As Rwanda joins the rest of the world to mark World Patient Safety Day this Thursday, studies have shown that much as a lot of people are treated successfully, there are times when things can totally go wrong. From diagnostic to medical and surgical errors, medics are just human and using technology won’t guarantee total safety either, despite taking oaths to protect the sick at all costs before practicing in hospital settings. But do patients have any rights within the health centres or hospitals? Yes, they do, medics say.

"It is the right of the patient to know results from a diagnosis, the medication to receive, whether tablets or injections, and the side effects to expect from such treatment,” says Dr Achille Manirakia, a general practitioner at the University Teaching Hospital Kigali.

According to Dr Manirakiza, such information is usually overlooked because patients overate safety in hospitals and leave everything to medical workers who are naturally susceptible to human errors.

"Medical workers are likely to forget, a patient who is alert can alleviate a few challenges, but it comes with acquisition of information,” he adds.

The World Health Organisation (WHO) points out that the risk of patients dying in Sub-Saharan Africa is higher than elsewhere in the world as a result of reduced patient safety.

This is because outstanding issues such as hygiene during surgery are sometimes not given enough attention and until they are addressed, safety of patients will remain a concern.Handling patients welfare in Rwanda

The Ministry of Health in a bid to promote awareness about the rights of patients expects a charter of patient’s rights in all public hospitals.

Additionally, medics who have been found culpable of breaching their code of conduct can be sacked or prosecuted under the law.

Ruhengeri Hospital’s internal medicine specialist Rachna Pande points out that no treatment is perfect and every tablet or injection has certain risks that patients should be made to understand.

"First of all, the response of a patient to a given treatment is highly variable and dependent on many factors.

Patients are largely ignorant of these facts which only leaves the medic in position to provide explanations,” Pande explains.

She adds that providing sufficient information to patients improves confidence that culminates into proper drug adherence.

"Patients have a right to accept or refuse a treatment procedure,” she says.Risks of nosocomial infections from hospitals

When individuals responsible for the infection prevention and control programme are unqualified or do not have time to carry out their responsibilities, both patients and staff are at high risk for acquiring hospital-associated infections (nosocomial infections) and some may die.

Standard 7 of the Rwanda hospital accreditation provides that one or more individuals qualified in infection prevention and control practices through education, training, experience or certification oversee and coordinate all infection prevention and control activities.

"Effective infection prevention and control requires consistent oversight and coordination by one or more qualified individuals. This is essential for caring for infectious disease patients as well as preventing patient and staff infections from drug-resistant and other hospital-endemic organisms,” reads the standard.

In hospital settings there are different sections but some are more susceptible to contamination that others.Safety in neonates

Shadrack Nambayisa, the unit manager at neonatal intensive care unit at King Faisal Hospital, explains that neonates are highly susceptible to harm and internal standards should be set to safeguard them.

"Policies are designed but within the unit we have incidence reporting, evaluation assessment, among others.

Keeping records from such information helps to provide relevant training such that in the event of reoccurrence safety is improved,” Nambayisa explains.

Within the neonates section, all patients are supposed to be identified for the purposes of simplifying access and feeding using breast milk.

Nambayisa, who is also a trained nurse, adds that access to a neonate is only possible for the parents of the baby and no other individual or family member is accepted.

"On top of this restricted entry, they have to put on protective gear such as aprons, desist from handshaking and the breast milk should be kept in a refrigerator to minimise microbial growth,” he adds.

Precautions in radiography

Most times people have complained that ultrasound has harmful effects to the baby because it emits radiation.

However, Dr Wellars Nkurunziza, the head of the radiology unit at King Faisal Hospital, Kigali, explains that ultrasound involves no radiation to cause harm during pregnancy.

"We use sound only and this is safe for pregnant women. Even the MRI scanner is also safe for pregnant women,” Nkurunziza says.

Nkurunziza, who is also a radiologist, warns that during X-ray, radiography, mamography, fluoroscopy and CT scan, a lot of precautions should be taken because of the radiation doses.

"First of all, to ensure patient safety, you have to justify the clinical diagnosis rather than just carrying out a procedure for the sake of it. Secondly, the machines have to be calibrated to ensure that precision is maintained,” he explains, adding that: "All other safety undertaking include the use of protective clothing for the gonads and the thyroid for the pediatrics when taking X-ray shots”

From medical prescriptions to standard diagnostic procedures, experts advise that patients and caretakers maintain consciousness of their rights. In fact for all sophisticated procedures consent forms should be signed to provide a green light for further medical operations.

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A patient’s bill of rights

1. The patient has the right to considerate and respectful care.

2. The patient has the right to and is encouraged to obtain from physicians and their direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.

Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.

Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees. The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known.

3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical con-sequences of this action. In case of such refusal, the patient is entitled to other appro-priate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.

4. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.

Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance direc-tive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.

5. The patient has the right to every consideration of privacy. Case discussion, con-sultation, examination, and treatment should be conducted so as to protect each patient’s privacy.

6. The patient has the right to expect that all communications and records pertaining to his/her will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasise the confidentiality of this information when it releases it to any other parties entitled to review information in these records.

7. The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.

8. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.

9. The patient has the right to ask and to be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient’s treatment and care.

10. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.

11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.

12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods.

Agencies

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Do you know your rights as a patient, and have you ever been treated unsatisfactorily at a health facility?

Josiene Uwamariya, house wife

I have not got any bad experience as a patient, but I don’t know my rights. Everytime I go to hospital as a patient or caretaker I am always received well and given the medication as long as I have insurance.

Mike Irafasha, banker

I don’t know the stipulated rights but I know I deserve to be given the services I seek in a health facility. I have not had a bad experience in hospitals.

Pacifique Ngabo, university student

I don’t know my rights as a patient but I know as a human being I am entitled to healthcare services. The only bad experience as I have I have had as a caretaker was when my patient was asked to first get medical insurance, which delayed his treatment.

Jacques Mugabo, bus driver

I have no knowledge of my rights as a patient and I wish we would be educated about them because it helps when you know such information. I have not got any bad experience as a patient in any public hospital because I think our doctors are professional.

Compiled by Shamim Nirere