind. At least it is some form of entry into the medical realm.

It gets worse when coaching is sometimes carried out by those who place a premium on subordination; combining fickle and disjointed instructions with nebulous expectations that treacherously holds us accountable (and browbeats our confidence out). You get asked to do something you've never been shown how and you expect it to be a learning opportunity until you get chided and criticized for not doing it right. A classic set-up for intimidation and coercing subservience because after all, “the time to be spoon-fed information is over!”  This drill ultimately influences dull and irascible characters at the hospital with minor scope for improving its unpleasant interactions.

Moreover, the hospital’s hierarchy endorses some egotism from the upper ranks such that it becomes hard and even offensive for egalitarian communications with the few who regularly condescend or throw tantrums. The reactionary behaviour seems to be justified to them as trying to manage and solve issues when it also made them look conceited, socially immature, and unprofessional. In fact, my friend’s mom who suffers from breast tumor had a rude surgeon reproach her for moving in the MRI machine. He was so rude that she has since avoided medical attention. Nevertheless, they are exceptions because on a personal level, most of the doctors I interacted with gave me the impression that they genuinely want to improve patients' lives if not for the accumulating pressure that affords them little breathing space.

For instance, the ministry decided to introduce a new virtual network called I-Seha back in 2012 that was planned to be integrated for a more streamlined and accessible workflow. Instead, not one department or individual was happy about this new change. It is rumored that this project was not wholly implemented after it was auctioned-off to the Ministry, implying that someone pocketed part of the allocated budget. Whether or not this is true, I-Seha compounds the problem by being slower and less user-friendly than its predecessor causing a queue to form over the few PCs available in each department, piling work.

The last department I rotated in which ‘broke the camel’s back’ because I quit mid-rotation was General Surgery. The firm I was attached with consisted of a team of mostly good doctors with great personalities, like senior doctors Abdulla and Zulfiqar who stood-out like flower blossoming from concrete. It was very healing to have the luxury to spend time with these inspiring doctors (although interns are typically cuffed to admin tasks). Unfortunately, the current and its penalties overhauled my aspirations.

The department held morning meetings that were compulsory for all the firms to attend. The already dilapidated setting becomes hostile. Presenters, mostly juniors, face the brunt of the disdain as any erroneous opinion can inflame consultants. It sometimes becomes a twisted show of humiliation that chips-away at the presenter’s self-esteem. Granted some were there to sincerely help educate us, regrettably, their voice is drowned by the clamor.

The more time I spent serving in my position, the more my resentment simmered for a system that forces you to barter compassion for your own sanity. To tolerate it, I had to become indifferent. The extra layer of skin was what made the staff functional in this drudgery because Salmaniya functions beyond its threshold - it is a shattered dam that submerges anyone involved in its carcass under a swamp of grievance that desensitizes you to other human beings, and then demoralizes. What was once a source of inspiration was making my stomach turn: the white lab-coat, medical textbook, being called a doctor, because it all operated with apathy. Whatever knowledge I anticipated from the internship, whatever virtue I devoted to its health-care objectives, whatever enthusiasm I mustered for my miniature role vanished when our firm’s 28 year old patient got transferred to the ICU from a complex series of negligence.

In hindsight, the most under suffrage were nurses who tousled, and were even at the mercy of interns. There’s an unwritten rule at Salmaniya that certain clinical activities are no longer significant for seniors to contribute to, like writing and authorizing medications, collecting blood, performing ABGs. So nurses would constantly badger us for them, especially during on-call days, which was when I observed the true ‘angels of mercy’ at work, committed to their patients with a level of connection I couldn’t see in doc…some doctors.