Swot and Spar notes

Week 1 (12 - 16 April 2010)

Strengths

I have recently completed my OPD block at Kalafong Hospital where I gained a lot of experience in assessing and treating patient's with back problems. I am therefore finding it relatively easy to treat the physiotherapy out-patients (OPD) at Elim hospital as it seems that the majority of the patients present with back problems.

Weaknessess

I am finding it difficult to blog. There have been occasions when I have lost my saved blog posts as the work that I type sometimes fails to post or save properly as it should. This it exremely frustation and time wasting as I end up having start all over again. I am unsure as to what is causing the problem but I am now trying to back my work up on microsoft word documents and will save as often as possible.

I have still a lot to learn about the different cultural traditions and beliefs which is still new to me. I may not be as sensitive or understanding to my patients ways when assessing and treating certain patients as I should be (I am still learning).

Opportunities

I have a lot of freedom to learn especially during the home visits in the community and during the outreach programs. I have to organise projects by myself with minimal assistance from the staff who are open to suggestions. I am building on my managerial skills and am learning to priorities according to what I feel it most important.


Threats

We have transport limitations at the hospital as the transport department is reluctant to allow us (MEDUNSA students) to make more home visits. We therefore have to arrange our own transport and go to the Watervaal community by ourselves which is not ideal.
There is also a transport problem that may prevent us (MEDUNSA students) from going with during the weekly community outreach program.

The language barrier is limiting me from conducting thorough assessments with certain non-english speaking patients (As many as 40 % of my patients did not speak english). The physiotherapist and physiotherapy assistants are seldomly available to assist with translation. I therefore, base my treatment on objective findings alone and cannot ,unfortunetely, perform extensive assessments on certain patients.

Spar notes (22 April 2010)

Situation

I went to visit a patient at her home in the Watervaal area. I have been seeing her since last week (13/04/2010) and had planned to begin assisted crutch walking and balance training for todays treatment session. I soon was informed that my patient had collapsed earlier and I realised that she had sustained another stroke. The patient has a history of uncontrolled hypertention. On my previous visit, I had advised the family to see to it that the patient received hypertensive medication as soon as possible to prevent her having another stroke.

People

As I arrived I came across two new faces which I later identified as the patients eldest daughter (Dorothy) and son-in-law. The house help, eldest granddaughter (18yr old)and the patient's younger daughter (breadwinner) were all present when I arrived at the house. Dorothy and her husband had arrived after receiving a phone call informing them of the patients condition.

Activity

The patient was not communicating as she normally does and was drooling. She seemed confused and later broke down saying that she just wanted to die. Dorothy was releived to see me and hoped I could assist her. We decided to take the patient to the local clinic (Watervaal) to get further management. I assisted the family in tranfering the patient to their car and accompanied them to the clinic. At the Watervaal clinic I spoke to the nurse in charge and I explained the situation and she then told us to rather go see a doctor at Elim Hopital. We then travelled to Elim hospital and took her to casualty. I tried to comfort Dorothy and the patient and I explained to them what CVA is and how it comes about. By this time, the patient was in a daze and was disorientated. She could not assist me when a nurse and I tranferred her from the car into the wheelchair. Once I finally got the patient to the relevant doctor, I informed the doctor of her medical history. The nurses took her blood pressure which was 221/104. After further assessment the doctor then admitted the patient. I later went to see her and it seemed that she was sedated and could not recognise me.

Reaction:

I feel that the CVA could have been prevented. The patient and her family were well informed about the need to get her anti-hypertensive medication to prevent just such a situation. I feel that nothing was done due to the reluctancy by her younger daughter (the breadwinner of the household) to take responsibility to help her mother. I was later informed by Dorothy that the younger daughter had a pyschiatric history (Bipolar disorder) which may explain the loss of interest in her mothers condition. Although it was sad to see my patient go through such an ordeal, I felt I learnt a lot from the situation and will be better prepared for the procedures to be followed if such a situation should happen again. I saw "another side to stroke". We as physiotherpist are usually only involved in the rehabilitaion stages and we dont get to see the actual attack happening. I will follow up on the patient and reassess her in the wards and take it from there.

Spar Notes (30 April 2010)

Situation

I was sitting in the physiotherapy department when a patient approached me and demanded that I give him a disabilty grant.

People

Jacomie, Rosy and I were alone in the department as the other permanent staff were at a departmental function. Fortunetly Mr Matswiki arrived later to handle the matter.


Activity

The patient was explaining that he had being given a temporary disabilty grant (6 months) which was now expired and he was referred by a doctor for a physiotherapy assessment before another grant could be issued. He had a injury to the left arm (possibly a fracture) that had complicated and from what I could see he seemed to have a flexor contracture of the wrist. He made racial remarks at me and Jacomie and blamed us for all the trouble he had to go through as each health professional kept on referring him to different hospital or department etc. He somehow expected us not to give him the grant and did not want us to assess him (which is procedure) and would not let us view the documentation that brought with incase we stamped or refused to give him the grant. Mr Matswiki had arrived at the department and soon took over the matter. The patient raised his voice and was extremely aggressive and showed violent body language. He said to us that his child was starving and he could not provide food on the table because he could not work. I did not understand what they further discussed because the were talking in Venda. I do not know what the final outcome of the matter was but was relieved to see the patient go.

Reaction

I remained calm throughout the encounter and I ignored the patients comments. When Mr Matswiki arrived I took my tazer out of my bag as a precautionary measure. I felt that the situation would have escalated if my Matswiki had not arrived and I beleive the patient may even have become violent. Just from a general observation I do not beleive that the patient was so functionally impaired to deserve a disabilty grant and I think he had been refused a grant at other hospitals prior to visiting Elim.
This incident just highlights the numerous socio-economic and political problems in south africa. The disabilty grant is so often the only income for some patients and without it you are take away their lifeline. It makes the job of health professionals particularly challenging as it is our goal to improve the patients condition which may have negative impact on the patient because they will no longer have a source of income.