Dawa Lama wore a dark expression as she looked at her nephew Nurchung Lama, who was sitting on the hospital bed along with two other patients. He had wounded himself while cleaning his cycle, and had been rushed to the emergency services at Teaching Hospital in Maharajgunj at nine in the morning. After an attendant cleaned the wounds and applied dressing on it, they had been asked to wait for a doctor to check up on it. It was one in the afternoon and the doctor still hadn't arrived.
"Who do they think they are? He's not the only doctor in the world," said Dawa angrily as she demanded for the discharge papers to be handed over. "We'll go to some other place," she told Nurchung, who kept quiet throughout and seemed too tired to be a part of the hullaballoo. Other patients, however, agreed with the point Dawa was desperately trying to make. There was a general feeling of dissatisfaction amongst the patients and their relatives who had been waiting for someone to show up and do something about their deteriorating conditions.
The doctors, on the other hand, looked haggard and equally tired. They attempted to make the patients understand, but it was of no use. Emergency department is where patients of all kinds throng to, making it one of the busiest departments in the hospital. Because of that, it puts an extra burden on the doctors and all the medical attendants present there. Each patient wants the doctors to attend to them first, which, more often than not, makes the situation trickier than ever.
Doctors prioritize those patients who are in immediate need of medical attention. The patients are categorized and put into green, yellow, and red areas according to their seriousness, with the most critical cases going to the red area. Even though a certain patient came before somebody else, if his case is not as serious as the one who came after him, then the medical authorities are bound to make the former wait. This system seems to be the norm in most of the hospitals in Kathmandu.
Nsuchhe Man Dongol, Head of Department of Emergency Services at Bir Hospital in Kathmandu, says that it is something that most of the patients don't understand, but the medical authorities have to work according to that particular rule.
"Emergency service is round the clock. There are at least three doctors at the emergency department, three each from surgery and medicine to look after the patients. There are even two to three doctors waiting on-call. They all are there, along with the nurses, to look after the patients. We have an average of around 200 patients coming in every day, and it gets very hectic sometimes," he says.
He adds that sometimes doctors are busy with their cases and can't attend to all the patients immediately. He also admits that this is something that they have always struggled to make the patients understand, and that it becomes the reason of unnecessary misunderstanding in the chaotic emergency department.
Agreeing to that, Parashu Ram Koirala, chief of Hospital Administration at TU Teaching Hospital in Maharajgunj, says that it is natural for the patients to want to be treated first. "It is a matter of counseling. Because it is usually very hectic there, doctors can't always tell a patient to calm down. When such communication fails to take place, both the parties have plenty to get angry about," he says.
Januka Balami, 42, would be the perfect example of such a case. She came to Bir Hospital citing extreme stomach ache around two weeks ago. But she doesn't know what she actually is suffering from. "I don't know what is wrong with me and the doctor hasn't told me anything," she says. Though she and her husband were not as angry as Dawa, they looked lost. Originally hailing from Chitlang, they almost seemed thankful to have a place to stay as they lost their only house in the earthquake of April 25.
Emergency services at the private hospitals, however, are a different story. They are comparatively less crowded. A nurse at the emergency services of Sumeru City Hospital in Jawalakhel said that they don't get many patients in their department. "After the initial treatment, the patients are immediately referred to public hospitals like Patan Hospital," she said.
It is different for road traffic emergencies. Rajib Shrestha, chief of Administration at Alka Hospital in Jawalakhel, claims that the victim's treatment is their first call, though because of complications involved in it, the police have to be summoned first. "As soon as a patient comes in, the police who are here round the clock get into action. If the perpetrator is with them, then they take their license and then they have to bear the cost of the entire treatment," he says.
For those patients who can't pay for the treatment, they are referred to public hospitals, or the police follow up. "But that is usually not the problem," he says, though he shares that there have been cases in the past where the patients couldn't pay the hospital.
Because the emergency department has to be ready for all sorts of cases, it seems that there isn't enough investment in the resources to boost a hospital's capacity to treat the patients. The government should be careful about investing in these resources as it is a question of life and death. Besides that, doctors and other medical attendants should be careful about communicating with the patients regarding their conditions, so that they will have a better idea of what they are dealing with. It might help remove any underlying tensions between the two and make emergency care better and effective, as it should be.
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