On my second clinical practice block I was placed at Paarl Provincial Hospital where I worked with a variety of patients that reflected the statement of South Africa being “the rainbow nation”. On a daily basis I worked patients of different races, religions, sexual orientations and beliefs and I made an effort to treat every single one of them equally and without discrimination, but unfortunately I was not always able to. According to the Health Professional Council of South Africa (2018) a patient has the right to a positive disposition displayed by the healthcare providers that demonstrates courtesy, human dignity, patience, empathy and tolerance. The South African Human Rights Commission also states that no one has the right to discriminate against another based on their race, gender, sex, marital status, ethnic or social origin, color, sexual orientation, age, disability, religion, conscience, belief, culture, language or birth among others.
During this blocked I encountered a patient who was cover in tattoos, similar to the man in the image, and among these tattoos was a specific one that stood out. It was a simple tattoo, but the meaning behind it was powerful. It was a tattoo of the number 27. After talking to this patient I found out that he was an active member of the 27 number gang. Members of this particular gang are career criminals who specialize in violence. Immediately after I found out that he was a member of this violent gang, I was hesitant to be near him. Each session I had to spend with him I only verbally explained to the patient what to do and how to do it and I aimed to end the session as swiftly as possible as I was afraid that he would be violent towards me. I constantly judged the patient based on his appearance and his gang affiliation without even knowing him personally. Then in my last session with him I had a lengthy conversation that changed my whole perspective. He explained to me that he grew up in a gang ridden area and that the only way he could keep himself and his family safe was to join a gang as the gangs offer “protection” to their members and their families. Now that he is older, he wants to leave the gang and start a new life. He explained that he has a love for painting and that he wanted to become a world renowned artist, but he also stated that once you join the 27s it is almost impossible to leave.
As a healthcare professional I had the responsibility to treat him to the best of my abilities and without discriminating against him due to his gang affiliation, but I did not. I believe that I had a right to be afraid of him due to the rich history of the gang, but my actions were inappropriate. Initially I could have talked to the patient and if he showed any signs of violence I could have followed certain steps. According to (SAMA, 2019) I should follow the following steps: I should asses the consulting environment, I should be aware of the escape routes from the consulting room, I should summon the security personnel before assessing such a patient, I should avoid consulting with such a patient alone, I should have enough assistance to restrain the patient if need be and I should be familiar with the institution’s guidelines.
This experience made me realize that you may have all the knowledge in the world, but if you are unable to communicate with and treat any patient without any discrimination against them, you will be unable to effectively treat them. In the future I would advise students to take their time with the initial assessmet of the patient and get to know them more. When you know the patient’s story, you will have a clear understanding of his/her situation and how your treatment will affect his/her life.
References
15 basic human rights you should know. (2018, March 20). Retrieved from South African Human Rights Commision: https://www.sahrc.org.za/index.php/sahrc-media/news/item/1262-15-basic-human-rights-you-should-know
(2019). Retrieved 14 October 2019, from https://www.samedical.org/images/attachments/guideline-for-medical-practitioners-safety-in-the-workplace-013.pdf
Conduct and Ethics. (2016, September). Retrieved from Health Professions Council of South Africa: https://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/conduct_ethics/Booklet%203%20.pdf
Understanding the 27’s. (n.d.). Retrieved from The Numbers Gang: https://thenumbersgang.weebly.com/the-27s.html
COMMENTS
I really liked your article Tiaan and can relate to your experience as I have had a similar experience myself. I think your topic is really relevant considering the communities we work and live in and I am sure other healthcare professionals will also have come across gang members and have had to treat them and possibly had similar ethical and moral concerns. I feel, as if I would of possibly responded in the same way as you did, but do feel that you treated the patient and still gave them the ethical respect they deserve, even though you feel you did not handle the situation in the best manner possible. Unfortunately we live in a country where violence is a real hot topic, and violence in the healthcare setting is also a real honest concern. Even though you said you would ask another health professional to join you in such instances, I do think that asking a colleague to join you in treating a patient out of fear, will not always be possible as through own experience, hospital and clinics are already short staffed and over populated regarding patients. Can you think of any other ways you can assess and treat your patient in such circumstances, especially if there are no other personnel to assist you. In other words, how can you be and feel safe, without extra hands to assist you? Are there any policies in place to keep the healthcare worker safe, but also protect the rights of the patients and are there any suggestions that you can make to add to or enhance such policies? Lastly, do you have any advice for your student colleges and future students on how to ethically correctly and morally handle situations as the one you experienced? If you can, maybe you can add an appropriate article/ reference for answering the above questions/ advise? Thank you for your article, it was really insightful, relate-able, honest and I can see that this incident has changed your ethical perspective of treating patients with violent histories.
Stefanie van zyl
2 thoughts on “Don’t judge a book by it’s cover”
Hi Tiaan,
I literally got goosebumps while reading your post. I think that at the moment these types of stories are especially chilling due to the gender based violence movement that has currently been brought to the forefront in South Africa. I have also once had to treat someone who openly attmitted to raping and killing women and said to me “girly, don’t worry, I would never hurt you.” At first I wanted to run away and not treat him, but then I realised that it was important to treat him as my patient, to get over my fear and I think I grew as a personal while doing so.
In terms of the guidelines of the assignment, I feel as though you should relate your text/writing piece to the image you have coupled it with. I agree that the image you have chosen relates to your story, however I do not feel that you have incorporated the artwork into your writing. For example, you could say something along the lines of “if you look at the man in the photograph he is covered in tattoos. You may judge him for having these tattoos or you disagree with the images he has chosen to put on his body. I initially judged my patient for having a gang affiliated tattoo on his body. However, at the end of the day I don’t know his background story or circumstance, which one cannot read off the map of tattoos such as the man in the photograph.”
Thank you for sharing this powerful piece!
I really liked your article Tiaan and can relate to your experience as I have had a similar experience myself. I think your topic is really relevant considering the communities we work and live in and I am sure other healthcare professionals will also have come across gang members and have had to treat them and possibly had similar ethical and moral concerns. I feel, as if I would of possibly responded in the same way as you did, but do feel that you treated the patient and still gave them the ethical respect they deserve, even though you feel you did not handle the situation in the best manner possible. Unfortunately we live in a country where violence is a real hot topic, and violence in the healthcare setting is also a real honest concern. Even though you said you would ask another health professional to join you in such instances, I do think that asking a colleague to join you in treating a patient out of fear, will not always be possible as through own experience, hospital and clinics are already short staffed and over populated regarding patients. Can you think of any other ways you can assess and treat your patient in such circumstances, especially if there are no other personnel to assist you. In other words, how can you be and feel safe, without extra hands to assist you? Are there any policies in place to keep the healthcare worker safe, but also protect the rights of the patients and are there any suggestions that you can make to add to or enhance such policies? Lastly, do you have any advice for your student colleges and future students on how to ethically correctly and morally handle situations as the one you experienced? If you can, maybe you can add an appropriate article/ reference for answering the above questions/ advise? Thank you for your article, it was really insightful, relate-able, honest and I can see that this incident has changed your ethical perspective of treating patients with violent histories.
Stefanie van zyl