What does it take to get hospitals to care?

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I recently went through a terrible ordeal to get hospital treatment due to a mild case of hives, which quickly turned chronic after failing to get proper timely treatment. I was appalled to find out that this bureaucratic, strenuous and painful experience of mine is extremely common among patients and so I decided to write about my personal experience in the hope to shed some light on the inexcusable state of the health services and prompt the government and relevant authorities to make crucial corrections in the manner in which hospitals provide care to the people. 

Let me first give you a quick background on my history with allergies. I was diagnosed with acute urticaria, or hives, nine years ago when my body started developing rashes. When I got it tested, it was an allergic reaction to dust and some plants, particularly wormwood. Besides allergic reaction to medication and food, urticaria can be triggered by stress, cold temperature and other unknown reasons. It's been a strenuous fight for me and I’ve tried my best to avoid resurgences by keeping up a well-balanced diet and staying away from anything that could trigger it. However, while trying to treat the common cold with hot lemon water, I accidentally caused another trigger.

I’ve never had any problem with lemon water before but with the terrible itchiness and skin rash, I immediately took my prescription medicine for allergies and applied ointment. The medication didn’t work and by evening, it got worse – the hives covered almost my entire upper body and was spreading fast. In addition, I had a fever due to the cold so I headed to the National Dermatology Center (NDC).

Luckily, the center is only seven minutes’ drive from home and as soon as the doctor on duty saw me, she prescribed a sodium chloride 0.9 percent injection, a shot of one milliliter of dexamethasone and a shot of vitamin C to stop the inflammation. The doctor told me to come back in the morning to get checked properly.

Injections for allergy

That night I didn’t get much sleep due to the itchiness. The hives on my chest faded a little but had spread to the back of my head and forehead overnight so I went back to NDC, arriving a few minutes before 8:00 a.m. Even 30 minutes before the opening time of the reception, a dozen people had formed a queue. Twenty minutes later, I was in the office of the doctor who diagnosed me with urticaria and advised I get on the day treatment, a partial hospitalization program, as the center is running low on beds and the inpatient waiting list is long.

Regarding the day treatment, the doctor said, “It’s just like being hospitalized – only you will be sleeping at home.”

I wasn’t sure about the day treatment but as the doctor insisted, I followed her advice and agreed to the partial hospitalization program. After waiting in lines to get blood and urine tests, I was sent to another doctor who was in charge of day treatment, to whom I’ll refer to as Dr. Azaa (not her real name).

I finally met Dr. Azaa after waiting 15 minutes outside her office as she saw another patient. As soon as I opened my mouth to tell her what had happened and answer her questions about my history with allergies, she started talking on the phone with her daughter, ordering some chores. Doctors taking personal calls while meeting patients is not uncommon in Mongolia, which would be considered unprofessional, unethical and extremely rude in most other countries. I was exhausted, tired and starving as I had to fast since the day for the health checkup and get whatever that triggered the allergy out of my body. Repeating my answers a couple of times in between her calls, my day treatment log, called “story” in Mongolian hospitals, was created and she wrote me treatment for seven days.

With my story in hand, I was sent to find Room No. 111 where a nurse administers the daily treatment. I sat still for two-and-a-half hours to get intravenous administration of two large injections and more needles for vitamin C and dexamethasone shots. By 1:00 p.m. all of my treatment, including an enema, was complete but I noticed purple marks on my forehead, cheeks and chin where it was clear before. The nurse thought it was strange too but still sent me home with a bunch of medicines to take.

I was in a much better mood after a small bowl of clear soup and taking the medicine at home but soon after, my face started to swell and I started getting hot flashes. I immediately phoned NDC to check if this was normal but the woman on the other line said, “I’m not a doctor. You should come and see a doctor before the center reception closes at 4:50 p.m.”

It was almost 4:00 p.m. so I hurried back to the hospital and by then I couldn't feel my face. It swelled so much that I had trouble opening my eyes. I went straight to Dr. Azaa and she seemed slightly surprised to see my face and prescribed another dose of allergy shot and ointment. While getting the shot and applying ointment on my face, I was so in shock that I burst in tears – I mean I did exactly as the doctor advised and thought I would get better but it got worse. My face puffed up, becoming unrecognizable, though the hives on my body were slightly better but itched just as intensely.

After calming down, I went to Dr. Azaa, who had apparently moved to another room on the other side of the building for a night shift. Once again I found myself waiting for her in the corridor and had another outburst of tears because of the pain but when Dr. Azaa saw me, without a hint of sympathy, she scolded me for crying.

“I’ve given you all of the treatment you need. Why are you crying? Stop crying,” she yelled.

Thankfully, I calmed down after a while and she put a cold compress on my face and explained that the hives worsened in the facial area due to exposure to cold temperature, which was unavoidable as the temperature outside averages -20 degrees Celsius in January in Mongolia.

Other than a cold compress, she could do nothing else but send me back home as I’d already gotten so many medications earlier that day. But she did prescribe another enema and an ointment to reduce the hives and stressed I eat nothing and drink only water. I begged her to let me get admitted to the hospital, even offered to pay for the bed but she said it was “impossible” because I’d already created a day treatment log. She said, a matter of factly, I should have told her that I wanted to get admitted before the log was created. The previous doctor recommended me to get day treatment. This is "professional" advice which I followed. How was I supposed to know that creating a log meant I can’t be admitted? The doctor wouldn’t even try to explain why the only reason I couldn’t get admitted to the hospital, even though my condition warranted it, was because I have a day treatment log.

The most shocking part was that while this conversation ensued, a nurse in charge of managing beds was phoning people on the inpatient waiting list and telling them to get admitted tomorrow morning. Two people even passed the offer, saying that they were better. To top it off, another nurse came into the room and told the nurse to let two people, whom she presumably knows personally, get admitted as she has “already taken care of everything”.

Devastated, I went home making sure all of my face was covered. At home, I applied ointment, took my medicine and did the second enema of the day.

Unfortunately, the swelling on my face didn’t subside by the next morning so I dragged my aching body back to NDC again. Arriving at the center, I went straight to Dr. Azaa's office but her door was locked. I went to the nurse's office where I get the day treatment but it was also locked, so I went back to the reception to get my health test results and waited outside Dr. Azaa's office. Twenty or so minutes later, a nurse passed by and told me Dr. Azaa was working at the Emergency Department so I hurried there. Dozens of people were queuing outside the room but I couldn’t bear to wait any longer and went straight in, but the doctor wasn’t present. There were only patients and nurses bickering about the inpatient waiting list.

Dr. Azaa finally made an appearance but sent me back to fetch my log from the nurse but the nurse said she'd put it in a folder in the doctor’s room. With all the running around, I felt dizzy and hazy and even had trouble breathing, but thankfully Dr. Azaa had good news for me. She decided to hospitalize me by “scrapping” my log and making it as if it never existed. To do that, I had to return all the medication, injection and medicine I received the day before from home, which I readily complied with. 

It took around 30 minutes for my father to bring all of the medications I received from home and another 20 minutes to buy some that I'd already used. When I went back to Dr. Azaa, she was busy registering new inpatients so I had to wait in a new queue. Being blasted by wind whenever someone entered or exited the room only fueled the rash on my face. Apparently, I was having a fever, reaching 38.6 degrees Celsius, which I found out later. I was barely conscious and shivering by the time Dr. Azaa called me in but she started to bombard me with questions she’d asked the day before to write up my new log for inpatient treatment. When I had trouble getting my voice out, that’s when she noticed me and immediately told nurses to administer all a batch of injections. I almost fainted in her arms and an oxygen mask was put on me to steady my breathing. The doctor explained later that this was an anaphylactic shock, a potentially life-threatening allergic reaction. Even with the oxygen mask on, I was asked the same hundred questions like my address, weight, height and so forth -- all available in my previous log.

At 11:20 a.m., I was moved to the Intensive Care Unit with my elderly father piggybacking me four flights of stairs as the center didn’t have an elevator or gurney. I had to suffer my illness, endure verbal abuse and nearly pass out in front of the doctor to get admitted to NDC. Many of the patients at the center told me that they too went through similar experiences to get admitted to not only NDC but other public hospitals.

Later while admitted, I had a chance to speak with Deputy Head of NDC in charge of treatment B.Battsetseg. After hearing my ordeal and looking through my medical report, she said, “A patient with this kind of diagnosis should not have been treated this way. We have a whole system for emergency patients. We even put on a card around their neck showing that this person needs urgent treatment and to let them get treated first. We’ve already handed out these cards to doctors and made necessary arrangements and yet they seemed to have not followed that system.”

Regarding the medical log, she said, “This repeated process of writing up records is troublesome for all sides. As this is a legal document, we have no choice but to write them up. However, now we’re connected to an e-health program that keeps a digital medical record. We tried to shift to the system before the New Year’s but couldn’t get permission from the ministry until recently.”

I understand that the center is busy and hundreds of patients come to get treated each day, but is it sensible to have patients run around back and forth, refuse to admit them because of red tape, and exasperate their condition before allowing them to get hospitalized? I know NDC is financed by the state and needs to log patient details to receive funding but denying proper care over logs for other treatment is just plain backward and abusive to patients. In the end, the medical log which was said to be “impossible to delete” was scrapped as if it never existed at the whim of the doctor. Had the hospital operated with a better system and with more care, my condition wouldn’t have deteriorated so rapidly and I wouldn’t have needed as much hospital care. In the end, the healthcare system itself is exacerbating its already high load by sidelining and maltreating patients.

This wasn’t my first bad encounter with NDC or public hospitals. I’ve been mistreated by doctors at NDC over the past nine years whenever the hives recurred for whatever reasons. I’ve been following a strict diet, exercising more, and avoiding stress but the allergies are coming back more intensely than before. I’m forced to endure long queues, run around the hospital senselessly, and tolerate doctors’ verbal abuse to get the medical treatment I pay for through monthly health and social insurance premiums.

The Mongolian healthcare system needs urgent reform to make healthcare services more patient-oriented and flexible. Doctors, nurses, health experts and their heads need to come up with a solution to make the healthcare system effective and efficient.

Before going through this exasperating ordeal, I had no idea that getting admitted to a hospital could be a troublesome and even potentially perilous task. I personally felt the vital need for the health system to reform as I don’t wish anyone else to go through the same experience. One of our fundamental rights as a human being is the enjoyment of the highest attainable standard of health. But right now Mongolian citizens are forced to survive through healthcare services that systematically abuses and agonizes patients.

National Dermatology Center

Dulguun Bayarsaikhan