Long Essay Hospital
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A visit to a hospital is an experience in itself. During last summer, one of my friends met with an accident. He was admitted to the Safdarjang Hospital, where I paid him a visit. I took this opportunity to see the entire hospital. As I entered the hospital, I saw people coming and going. I went to the enquiry office and enquired about the wards.
Some of the people, after recovering from their illness, were sitting in the lawns of the hospital. They were playing cards and chess. They were enjoying themselves on the grassy lawns while some of the people were going home after completely recovering from their illness. They were in a delightful mood.
The entire hospital presented a very gloomy look to me. The plight of the patients and the seriousness of the prevailing atmosphere touched me deeply. The behaviour of the doctors and nurses was worthy of commendation. They acted most wisely and ably while handling the problems of the patients. The patients, in turn, were also happy with their sympathetic behaviour.
The COVID-19 pandemic has been a stark reminder of the fragility of population health worldwide; at time of writing, more than 1 million people have died from the disease. The pandemic has already made evident that those suffering most from COVID-19 belong to disadvantaged populations and marginalised communities. Deep-rooted inequalities have contributed adversely to the health status of different populations within and between countries. Besides the direct and indirect health impacts of COVID-19 and the decimation of health systems, restrictions on population movement and lockdowns introduced to combat the pandemic are expected to have economic and social consequences on an unprecedented scale.
Maria is a Mexican migrant who has just returned from Connecticut to the Bronx. Her partner Jorge died in Connecticut from COVID-19. She now has no income and is looking for an apartment for herself and her three children. When Jorge became ill, she took him to the hospital, but they would not admit him and he was sent away to be cared for by Maria at home with their children. When an ambulance eventually took him to hospital, it was too late. He died that same night, alone in hospital. She thinks he had diabetes, but he was never diagnosed. They only had enough income to pay the basic bills. Maria is depressed, she is alone, but she knows she must carry on for her children. Her 10-year old child says that if he could help her, he would work. After three months, she finds an apartment.
The COVID-19 pandemic has made it evident that to improve the health of the population and build healthy societies, there is a need to shift the focus from illness to health and wellness in order to address the social, political and commercial determinants of health; to promote healthy behaviours and lifestyles; and to foster universal health coverage. Citizens all over the world are demanding that health systems be strengthened and for governments to protect the most vulnerable. A better future could be possible with leadership that is able to carefully consider the long-term health, economic and social policies that are needed.
While the utility of primary prevention is understood and supported by a growing evidence base, its implementation has been thwarted by chronic underinvestment, indicating a lack of societal and governmental prioritization. On average, OECD countries only invest 2.8% of health spending on public health and prevention. The underlying drivers include decreased allocation to prevention research, lack of awareness in populations, the belief that long-run prevention may be more costly than treatment, and a lack of commitment by and incentives for healthcare professionals. Furthermore, public health is often viewed in a silo separate from the overall health system rather than a foundational component.
Governments are challenged by how best to provide care to their populations and make their systems sustainable. Neither universal health, single payer systems, hybrid systems, nor the variety of systems used throughout the US have yet provided a solution. However, systems that are ranked higher in numerous studies, such as a 2017 report by the Commonwealth Fund, typically include strong prevention care and early-detection programmes. This alone does not guarantee a good outcome as measured by either high or healthy life expectancy. But there should be no doubt that prevention and early detection can contribute to a more sustainable system by reducing the risk of serious diseases or disorders, and that investing in and operationalizing earlier detection and diagnosis of key conditions can lead to better patient outcomes and lower long-term costs.
In middle-income countries, private investors often focus on extending established businesses, including developing private hospital capacity, targeting consumers already benefiting from quality healthcare. As a result, an insufficient amount of private capital is invested in strengthening healthcare systems for everyone.
Dependence on a steady stream of fee-for-service payments for outpatient consultations and elective procedures is leading to pay cuts for doctors in India, forfeited Eid bonuses for nurses in Indonesia, and hospital bankruptcies in the United States. In a recent McKinsey & Company survey, 77% of physicians reported that their business would suffer in 2020, and 46% were concerned about their practice surviving the coronavirus pandemic.
In this regard, strategic purchasing for health has been advocated and should be highlighted as crucial with the emergence of the COVID-19 pandemic. There is a need to ensure value in the way health providers are paid, inter alia to increase efficiency, ensure equity, and improve access to needed health services. Value-based payment methods, although not new in many countries, provide an avenue to encourage long-term value for money, better quality, and strategic purchasing for health, helping to build a healthier, more resilient world.
Joyce lies next to 10 other women in bare single beds in the post-partum recovery room at a rural hospital in Uganda. Just an hour ago, Joyce gave birth to a healthy baby boy. She is now struggling with abdominal pain. A nurse walks by, and Joyce tries to call out, but the nurse was too busy to attend to her; she was the only nurse looking after 20 patients.
Systems are straining under significant pressure to ensure standards of care for both COVID-19 patients and other patients that run the risk of not receiving timely and appropriate care. Although poor quality of care has been a long-standing issue, it is imperative now more than ever that systems implement high-quality services as part of their efforts toward UHC.
Poor quality healthcare remains a challenge for countries at all levels of economic development: 10% of hospitalized patients acquire an infection during their hospitalization in low-and-middle income countries (LMIC), whereas 7% do in high-income countries. Poor quality healthcare disproportionally affects the poor and those in LMICs. Of the approximately 8.6 million deaths per year in 137 LMICs, 3.6 million are people who did not access the health system, whereas 5 million are people who sought and had access to services but received poor-quality care.
The construction is part of a two-phase project to expand the capacity of Butaro District Hospital to serve more patients and become a university teaching hospital for students from the nearby University of Global Health Equity.
The 62-foot-long building will accommodate new departments and double the capacity of existing wards and services, including a modern emergency department, a new imaging unit with a CT scanner, and new pediatric and adult wards.
The new spaces are designed in a way that prioritizes the comfort and safety of patients. The floor plan is meant to ease the flow of patients and staff. Big windows and higher ceilings will allow natural light into the building. To create a more welcoming environment for young patients, the new pediatric ward will include a large outdoor playground. The expanded hospital will also have a cafeteria for students and health workers, while patients receive free meals at the nearby support center.
A short walk from the construction site, the economic impact of the project is on display in the boisterous town of Rusumo. A gas station refuels construction trucks; banks have long queues of people waiting to cash their paychecks; hostels have seen a spike in demand since construction began.
Seraphine Uwimana, 46, was one of those patients. The mother, who lives in Kigali, was diagnosed with stage three breast cancer in 2019. Because this stage is considered advanced, she had to travel regularly between Butaro and Kigali for a CT scan as part of her treatment. The journey is three hours long and includes an hour of travel on a rocky dirt road. Once the new CT scanner is installed in the expanded facility, such a trek will no longer be necessary for future patients.
The recent literature suggests that simple anthropometric parameters (weight and body mass index) underestimate the nutritional risk of patients admitted to hospital.12 Recent weight loss appears to be the most important single indicator of nutritional status.12 The Malnutrition Universal Screening Tool and the Nutritional Risk Screening Tool 2002 are simple screening tools that identify patients who require more in-depth nutritional assessment and periodic monitoring.
Nutritional risk continues to be unrecognized and under-treated in clinical practice. Routine screening of all patients is not always done at hospital admission, and nutritional support is often not started for undernourished patients at high nutritional risk. In addition to the impact on morbidity and mortality, disease-related malnutrition also has an economic impact. In one study, the estimated cost of treatment for a patient at nutritional risk was 20% higher than the average cost of treating the same disease in a patient without nutritional risk.15 Given increasing treatment costs and decreasing insurance reimbursements, hospitals need to develop comprehensive strategies to identify and treat malnutrition in patients at hospital admission, to monitor the nutritional status of patients while they are in hospital and to provide nutritional support for those found to have a compromised nutritional status. 153554b96e
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