Tuesday, March 26, 2013

Blood Donation 4: At the Philippine General Hospital

Below are my facebook notes today when I went to the Philippine General Hospital (PGH) to donate blood to a patient who has been at the intensive care unit (ICU) for a month now…

Arrived at the hospital around 7:30am. Guard at the entrance won't allow me because I don't have written authorization letter from the patient or his/her guardian that I am donating blood. I said I don't have one because the notice to ask for blood donors was done only via facebook.

Anyway, I went to the 6th floor, patient's room. I was told to go to 2/F, ICU, the patient is there. I saw Rosalie at the ICU, my heart sank. The staff there gave me a form to give to the blood bank as my authorization letter.

At the blood bank, there were many donors in a small room, air con. I arrived there around 7:50am. Guard gave me the form to fill up, medical questionnaire to prove that donor is indeed in good health (no HIV, no malaria, no tatoo, no body piercing, no maintenance drugs, etc.). Then guard said, "Balik na lang po kayo 10am, next batch na po kayo"

Aray ko, paano trabaho ko, sabi ko sarili ko. Pero andito na ako, hintayin ko na, as I remember the sorry condition of the patient. I went out for breakfast, then to an internet shop.

I have donated blood 3x to 3 different patients before. At Makati Med, Asian Hospital in Alabang, and Medical City Ortigas. Donors are treated well in all of them -- clean, air-con, big rooms with cable TV, but few donors. Clean CR is just nearby. The staff there are very friendly and courteous, they told me they really lack blood donors, the hospital has to buy blood somewhere sometimes.

Went back to blood bank section at 10am as instructed, guard said it's only for further interview of our response to the questionnaire, the doctor that will take our BP, heart rate, check any suspicious physical problem, will come at 11am, ouch, then blood sample extraction. All these were finished by 11:30am. We were told to come back after 1 1/2 hours (ie, 1pm) as they will analyze our blood for any impurities (ie, free of HIV, malaria, dengue, whatever viruses/bacteria).

I just got out of PGH compound and crossed Taft to eat and walk around, when the incoming President of the PGH Medical Foundation, JB Baylon, called me. He was in his car and he's going to the PGH, what a coincidence. He asked me to hop in, I did. He brought me to the Foundation office, we talked about many things about public health, PGH, private giving, the Foundation, etc. Thanks for the lunch treat and the chat, JB.

Went back to blood bank around 1:30pm, only to see that those who came ahead of me have never been called yet for the final blood letting. Waited till 2pm, still nothing...

When situation gives you lemon, make a lemonade, so they say. So I walked around and toured the various wards of PGH -- pedia, orthopedic, neurosciences, trauma, etc. My first tour of the hospital actually, by myself. The air around the hospital rooms and corridors seems suspiciously unhealthy. I remember the issue of anti-microbial resistance (AMR) and hospital rooms as nests of new and evolving diseases themselves.

Went back to blood bank around 2:30pm, no one was called for half hour for the actual bloodletting. Many fellow blood donors waiting outside getting more bored, like me.

I went inside and asked what's going on. I saw 6 empty chairs, the staff inside were chatting among themselves, I saw a lady trying to selli bags to the staff.

I controlled my anger as I was told by Andy of the PGH Medical Foundation that the hospital has only one "centrifuge", a machine that tests blood samples for any impurities, which then will be the basis whether to accept or reject a prospective blood donor. That's one major reason why things are soooo slow at the blood bank.

The staff inside, instead of chatting among themselves, at least one of them should have gone out and explain to the waiting blood donors outside, why things are slow, why an ordinary blood donation would ruin practically their whole day's work, but none of that. One male staff, the one who got my blood sample, looked irritated why I asked them when will they call again blood donors so we can go home or go to work.

Later, a lady explained to me that they have to perform 8 different tests to each blood sample. Even if a sample passes 7 of those but fails in one test, a potential donor will be rejected. Sometimes they repeat the tests if they doubt the results. I think it is a valid explanation, but if I didn't ask, she will not explain it to me or to anyone among the donors.

Sensing my impatience, she asked me to sit on the reclined chair for the actual blood letting. Which took me only about 5-7 minutes to fill one bag. Then 15 minutes mandatory rest period.

Went inside the Blood Bank around 7:50am, finished everything by 3:20pm, 7 1/2 hours!

Before going out, I waited if they will give us even a glass of water, none. So I asked the female staff if they don't give any water, she said No. In the 3 private hospitals where I donated blood before (Makati Med, Asian Hosp, Medical City), a bottle of juice or at least tetra pack juice is given immediately to the donor to combat dehydration, free. Here, we were only given a handout to read, “What to do after blood donation”, something that the private hospitals give to us while blood is being extracted.

Am 18-20 liters container of purified water would normally cost P30-35, and can give probably 200+ glasses of water. Plus the cost of a plastic glass, maybe P0.50, so a glass or two of drinking water after a blood donation would cost the hospital only around P1, and they would deprive it to donors? If PGH is cutting cost, a P1 drinking water would affect their finances? I won't buy it. OA lang PGH management for this type of "cost cutting".

Anyway, I have to buy my own drinking water or juice at the PGH coop store, which in itself is also crowded. I queued for about 2-3 minutes to buy the juice and immediately drank half of the bottle. Dehydration is a threat to blood donors, that is why immediate rehydration is recommended.

Then I went back to the ICU and gave the form given to me by the blood bank division. Gave it to the nurse, proof that another bag of blood has been replaced for the patient, Mrs Rosalie Mendoza, the wife of a friend, Bong Mendoza. She has been at the ICU for a month now. I pitied her condition, tubes inserted in her nose, mouth and arms. She cannot speak but she can hear and smile. Reading her lips, she asked my name, I said I am Nonoy, friend of Bong, I donated blood, she smiled.

My disappointment and anger at PGH blood bank has simmered when I saw Rosalie again before I left the hospital. I know that ALL patients who ask for blood are in serious and critical conditions. The two patients where I donated blood before were also at the ICU, in much worse conditions than Rosalie actually.

At the PGH Medical Foundation informal meeting that I joined, we were informed by the staff that a new Centrifuge machine would cost between P500 to P600K. If the foundation can donate to PGH at least one machine, and PGH will hire additional staff, then the blood donation procedure can be made faster. It's less than one hour at MMC, others. So donors can leave early and go home or go to work after.

My modest suggestions, at least at the PGH blood bank division:

1. Put the blood donation section in a bigger room and reduce waiting time. Unlike patients who have to stay in the hospital anyway, blood donors have work to do and want to leave as soon as blood donation procedures are over.

2. Get even 1 or 2 additional staff or medical intern to hasten the screening of blood donors. 

3. Be more realistic in time constraints. If donors should come back after 2 1/2 to 3 hours, say so, not the unrealistic 1 1/2 hours.

4. Staff should go out and explain to donors why the entire process is taking so long. So that donors can plan their day, whether to wait for more hours, or go home and come back the next day.

5. Give water to blood donors, even just one glass. It will cost the hospital only P1 or less per plastic glass of water.

My more serious suggestion of course, is to privatize the PGH. Government will use the P2 billion a year budget to shoulder the healthcare bills of the poor -- on top of existing public health programs and budget -- and won't give that money to other Departments. That is, fund poor people, not the hospital. When hospitals are private, there is the threat of bankruptcy or the prospect of expansion, so people there have the incentives to be efficient, remove lazy or inefficient staff, please the patients. In a public hospital set up, there is zero threat of bankruptcy, people are assured of security of tenure unless they do something really stupid and/or explicitly corrupt. So there is little incentive to be efficient in most cases.

But this idea won't catch fire and hence, not feasible. So some reforms at the PGH and other government hospitals need to be introduced to minimize wastes and inefficiencies.

Earlier, my problem with PGH is the absence of a public CR. At the 6th floor, there was none, only at the patient’s room, but it’s locked because the patient is at the ICU.

I went down to the ICU, also no CR. The guard said, “Sa baba po, sa labas ng building" At the blood bank, also at 2nd floor, no CR either. Guard said I can go to the CR of the Wards section.

Went to the ground floor, wards for children. Not so crowded but sorry state of children there. Anyway, I went inside not for sight seeing but to look for a CR. Sa dulo ng ward, may CR, "For Men", hay salamat, CR!!! Kaso locked naman. Either may tao sa loob or it's always locked and reserved only for patients and their guardians.

I went out of the buildig, CR is at the pay parking area, "Bayad P2.00 ihi. Doon po sa payment booth ang bayad" was the notice. So I went to the payent booth, "Sorry po sir, sira ang CR, barado po." “Patay, eh saan malapit na CR?” I asked. Sa OPD (out patient department) bldg po, was the reply.

Went to the next bldg, OPD, so many patients. The guard was helpful, "doon po CR sir", and at last, CR!!!! and it's open, clean, with donation box, i dropped coins.

There are clean CRs at the nearby PGH Faculty Medical Arts Building (FMAB). But the PGH guards never suggested the FMAB bldg, only the CR outside the building, weird.

See also:
Tips in blood donation, December 23, 2010
Tips in blood donation, part 2, April 03, 2011
Blood Donation 3: Apheresis, August 04, 2012

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