Shrink's Views

ramblings of an unknown psychiatrist

“Divide and Serve”

Posted by Dheeraj Kattula on December 29, 2009

I worked in a Hospital associated with Leprosy work for quite some time. Few months ago I went back to my parent hospital and my own specialty. I returned few weeks ago to cover for absence of a doctor for a period of 3 weeks. Dr Johnson, the doctor whom I have relieved was also here for a short term replacement only. I went with him to the Leprosy home for a routine visit. I found that the whole atmosphere there has changed. Patients were more involved in care for themselves and also for others. This came as a shock to me. I have seen them for years. I found them indifferent to their own problems, not to speak of problems of others.

 Dr Johnson organized games after the clinic was over. I was overjoyed to see the participation of the inmates. I was curious to know, what magical spell he had cast that the whole culture had changed in a span of 6 weeks that he was here.

The problems that patients faced were usually reported to the paramedical staff. Those staffs were responsible to settle the problems and refer appropriately to the hospital. The paramedical staffs are also responsible for arranging food, supplies, accounts etc. They were not answerable to the hospital administration directly. Their broad job descriptions and not being in span of authority of anybody on a daily basis gave them freedom. The patients suffered. Hospital could only help when hospital staff visited the Leprosy Home or when patients came themselves to the hospital. My predecessor and I tried to change the organizational structure for the better. We failed. So, we reduced the target of quality and tried the best that we could do instead of looking at the best that patients could get.

Dr Johnson changed the system without changing organizational structure in any way. He divided the patients into groups of 6-8. He selected young, intelligent persons within their group to the group leader. He divided the groups in such a manner that each group had a balance between young and old, fit and disabled etc. So there were groups among men and groups among women. He selected one representative from men and one from women. The group leaders are supposed to meet these representatives everyday and report the problems faced by individuals in the group like who has got fever, who pricked her/his foot with a thorn etc. These reps were senior inmates who have received some medical training. They knew when a patient could wait for the next visit of paramedical worker/ nurse/ doctor and also when a patient needed to be moved to the hospital.

Within a short time the groups became alive. They met regularly. They knew each others problems. They started to help each other in other ways as well. Their attitudes changed. Initially, they had to report their problems to STAFF. Now they had to report their problems to their OWN people, which is much easier. Dr Johnson taught me the principle of decentralization in a novel way. The paradigm that patients can care for each other is also new. The beauty is that it also works. There is another lesson. Individuals, as weak as they could be can become more self-reliant in groups. Leprosy home visit would remain memorable for many reasons.

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