Bureaucracy: the medical student’s* constant companion

Or, a crazy stream-of-consciousness rant about my morning:

As a med school “super senior” who has done a fair share of away rotations, I have certainly seen a good amount of red tape, especially in my attempts to prove to away institutions that I am, in fact, vaccinated against mumps, OSHA-trained to safely dispose of needles, and insured against malpractice. But the bureaucracy I experienced this morning was, as my roommate put it, “a caricature of itself.” To briefly sum up the entertaining events of the morning: I started (rather, was supposed to start) a rotation today in toxicology at an unnamed hospital in the Midwest (I am applying for residency out here…can’t be too careful, ya know). After being unable to determine the exact date or time or location for anything this morning, despite multiple emails and calls to several people, I finally found a time and place to aim for. After waiting for ages in a boiling hot room of an ancient building with 40 other short white coats, we filled out some paperwork, then watched a video on proper needle-disposal and hand-washing practices (Really? Turn on the hot water? Ya don’t say), then attempted to get paperwork to get our ID’s (one of the only things I was told about the rotation I was starting was that I was not to show up without an ID). So I enter a very inefficient woman’s office (I already don’t like her…I recognize her name as one of the people who has never returned my phone calls), and am told to find my paperwork from a giant file cabinet, loaded with manila folders theoretically alphabetized by last name (welcome to 1954). She is flummoxed when I can’t find my paperwork. ‘What’s your last name? Are you sure you sent in your paperwork?’ Yes. Three weeks ago. ‘Are you sure it’s not in there?’ Yes. ‘What’s your last name?’ Rinse, repeat. She phones the administrator of my rotation, who…says she’s never heard of me. Despite the fact we’ve exchanged emails in the last week. Finally she admits she received my application. And although the papers themselves cannot be located, I have brought along an extra copy of all my immunization records. I am prepared! Yet I cannot get an ID because there is no list of all the negative TB tests I’ve had. I had a negative one in August (yay! No post-Africa TB for me) and records of one a year for the past 5 years (though with no listed results for the other ones). I explain that if my last one was negative, they’re all negative, because you can’t be positive and then negative. She says, “I know you’re trying to use logic, but I’m telling you I need this piece of paper.” Ah yes, silly me for using logic when I just need to produce a piece of paper. And here I thought the point of this was to show you I don’t have TB. Which I can do with this one paper I’m clutching in my clenched fist. But nevertheless, I understand it’s your job is to push paper, and you need this form. So the form gets faxed from my school’s student health department (good lord they are nice and helpful there), but all the while this is taking place, I am told to vacate my chair several times. Even when I’m not sitting in it (like when I’m in the hall pleading with the student health nurse to find my files, my bag and coat are still on it). But for some reason, this woman wants to have students lined up in a specific way: 1 at her desk, and 3 sitting in the chairs (which are not in a row) in her office. Nevermind that no students are actually lining up like this, they’re just entering her small office when the previous student leaves. And yet…she’s fixated on the fact that she needs her chair so students can sit in it while they’re lined up, even though no one is attempting to sit there. Eventually, just for entertainment purposes, I keep sneaking back in there and sitting in it while I’m waiting for my fax, just to see if she notices. Finally she accepts my vaccination sheet, and sends me off to get my ID. It’s OK that it’s 10:30 am and I was told to report to toxicology conference at 9am. Whatever. So I find my way to the ID badge office, and after telling the man working there I’m a student and handing over my paperwork, I am told, “A student? We’ve reached our quota for the day.” I look around. Quota? But there’s no one in here. There are three employees back there doing nothing. You’re telling me you can’t make me an ID? No, apparently there’s a “student quota” for ID’s which is usually met by 8:30am on a Monday. But, since an initial ‘no’ is rarely the final word, I am nice and persistent and smile and finally get my shiny new ID. (And I’m not even scowling in the photo). So, only two hours late, I start to make my way to toxicology conference. It’s in the Poison Control Center. I figure since no one answered my emails, I’ll just google the exact address and ask at the front desk. Seems simple, no? So I google it, it’s a block away, I go there and can’t find any doors where google maps tells me they’ll be (I know, I know, I should have learned by now not to trust google maps). So I call the administrator of the rotation to ask how to get there. “Oh, conference is at the poison control center downtown on Monday!” Of course, there are several poison control centers scattered around the city. Could NO ONE have mentioned this to me? Ok, deep breath. “And conference will be over soon anyway, so it’s not worth it to go over there.” Ok, that’s fine. I tell her I want to reach the program director to find out where and when I can meet her so I know what I should be doing for the rest of the day (since I can’t talk to her at conference like originally planned). I am told she’s in conference (duh) and won’t answer her phone, so I should send an email to this woman, who’ll forward it on (is anyone still following me here?? I’m confused just re-reading it, and I lived through it a few hours ago). I suggest I can just send the director an email directly, but the administrator would rather I send it to her, and she’ll forward it. Fine. So I hang up and send a one-line email about how to contact Dr. So-and-so. I wait. Five minutes later I get a response from the administrator (I am cutting and pasting this), “Did we speak or is this a recent e-mail. I thought we discussed that the conference was over at the poison control center downtown?” Um, what? I’m sending you an email because YOU TOLD ME TO SEND YOU AN EMAIL. And YES we just spoke it was 5 minutes ago!!! Ok, deep breath, calm response, saying I would like to reach the director I was supposed to be meeting at conference to see where I should go for the rest of the day. Five minutes later, another email, “They r done for the day. Conference is from 9:30 til 11:30. PLEASE CALL ME.” At this point I was beginning to think I was in some parallel universe TP'd in red tape, from which I was unable to escape.
Anyway, here’s hoping to a more efficient and well-organize day two…. ☺

*I realize that bad bureaucracy happens to good people everywhere. I have just experienced 95% of my life's red tape in the past four years.

WOW...

...I am the worst blog-updater ever. In my next life I'll be better at it, I swear.

A picture, just to make this post a little longer:

Wow, that's an oldie. I promise to update more often. Well, I guess all I can promise is that I'll try to anyway...

The Hippo says Hello

There he is. Yup, he's looking right at you.

The view of some houses from the river trip. We took a boat down (up?) the Ogooué river, into a giant lake, picnicked on the shore, saw hippos (see above), played soccer, took pictures, and celebrated the end of our roommates' (see below) stage (internship) at Schweitzer.

These are the triplets of the hospital. Not actually triplets, but they're all the same age, two have nearly identical names, they all lived (pretty much) on the same surgery ward, and they all have Buruli ulcers. I loved these girls so much, I will try to write a longer post about them. In this picture they are watching a video I took of them dancing on my bed. (No, they were dancing on the porch, but watching the video sitting on the bed. Goodness English is confusing.)

Two pictures I love of my roommates. L-R: me, the impossibly adorable Larry (girls get boys' names here), Narcisse, and Elizabeth A Point Sack.

new pictures

Some of the many birds' nests in the trees at the hospital.  I just liked this picture.

One of the many posters hanging around the hospital about AIDS ("Everyone together against AIDS").  

These roosters are so stupid.  I thought roosters were supposed to crow at dawn.  These roosters (and there are many of them, some mere feet from my head in the morning) crow at all times of day and night.  We now dream of coq au vin.  

A haiku, courtesy of my roommate:

Oh, stupid rooster. 

Crowing your virility

You're just a small cock   

Yay! Gabon's making headlines!

Oh wait, but not for anything good.  Please see the wonderfully-written nytimes article on the recent developments here.  In brief, the president of Gabon ("Africa's longest-entrenched autocrat") died this weekend.  The government has responded by closing the airport and borders and imposing a curfew.  But everything's just fine here, so please don't worry.  We are far from the capital, which is where things usually go down anyway.  Just wanted to write a quick note in case anyone was worried about me being in the middle of a politically-unstable central african nation.  And now back to your regularly-scheduled programming.  

New Pictures

Welcome, indeed. :) 

This is the hospital, outside the Polyclinique, where I spend most of the day.  This was taken on a particularly muggy morning, normally it's brilliantly sunny.  The yellow building is one of the surgical wards, but they all kind of look like that.  Those giant trucks are from the military hospital.  A large brigade of soldiers descended last week with ophthalmologists and otolaryngologists and their mobile exam rooms and ORs (the above trucks) and saw patients from 7:30 am until midnight.  People were sleeping overnight outside to have a place in line.  

Typical hairstyle.  Women are crazy about their hair here.  Everyone has an elaborate weave or a wig.  It's pretty awesome.  

We went to a culture festival in Libreville this past weekend, and this is a picture from outside the Senate building, where there were a bunch of different dance groups from all over the country.  It was pretty cool.  :)  (Gosh, I'm so eloquent this evening, eh?) 

Dr. J- Rant Of The Day

I work with a rather, uh, charismatic doctor here. He likes going off on rants about various subjects from time to time, that range from the incompetence of some staff to the living conditions of Chinese workers in Gabon. His chosen subject the other day was the state of medicine in Gabon. Which is: not good. The government has been unable (or unwilling) to pay its bills to the hospitals for quite some time, and the result is that all of the hospitals have been on strike since January. (Not this one, it’s funded mostly by international foundations.) So the result of the strike is that sick people are not getting medical care, then when they’re gravely ill, they come here (to the HAS: Hôpital Albert Schweitzer), where often it’s too late (Dr. J-: "Do they think we're magicians?!"). The HAS has also been relatively overwhelmed with patients since the strike started: the maternity service has patients on mats on the floor, because they’re out of both beds and mattresses (“Patients are on the floor, four to a room! That is no way to treat people”). The medicine service sometimes keeps patients in maternity and surgery because there are no medicine beds left. It is frustrating that the government is unwilling to pay for medical care for its citizens, and it’s easy to place blame on any number of factors for the fact that people are suffering and dying of treatable diseases simply because there are no resources available to them, so his next statement caught me off guard: “And who is responsible for this?? We all are.”