The Hardest Job at the Hospital
One morning, whilst walking out of the ward I found a hospital security guard — a young lady — in a heated argument with two guardians.
The guardians standing outside the main door into the ward were insisting on coming in. The guard wouldn’t let them in because visitors were not being allowed into the ward at this hour. The guardians said the guard was just being difficult. The guard was clearly frustrated and hurt in the argument. She was almost in tears.
She had been stationed at the door to regulate the numbers of people walking into and out of the ward to visit or help care for patients.
In public hospitals, most patients have a carer or guardian (usually a relative) by their bedside. They stay with the patient throughout the course of admission. Apart from providing emotional support, they step in the gap left by the dire shortage of nurses.
The guardians are usually women. They ensure the patient is fed and bathed. They stay informed on what the doctors say or plan to do with the patient and dutifully relay the information to the wider family. They are the first to notice when the patient has not been seen by the doctors or medication is not being given. They accompany the patient to radiology for their x-rays or scans or escort them to the theatre entrance if they need surgery.
The Malawian community values caring for sick relatives. Friends and relatives take turns visiting and bringing food for the sick. If the family has means, the visitors and meals are plenty. The community looks after you and you are never really left alone.
The wards are open with several rows of beds and there is little privacy. If a patient doesn’t have a guardian, the guardians of nearby patients look out for this patient. They will share their food if they notice no one is visiting or bringing food to this patient. They may even speak to the doctor if they think that the patient is getting worse or not getting treatment.
The job guardians do is extremely valuable. They are the uncelebrated unpaid labour force in the health care system.
Having people constantly looking out and interested in what’s going on with those around them is beautiful community spirit. It also means they can be nosy and unduly interested in others’ private affairs.
Guardians are often asked to leave the wards when it's time for the doctors to see the patients. This decongests the space but also gives some semblance of privacy and dignity when doctors need to discuss sensitive issues or expose the patients and examine them.
Guardians don’t like being asked to leave their patients alone. They want to sit in, see and hear everything for themselves. Between one patient, there may be several people all wanting to stay by the bedside. In addition, people constantly want to visit the sick and stay longer than the visiting hours allow. They will find ways of walking in and out or lingering around the bed. This puts them in perpetual conflict with guards who are under instructions to ensure the guardians don’t get in or stay in the ward when they shouldn’t. The guards spend their days arguing with guardians and visitors who have many different reasons for asking to be let in — some legitimate, some not.
On this morning, I found the young guard and guardians' argument disturbing. Maybe the guardians really had a legitimate reason to ask to be let in. They kept saying their patient needed help with turning and that she was heavy and would need at least three of them to be let in just to turn her.
The guard was exasperated. She kept saying to the guardians that so many people lie just to get into the ward. She had a point. I imagined she may be frustrated for many other reasons as well. Constantly arguing and trying to reason with people that don’t want to listen is exhausting. And she probably gets paid very little. Or maybe she was just having a bad day.
I stopped and offered to go back inside the ward to check on the patient these guardians were talking about and confirm that she really needed help. I found that the patient was indeed a morbidly obese woman that would need at least four people to lift her and move her in bed. I went back to the guard at the door and asked her to let the two guardians in. I politely explained to the guardians that they would have to leave the ward again once they were done turning the patient to which they agreed.
That diffused the tension and I walked away. The guard was still looking hurt. I don’t know if the two guardians took my instructions and really left the ward after turning the patient. It left me wondering how you win when two well-meaning parties, both doing difficult jobs in difficult circumstances, clash.
