How much has changed since the 19th Century?

 

Florence Nightingale though she had her hands full, trying to reform nineteenth century English hospitals. Run down hospitals, drunken unskilled nursing aids, surgeons who refused to wash their hands and patients left hungry, their wounds covered with dirty bandages. 

She struggled agains a conservative medical profession, lazy politicians and an obstructive bureaucracy for decades. By the time she died, English hospitals had become clean places that gave sick people the chance to recover. 

Imagine the ‘Lady with the Lamp’ coming back to visit modern-day private hospitals.

Plush, carpet-lined corridors, pay TV, wifi, iPads and expensive sandwiches. But expensive furnishings won’t help frail, older patients who had fallen out of bed. Wifi won’t help patients sick from chemotherapy. And pay TV won’t bandage a diabetic leg wound. Qualified staff are the biggest expense in any hospital budget. And when money is an issue, staff are the first to go.

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The actual clinical standards in hospitals are, as any nurse or doctor will tell you, a very fragile thing. Prone to dropping quickly when staffing levels fall or the checks and balances are watered down. Who is there to enforce clinical standards, when the same doctor who owns a clinic or hospital, admits and treated his or her own patients? How can patients safely receive complex medical treatments, when there are fewer qualified doctors, no set nurse to patient ratios and no clear hospital guidelines to follow?

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From both personal experience and conversations with private cancer patients, I can verify that in some private Australian hospitals, chemotherapy patients are never reweighed during the entire course of their treatment, no matter how dramatic their weight change might be. I have drug charts that show the accumulative dosage of their chemotherapy has never been documented along with any health assessments or current patient weights, the chemotherapy has been single checked to the patient.

Qualified oncology nurses have advised me that they have resigned from private hospitals, after seeing nurses with no post graduate qualifications in oncology administering chemotherapy and blood products to up to twelve patients on one shift, with only an enrolled nurse to assist. 

From stories passed on to me I can advise that some private cancer patients have received doses of chemotherapy without made aware of the risks of infertility. 

My investigations into public Australian hospitals have revealed that all patients receiving chemotherapy are reweighed before their treatments, and if their is a variation of over 10% in their weight, the chemotherapy dose is reviewed. All accumulative chemotherapy doses are calculated to reduce the risk of patients receiving an excessive lifetime dose and facing heart damage. There are in-hospital policies that enforce the safe and best practice administration of chemotherapy, including nurses having post-graduate oncology qualifications. Public hospitals have a fixed ratio of one nurse to four patients, all patients are told about the risks of infertility and are routinely referred to IVF prior to treatments.

If clinical standards are not enforced, then patients suffer. Transparency is not always welcome. Particularly when it involves wealthy and powerful people confronting and changing bad practices.

A senior pubic health official has told me that when patients complained to the health department about poor treatment in private hospitals, the department met strong resistance when investigating these issues. He said the health department was lobbied by business groups to back off from investigations.

There is a balance between the rights of doctors and hospitals to run their own businesses, and the rights of patients to receive safe and effective care. Sometimes that balance gets lost.

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The public misconception of Florence Nightingale is of the caring ‘Lady of the Lamp,’ who tended sick soldiers passing out comforting words. The reality is that she was a tough reformer, who battled for years, to bring improvements to English hospitals.

The time she lived in, was undergoing a revolution. Up until the eighteenth century, many European cities had open sewers running through city streets, filled with human sewerage, decaying meat from dead animals and chemical waste from industries like tanneries. The foul smelling waste was dumped into rivers, then leaked into underground water wells, contaminating the populations drinking water. Most people did not understand the connection between decayed waste, germs and disease.

The Sanitation Movement brought a revolutionary change. Edwin Chadwick’s painstaking research into the link between overcrowded housing, dirty food and water and the spread of disease, led to the passage of the Public Health Act of 1848. In 1854, a severe outbreak of Cholera in an area of London was closely monitored by Dr John Snow. In a now famous act, Dr Snow persuaded the local church to remove a well pump handle, after linking an outbreak of Cholera to the well, and surmising that the water was contaminated. The result? Outrage in some quarters of the church, government and medical establishment. And a drop in the number of Cholera cases in the area surrounding the well.

In 1847, the Hungarian obstetrician Ignaz Semmelweis noticed the extremely high incidence of puerperal fever in women giving birth in hospitals with doctors delivering the baby. He observed many doctors coming straight from autopsies to assist in women’s childbirth, without washing their hands before attending to patients. Uproar followed. It took people like Chadwick, Snow and Semmelweis years to convince the conservative medical profession to change their practices. Incidents of puerperal fever disappeared. Thousands of lives were consequently saved.

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According to News.com.staff in some Australian private hospitals lobbied to have a four-year report into infection rates in private hospitals withheld from publication, citing ‘privacy laws.’ The extensive report commissioned by the peak body that represents private health insurance companies, looked at 600 private hospitals and examined 25 million data points. Ratings were given to private hospitals from A +++ to C —. The CEO of Private Hospitals Australia, who was South Australia’s health minister until 2002, apparently took his report to both sides of Parliament, claiming the information was in the public interest, and should be released.

There is a whole lot of hospitals that are C —…And we just keep backing up the trucks full of gold bars to pay them.

Outcry at our dodgy private hospitals. The Daily Telegraph. John Rolfe. 10th March 2013.

Numerous academic studies have showed that modern hospital are still unsafe places. And that a large amount of patients are not receiving Best Practice standards of care.

The moral of this story?

Don’t forget where nursing came from. Years of tough battles to introduce reform into the reactionary and powerful medical industry. And don’t forget the lessons of the Sanitation Movement. Qualified staff. Best practice. And the courage to publish the results of studies into unnecessary disease and death. No matter who they upset.

© Wikihospitals 2014