Denise Ford
State hospitals are dysfunctional places over the festive season. Staff are run at skeleton levels, on the theory that “non-urgent” cases will be kept at a minimum.
Unfortunately, the state’s continued cutting of resources and beds in secondary and tertiary care facilities means that most beds are filled with very ill patients.
It hits the fan when everyone wants to go away for Christmas, leaving fewer staff for the same number of beds. The clinics also close, so the option of seeing a moderately ill patient twice a week at a clinic falls away, and in-patient care is often the only option. Coupled with this is the peculiar way in which patient demographics change over Christmas.
The first phenomenon is “granny-dumping”. Elderly and disabled patients are deposited in the hospital casualty by their families or carers, with vague symptoms of worsening confusion, a new stroke, weight loss or abdomi-nal pain. Occasionally they are just left in casualty for harried medical staff to make a guess at what’s wrong.
It’s not as cold-hearted as it sounds. Families with precious little community or state support often have to deal with people who should rather be in a nursing home or in some form of protected care. These facilities are dwindling in number, leaving ill-resourced individuals to look after the elderly, disabled or mentally ill. Everyone needs a holiday, and the state hospitals are hard-hit in December with patients who shouldn’t be there.
Christmas time is suicide time.
The unofficial psychiatry syllabus teaches doctors that personality disorder patients are “mad, bad or sad”. Suicide patients come from all three groups, as well as a selection of other psychiatric disorders, but the festive season is a particularly popular time for the “sads”. Social isolation and an abundance of alcohol has plenty of people reaching for bottles of pills, particularly on Christmas and New Year’s Eve. Precisely when all the people you need to talk to are on holiday.
If you survive the overdose, you get two days in a medical admission ward, staffed with busy and relatively unsympathetic doctors, while waiting for the hopelessly overworked social worker or psychiatrist to come in. Then it’s 10 minutes counselling to see if you’re serious, home if you’re not, institutionalisation if you are. It’s enough to make you reach for the pills.
The majority of suicide attempts with tablets are unsuccessful and most patients are only too happy to get home after a night of introspection with really ill patients around them. A few patients, especially alcoholic men who live alone, are successful. They generally employ more violent means to kill themselves, like guns, hanging themselves, or gassings.
Ours is a well-armed and ill-tempered nation. Assaults, stabbings, rapes, shootings and bludgeonings all skyrocket in December, most of them alcohol related. The hospital trauma areas are a soul-destroying place to work, as the season of goodwill seems to bring nothing more than a bloodbath.
South Africans are bad drivers. But they are worse pedestrians. Car accidents are an even bigger problem than usual over Christmas, as drunken revellers wander in the way of drunk drivers, and there are the usual polytrauma disasters of “PVAs” (pedestrian-vehicle accidents).
Small towns en route to major cities that have medical facilities geared for the occasional accident are suddenly faced with a deluge of car accident victims as South Africans do the grim lemming run to the coast and back. Bus and taxi accidents are disasters for these facilities and patients regularly die because of inadequate trauma care.
Christmas should be banned for anyone with diabetes. Alcohol and insulin are like fire and gunpowder, dropping sugar levels into the coma-causing range. Those who avoid the bottle can’t be blamed for not being able to resist a mince pie or 19, and arrive shamefacedly and 6kg heavier at their next appointment with blood pressures and sugar levels that make experienced doctors go pale. And then there are the “left it at home” brigade (generally from Cape Town, I find) who pitch at 3am because they need their treatment.
The drug interactions, especially with alcohol, are fascinating. Insulin can be a disaster, but alcohol plays havoc with a huge range of medication. Alcohol also has a number of other effects, with the usual post-party rush for the morning-after pill or the more tragic visit to the local abortion clinic two months later. The “holiday-heart” syndrome is an irregular heartbeat induced by an alcohol binge, particularly in young people, and is usually easily fixed.
And it doesn’t stop there. Sunburn, fireworks injuries, an increase in heart attacks, weight gain, Christmas-tree induced lung disease and an increase in food poisoning are all well described in medical holiday literature.
The aftermath of the Christmas season is not much better. January is a nightmare. Patients run out of their medicines in droves. They disappear to Godknowswherefontein to visit family and can’t get so much as a leaky condom from the local clinic. Patients from Malawi drop their precious tablets in the lake, and pitch on our doorstep in catastrophic states after a heartbreaking 40-hour bus trip.
Those who don’t end up ill bring half-a-dozen family members with them, all of whom are ill and have been fobbed off by their local primary health care centre with some Panado and a vitamin injection. Their urban relative’s brush with the urban hospitals (lots of staff, painful injections and machines that go ping) convinces them to pay us a visit.
Urbanised folk returning from foreign climes don’t just bring back suntans. The STD epidemic immediately post a trip home or on holi-day to the coast is alarming. But it pales into insignificance when compared with the malaria and typhoid cases that survive the trip from our borders and KwaZulu-Natal. Most state hospitals do not provide malaria prophylaxis, and the tablets are expensive, so holiday-goers take their chances. Occasionally, travellers bring back weird and exotic diseases, providing a real challenge to the specialists working in the areas of microbiology.
So, ’tis the season to be jolly. No one mentioned safe, healthy or sober. Humbug. Where’s the Grinch when you need him?