7(J). Outpatients and consent


We don’t give patients adequate information on the drugs and the side effects.

Clinical officer

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On discharge from Chainama Hills Hospital, roughly three quarters of patients were treated as outpatients. They travel to the hospital for periodic reviews. Due to the sheer volume of patients attending outpatient clinics, a clinical officer spends around five minutes with each patient. During each consultation the clinical officer asked rudimentary questions to find out some minimal information in order to write a prescription. Clinical officers had no time to discuss anything further, let alone provide counselling or talk through the patient’s social or family problems. The Head of Clinical Care of Chainama Hills Hospital explained that outpatient provision only extends to symptom management: “we just try to maintain the patients’ functionality, and to document this.”

Outpatient reviews were prescription routines without any involvement of patients, meaning that community-based care boiled down to chemical containment. Clinical officers did not inform patients of the potential benefits and risks of different drugs, or discuss treatment options – usually because no options were offered. No written material on medications was provided. Pills were typically issued in transparent plastic bags without any accompanying printed information. A clinical officer confirmed that:

[w]e don’t give patients adequate information on the drugs and the side effects. When they get side-effects they then turn to healers or the church, and they may be against our medicine.

Old ‘first-generation’ antipsychotic drugs were prescribed, although fee-paying patients had access to second-generation medication. Staff said that this was due to financial constraints and a lack of a laboratory that would allow staff to monitor the patients’ bloods. That said, there is only one drug – Clozapine – which requires a laboratory to carry out regular blood tests.

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