"Your transparency will lead to other people's transformation."Trent Shelton
If there is one excellent lesson life is teaching me is that life is a journey, not a destination, wisdom does not come with age and in some instances, even the most intelligent person can be a dumb***. Yes, you read that right! Life has a way of evening out the playing field and I see this in my everyday practice. Wondering what I am going on you will understand as soon as you read through this post.
As a young nurse( young is relative) I was always fascinated by patients who presented to the hospital with complications from poor treatment and lifestyle adherence to managing their previously diagnosed conditions. To give more insight here are a few examples a patient on TB treatment who had deteriorated to treatment failure directly as a result of noncompliance, a hypertensive patient who ended up with a hemorrhagic stroke because after diagnosis they stopped treatment when their symptoms abated,etc
I was well educated but relatively naive to the school of life so I had a very utilitarian way of thinking when it came to chronic illness. In my mind you got sick, you got diagnosed you got healed or you managed to maintain your quality of life. Well, this was how I had been. I have had my fair share of hospital visits by this time and honestly ninety percent of the time I tried to follow through. Notice that I said ninety percent. So one time I asked one of my then patients what hindered him from drug compliance and let me tell you on this day I learnt a lot. This then led me to be asking these questions what are the challenges you are experiencing with treatment or with the diseases that are currently under management.
would write a whole essay on this but here are a few examples.
1. Costly drugs or recommended treatment modalities
While in placement in a rural facility, I met an elderly lady who had been diagnosed with hypertension. She had used medication for a month but then stopped because she could not afford her treatment unless her children catered for it. However, they were also unemployed so that was presently an impossibility.
2. Lack of understanding of the prescribed treatment
Still, on the aforementioned lady, she thought the medication she had been prescribed was for a few months and was only to be taken when she felt her blood pressure was elevated. This for her was whenever she developed blurry vision or swollen legs.
3. Limited knowledge of the implications of the disease process to their everyday life
One time I met a patient who had developed severe anaemia during pregnancy and she never followed up on her appointments. On delivery, she was in severe heart failure. She reported that she didn't know anaemia may lead to such severe symptoms or complications.
4. Stigma and discrimination
A young lad in his first year at the university campus was always in and out of the hospital with diabetic ketoacidosis. On his third visit, he revealed to me that he was experiencing challenges administering his insulin in a timely manner because he was often around his peers and was previously taunted when he administered it in their presence.
5. Unavailability of the drugs
Despite the development of an essential drug list by MOH patients always decry of medication unavailability.
6. Lack of continuity of care
One time a middle-aged lady with irregular bleeding told me she didn't know she was supposed to be reviewed after the completion of treatment. On her return visit the bleeding had been ongoing for about a month non-stop as she was waiting to see if it shall get better as it was not as heavy as when she sought treatment.
7. Personal preference
A patient once came in with a failing liver because he got diagnosed with an infection and he preferred herbal supplements as an alternative to the medications prescribed.
8. Infomation overexpure
Often we find patients or caregivers who have a lot of information but not necessarily the correct treatment information. For instance, a young female presented to us with a history of irregular menses on further probing I learned she had using combined oral contraception to change her cycle dates as per need for over a year.
9. They felt disconnected from their care providers
An elderly patient shared with me that he has a challenge using medications prescribed by anyone younger than his sons. His youngest son was around forty at the time. He reported that the provider was always either on his computer and hence felt the provider was inexperienced to give him quality care. Unfortunately, on following up I learnt he had not been informed it was a paperless facility and he had never been in one.
Now before you draw assumptions it's important, to be honest. I find it challenging complying to treatment. I am very diligent at my worst but immediately I start feeling better I am more inclined to skip a dose now and then and at times even stop treatment prematurely. Being a health worker doesn't make me immune to this challenge as I become more transparent on this I'm learning that guarded exposure to patients can help them make better decisions and do better for themselves,. So if like me you are trying to be a better health provider learnt to ask obscure questions. Life is like a coin. pleasure and pain are the two sides. Only one side is visible at a time. But remember the other side is waiting for its turn.
If interested to read materials around this area look up the resources below
Faronbi, J. O., Faronbi, G. O., Ayamolowo, S. J., & Olaogun, A. A. (2019). Caring for the seniors with chronic illness: The lived experience of caregivers of older adults. Archives of Gerontology and Geriatrics, 82, 8-14. https://doi.org/https://doi.org/10.1016/j.archger.2019.01.013
O’Donnell, A. T., & Habenicht, A. E. (2022). Stigma is associated with illness self-concept in individuals with concealable chronic illnesses. British Journal of Health Psychology, 27(1), 136-158. https://doi.org/https://doi.org/10.1111/bjhp.12534
Sarker, A. R., Ali, S. Z., Ahmed, M., Chowdhury, S. Z. I., & Ali, N. (2022). Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PloS one, 17(1), e0262900.
