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Opinions Mon, 19 Aug 2019

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Families abandon sick relatives admitted at public hospitals

The trite saying goes that blood is thicker than water. This saying places much relevance on relationships as a matter of consanguinity or family rather than platonic friendships. It is therefore naturally and culturally expectant that a family would have the welfare of its members at heart, even to the point of death.

Contrariwise to this, that fellow feeling for family members is seemingly vanishing in society. The erstwhile burning empathy for one's relatives in particular and other loved ones in general is apparently not important any longer thereby giving credence to the common assertion that each one for himself and God for us all.

This diminished compassion for a fellow family member has become rampant at our public hospitals thereby making it difficult for hospital authorities to create more space for other patients. This situation also accounts for the travesty commonly referred to as no bed syndrome in the healthcare delivery system. Sadly, it is now a common scene at public hospitals especially within the Accra Metropolis that people bring their sick relatives for admission, visit them for few days and vanish into thin air. Under such unfortunate circumstances, hospital authorities make numerous follow-up calls to these patients’ relatives but to no avail. The abandoned patients’ relatives often pick up the calls and indicate that they are on their way to the hospital but will never show up. Later, they do not even pick up such calls at all.

Mostly, such abandoned patients do not have valid National Health Insurance (NHI) cards hence they must pay for the services and medications upfront. In some instances that they have the valid NHI cards, the insurance may not cover all the medications, other consumables and services contained in their treatment plan. For example, medical oxygen is not covered under the National Health Insurance hence whether insured or not, a patient who is placed on medical oxygen must pay for it once given.

This pathetic occurrence of families abandoning their relatives admitted at the hospitals often compels nurses and doctors on the wards to contribute money to buy medications and other items required for treatment of such patients. This is how generous some frontline clinicians can be in their frantic efforts to give the patient the best of care yet sometimes when these same compassionate clinicians make certain mistakes in line of duty, society descends on them heavily as if they were the worst of demons. It is sad to observe sometimes that patients are abandoned to the extent that hospital bed sheets become their only clothes.

In some instances, the hospital authorities give free medications and other logistics for the upkeep of the abandoned in-patients but this becomes extremely difficult on some occasions because of financial constraints the public hospitals are faced with.

For some years now, public hospitals have been managed with Internally Generated Funds (IGF) without national budgetary supports as it used to be many years ago.

As a matter of fact, a significant number (about 80%) of the patients seen at public hospitals are holders of valid NHIS membership cards. It stands to reason logically that so long as the National Health Insurance Authority (NHIA) delays in the reimbursement of claims submitted by the public hospitals, the hospitals will be, and actually are in serious financial difficulties and this has negative cascading effects on the quality of the care being offered to patients. From this, it can be inferred that the higher portion of the public hospital IGF is realized or mobilized from health insurance sources.

Knowing that the public hospitals depend largely on IGF from health insured sources, the National Health Insurance Authority (NHIA) should have approached submitted and vetted claim reimbursement a bit more expeditiously. In contravention of this rational expectation by the service providers including but not limited to the public hospitals, claims reimbursable have always been in arrears for so many months and the latest checks revealed that no hospital has yet been paid 2019 claims submitted and 2018 indebtedness to most of the hospitals are yet to be cleared by the NHIA.

It is therefore sad that even in this almost helpless situation the public hospitals find themselves, some uncaring families still abandon their admitted relatives at the hospitals regardless of what it takes to care for them. Some of these abandoned in-patients breathe large volumes of medical oxygen and consume medications but are unable to afford the corresponding bills and no family members visit them.

Astonishingly, some of the family members vanish and wait to be told that the patient is dead then they appear in a vulture-like manner to take the deceased's body for funeral and burial. An ugly scenario at one of the public hospitals in Accra in 2017 was this, for example. The patient was brought by her husband and children. She was admitted. They visited her about twice and abandoned her. Numerous calls were made by the nurses to these relatives but they refused to turn up. Out of frustration eventually, the health officials faked her death and the patient's husband and children resurfaced immediately in mourning clothes and well prepared to whisk her body away for storage elsewhere and burial later. On arrival at the hospital ward, they noticed to their dislike that the patient was not dead so they vanished again. When this patient died finally, the family members came for her body in a grand style. It was as if these family members sought to say that the only good blood relation is a dead one. Perhaps this heartless story may sound as a deceptive account or a fairy tale but it actually happened in a public hospital in Accra.

Another scenario was this. For so many years, the abandoned patient while he was healthy was not visiting home. He did not show up in his hometown even when his biological mother died. Convinced that he might have died elsewhere years ago, his family members performed his funeral rites without his body even though he was alive. Years later when they were told that he was on admission in a public hospital in Accra, they did not show up to see to his healthcare. On the day he died, the bereaved family members appeared in their numbers, paid all the accrued medical bills and took his body away. One may submit with a significant margin of certainty and with this scenario in mind that sometimes the abandoned patient is to blame. It is a matter of the biblical rule of thumb which demands that we do unto others what we want to be done unto us.

Possibly, the most jaw breaking aspect of the situation is that some families tend to litigate over the ownership of the corpse of the same relative (in-patient) that was abandoned while he or she was alive and on admission at the hospital. One faction of the parties claiming ownership of the corpse usually goes to court and files for an injunction which restrains the hospital authorities from releasing the dead body (object of interest) to any of the disputing parties until the case is determined. At this same time, hospital bills had accrued in huge sums and none of the feuding parties comes forward to pay. In fact, similar worst case scenarios abound in most public hospitals in the country.

Unfortunately, the hospitals are not destitute homes. They provide the needed care and when the patient is stable to go home, he or she is discharged. Patient relatives must know that as part of hospital bed utilization statistics, there are three indicators called average length of stay (average number of days a patient spends on admission), average daily occupancy (average number of patients admitted a day) and turn over interval (the day interval between the day a patient is discharged from a bed and the day or time another patient occupies that bed). These bed utilization indicators reflect the hospital bed use in tandem. An overcrowded hospital ward shows the worse of these and many other indicators and that is where the no bed syndrome comes in. Patient care is often a shared responsibility between the clinicians on one hand and the patient and his or her relatives on the other. Patients’ relatives must therefore eschew cynicism and play their required role in the patient care stratum.

It is in the light of the above assertion that it is so shameful that family members abandon their sick relatives at hospitals even when the disease conditions they suffer from are not communicable or anything worthy of stigmatization and renunciation.

Perhaps Apostle Paul's prophecy is at hand because religious leaders have cautioned time and again that we are in the end times. In 2 Timothy 3:1-5, Paul foretold that in the end times people will exhibit nineteen (19) different ungodly character traits and the first of these traits is that men will be self lovers. No wonder we take selfie pictures of ourselves and admire them dearly in the era of technological advancement.

The prophecy states, "But mark this: There will be terrible times in the last days. People will be lovers of themselves...having a form of godliness but denying its power. Have nothing to do with such people (2 Timothy 3:1-5, New International Version)."

It appears to a large extent that relatives of the patients abandoned at the hospitals have the form of godliness yet they deny its power to save humanity let alone save their sick family members. They just refuse to rescue the perishing and care for the dying.

Even as the public hospital authorities and the frontline health workers encounter this unfortunate situation of families abandoning in-patients almost every day or week, one can only pray that may our family tiers become strong again and may empathy and fellow feeling not depart from our midst. Even animals care for one another sometimes. It is therefore a shame when human beings neglect their own even to the point of death.

afetikorto@yahoo.com

Columnist: Philip Afeti Korto

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