Sitting here is SFO(just got the usual we are delayed and we don't know for how long) and can’t get wi fi connection. Just
like my apartment in Gallup. So I am going to have an Irish coffee at the Buena
Vista and try creating this blog in Word and put in on my blog later.This trip
home couldn’t come at a better time. I have been in the Navajo Nation in
general and the IHS in particular long enough to be bothered by the many warts
I see now. The honeymoon is definitely over. Although I still am glad to have
had this experience, I doubt that I will be back. Much to Dr. Mock’s
disappointment. He says he likes how I stir things up and wants me to stay forever.
The negatives of the Navajo Nation. The main thing that
bothers me is the trash. A people that supposedly takes pride in Mother Earth
certainly doesn’t take care of her very well. There is trash everywhere. Broken
bottles, mainly of vodka, plastic cups from the many Sonics and McDonalds, and
empty beer cans decorate the landscape in as much abundance as the cacti and
wildflowers.
Yes, there are stumbling drunks, in great abundance at the
first of the month, but they are benign. Sad, but benign. They talk and laugh
with you, occasionally hit you up for money, but are not aggressive and don’t
litter the street corners with cardboard signs and themselves. I am amazed at
how much they move. Walking everywhere. Up to the plasma center, across to the
liquor store, back to town, and often end up at the hospital where they can
get a meal and a bed while waiting to be seen in the ER for their daily visit.
And that is my segue into the Indian Health Service. This is
Medicaid gone really, terribly wrong. Not in that services are not available.
To the contrary. Everyone comes to the
doctor or dentist as often as possible. 20 yr olds have charts as thick as most
octogenarians in the private world. Wake up with a stuffy nose? Go the clinic.
Don’t like what they say(usually that antibiotics are not needed), go to a
different clinic in another town. Still don’t get what you want , go to the ER,
where they are so busy seeing non-emergent patients that they are likely to
cave in and give you the antibiotics you are demanding. And guess what? You get
better in a few days. So take a trip back to the original clinic to complain
that the white lady doctor doesn’t like Navajo people and wouldn’t give you the
antibiotics that the Navajo PA in the ER did and see how much better you are
already. Of course, you would have been better by now anyhow, but now you get
to make the rounds again to get treatment for the yeast infection caused by the
unnecessary antibiotics. And all this unnecessary care is totally free of charge.
Make an appointment to see the doctor? Never. That, too , is
seen as the white man not understanding the Navajo culture. Time isn’t a big
thing. Unless you can’t see all at once the 10 patients that all walk in at
8:30, demanding to be seen for either inconsequential or very complex problems
that really require a lot of thought and maybe some time, and someone has to
wait an hour. Then you get the stern glance at the watch, the “ how long are
you here” question, and the shake of the head cuz no doctors stay here longer
than 30 days. Kind of reminds me of the days when Chrissy was looking for a
husband.
I am considered the walk in doctor. Which means I don’t have
any scheduled appointments. At all. Some days I see 24 patients and some days I
see 5. Great use of my time. The IPC (stands for improved patient care, haha)
docs are the full time, permanent docs. While I am running around handling
lacerations, chest pain, fractures, and a lot of nothing wrong, but while I’m
here visits, they are leisurely walking from room to room, seeing only
scheduled patients, half of whom don’t show up.
Anyone who walks in, with any complaint, gets to sit in the waiting room
until I can get to them. Even if their own doctor is in that day. Even if they
just saw said patient the day before and made changes in their meds. I get to
jump in the middle of the stream and try to figure out what happened during the
2 hospitalizations they have had in the last 2 weeks, one of which was at
another IHS hospital. (Oh, did I mention that none of the medical record
systems in the IHS talk to each other? They all use the same EHR but they don’t
communicate with each other.)
BUT, here’s the killer. I have to see anyone and everyone
AND be absolutely done by the bewitching hour of 4:30. Then everyone, and I do
mean everyone, leaves or at least clocks out. Yesterday, I got in to see my
last patient at 4:20. She had issues that happened a year ago, but she was in
the eye clinic anyway so thought she’d check in for a medical appointment. I
came out of the room at 4:35 to find the clinic empty. Looked like the morning
after. Lights off, nurses gone. I needed to do a pregnancy test and some blood
work to evaluate the inevitable “oh, by the way” complaint, so I went to the
lab. The lab tech was there, but clearly informed me that it was “10 to 5”
clearly implicating that the lab was
closed. So I did the tests and drew the blood and got it ready for them to
process all while she sat there and watched. And when I turn in my time sheet, they will give me grief for having
put in “overtime.”
During our morning “huddle” I have tried to make suggestions
that maybe patients could be triaged by one of the 3 RNs we have floating
around everyday (in addition to 3- 4 assistants and a few health techs to walk
patients to the rooms), and the less urgent folks could be asked to make
appointments, but I am told it basically that it is a treaty right for native
americans to get health care when and where they want. It doesn’t seem to
matter that this is less quality health care than it could be as I really can’t
take the time to go over everything with one patient when I know there are 10
more waiting. Then I get the eye roll, there goes the white girl again look.
And you should see the looks I get when I say that I am fine staying late to
make sure patients are cared for, but it would be nice if a few of the support staff
stayed as well, since I don’t know the system………
Yep, I am ready for a trip to the chicken coop and some hugs
from my son and hubbie.
No comments:
Post a Comment