Thursday, May 14, 2015

There are no patient safety posts in Haiti

Today during rounds on the ward, I stepped back to see what commotion was going on in the hallway. There was a man on the floor struggling to get back up on his own power, clearly not succeeding. He had the characteristic piece of tape on his forehead marking him for surgery that day, which means he had had no recent food or water. Now in a facility in the USA a patient on the floor, even one gently lowered without impact, would set off a HUGE chain of events. Multiple staff would quickly rush to his side. There are set procedures for checking the situation before moving the patient. After the patient is moved to the appropriate place (back to bed, on s stretcher), a long chain of paperwork begins online to document what happened, review this documentation at multiple management levels, then put in place safeguards to prevent another incident. All of this is well and good. The intention is for the best care. But there is a totally different cultural context to this type of event in Haiti. As we briefly watched the man struggle, one of my Haitian colleagues told me that in Haiti when someone faints, it is believed that they should get back up on their own. (There was not time to elaborate more.) I also know from experience that in Haiti families are the primary persons responsible for getting a patient in and out of bed, not the staff. After the patient almost fell on a second attempt, the Haitian staff called out to the family to HELP HIM, which they did. He was returned to bed and checked by the medical staff. A totally different chain of events, which can easily be MISinterpreted as lack of caring or ignorance. It is neither. Cultural beliefs run deep. It takes time and empathy to change them and maybe for us to also learn that a hyperactive reaction is not always the best response.

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