miércoles, 17 de noviembre de 2010

The complexity of the hospital

This place is a small village full of life and hectic movements in the mornings during the weekdays. From very early in the morning, before sunrise, families come to the hospital, form long queue lines for marking an appointment or wait on the waiting room of the emergency unit. Health personnel also start very early in the morning too. Cleaning personnel, cooks, administrative, technicians, nurses, medical residents, staff doctors, psychologists, psychiatrists around 8am start with their usual activities. During weekends and after 4pm the hospital staff is reduced and only some technicians, nurses, medical residents and staff doctors at both the emergency unit and the pediatric acute care unit remain working at the hospital.
This hospital is one of the most complex and specialized pediatric institution at the country. But this doesn't mean it only covers complex conditions because many 'simple' ones are also covered. Hence the range of conditions goes from the 'simplest' to the most complex ones. Also healthy children are assisted at the hospital and are controlled by the 'healthy child' clinic.
Families and children may come from very different (and far) places to be treated at this hospital. But they are not the only ones. This place also attracts professionals from all over the country (and even other countries), and many medical residents who try the exam to get into residency. From all the residents that I met while conducting fieldwork more than 1/3 where not from the city of this children's hospital. In terms of medical residencies there are two types: the Municipal Basic Residency in Clinical Pediatrics (4 years), Infant-Juvenile Psychopathology (3 years), Biochemist (3 years), Pharmacy (3 years) and Pediatric Anatomical Pathology (3 years). The other type of residency is the Municipal Post-Basic Residency which have residencies in more than 15 sub-disciplines including Oncology and Hematology. In order to be eligible to a Post-Basic Residency first doctors need 5 years of medical school and 4 years of clinical pediatrics.
In many ways it can be argued that medical residents and nurses are the ones that sustain the everyday functioning of this (and others) hospital. Without their work, and without the work of technicians, administrative, and the auxiliary personnel (biochemists, biologists, biotechnologists, pharmacists, mycologists, etc.) this hospital wouldn't operate a single day. However, it is worth mentioning that during the weekdays a wide range of specialists throughout the many departments, services, units, teams work at this hospital. So in many ways this is a complex site, complexity in terms of people and specializations, and complexity in terms of the space and the machinery available. The building itself still retains the features that it had a century ago, there are more than ten different wings with parks in between. It takes time to families and even doctors to get to know the places, and some times it takes years. Many wings are intricate labyrinths and often when I was following residents they would take a short cut that I wasn't aware of.

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