Welcome to public health care

           The past weekend I was in Bathurst, a small community about two hours from where I live. We go door to door talking with and educating people about HIV, and if they would like myself and another nurse test those who choose. We met a man in his home who was diagnosed with HIV last year and who is suspected to have TB. It was immediately obvious that this man needed to be in the hospital. He was thin, dehydrated, and weak.  We went to the local clinic to see what assistance we could provide to this man, not being from around here, we thought the clinic was the best place to source out information. Walking into the clinic, there was barely standing room available. Young women to old women packed the little clinic and there were no signs of a friendly person to ask a question. My manager simply walked past everyone and down the hall looking for the In-Charge (I don’t know if this was because this is a normal thing to do here or if he’s just that balsy).

                The IC reported that “yes, they knew about this client as they had received confirmation that he was positive for TB that day and were  planning on sending for an ambulance tomorrow”. Wonderful! We left the clinic feeling he was in good hands and would be cared for.

 Day two.

                 On our way into the field we randomly stopped at a social support office to see what services they provided and to introduce ourselves as future partners. We realized that we could offer this man’s family food hampers to assist them as funds are tight. We headed to his house to get further info and met his son on his way to the clinic to see what time the ambulance was coming. We drove the son to the clinic where the nurses told him that he would have to bring his dad to the clinic in order for them to call an ambulance. HOLD UP! I am standing beside our car when they tell me this news – and here is my train my thought: They want us to take this frail, thin, sick, palliative man out of his house and bring him to the clinic!? WHY! WHAT! They want us to bring this man to the clinic! You mean the man curled up in the fetal position on his couch under his massive comforter! Can he even walk?! They want us bring this man to the clinic – the man they just informed us is positive for TB!?! WHY! Do they know how TB spreads? Do they want everyone in the clinic to have TB? Okay, so to confirm.... they want me, since I am the only one with a licence and a car, to go pick up this 80 pound man from his comfortable couch so he can lie on a cold stretcher. Uh huh. I thought that’s what you had said.

                What would have happened if we hadn’t decided to pop by? How would he have gotten to the clinic, and were they just going to leave him at home until he miraculously arrived? Did they want him to walk?

                We drove back to his house. His family was gathered around to help us help him to the car. I stood at the doorway feeling utterly helpless as his son coaxed him off the couch, helped him with his shoes, and helped him stand. He stood next to his son a frame of a man, so unbelievably thin. Taking a step forward his pants slipped down around his hips – I jumped forward as the nurse in me kicked in to help him with his pants, and then just as suddenly caught myself not knowing how my helping with his pants would be taken in this situation. This man and his family do not know me as a care taker – they know me as a women who came in asking about HIV and TB. His son caught his pants as we noticed them slipping at the same time, and cinched his belt in farther. I honestly don’t think his belt could go any further. Having to pee before we left, they used a bucket in the lounge. My mind was reeling with everything that I was seeing and learning. This man, didn’t even have a urinal?! Can you imagine us giving a patient in Canada a bucket to pee in! They would just stare at us like we had lost our mind! But here, in this setting, where this man doesn’t have a light bulb in his one light, where his flooring is cracked and worn, where the window into his bedroom is broken.... using a bucket as a urinal just seemed normal.

                So, into my car we go, (I hope all of the disease control officials out there aren’t reading this!) and yes, of course I rolled down the windows! We drove up to the clinic and helped him into a room. His son helped him up onto the assessment stretcher and then backed away as the nurses walked in. The nurses walked in and immediately started talking to my manager as they got an IV set up ready.  I was watching my client as he struggled to get comfortable as there were no pillows or blanket nearby to help. I noticed his packsack that his son had brought and searched through it finding a coat. I rolled it up and placed it behind his back so that he could lean against it and take a load off. As I finished getting him ‘comfortable’ my manager told me it was time to leave. Leave?! What do you mean?!  He wanted to leave so as not to step on the nurses’ toes. I wanted to say, “but who’s going to take care of him?” The nurses had walked into the room and started working without even acknowledging him. They didn’t say, “hello”, there was no, “how are you feeling?” no, “are you comfortable? do you have any pain?” There was no acknowledgement at all that he or his son, were even in the room. I couldn’t believe it.  I didn’t want to leave him with nurses who didn’t even know he was there.   

                 ... I got in the car completely baffled. I kept repeating over and over about how it’s human nature to say hello! To ask how people how they are! If you see someone who needs help, you want to help, you feel something! The women I left him with hadn’t even said, ‘hello’ to him??? I was also thinking about his son,  that man’s dad was most likely dying and they didn’t say hello to him either, didn’t acknowledge his presence, didn’t ask him how he was coping. ...I drove away feeling so confused and so helpless. I know I can’t be thinking, “at home we would do this,” the entire time I’m here. But driving away thinking about how all of us would swoop in, getting him comfortable: give him water, a warm blanket, prop him with pillows, offer his family support - where was the extra care here? Are the nurses here so desensitized to this man’s condition that it no longer registers with them?  Were they upset with us barging in, disrupting their day and insisting that they care for this man, that they were ‘out of sorts’ and didn’t provide the comprehensive care that they normally would? Or is this just the way it’s done here?

             The first three hours of that day were enough to fill an entire day.