Tuesday, 20 July 2010

NHS Sterotyping...at your service?

An ambulance attending an emergency during the winter snow of 2009-2010


National Health Service (NHS) was established in 1948 on the 5th July.Since then it has evolved significantly in service, in staff and in clientèle. I am in my 11th year of living in the United Kingdom and prior to the last year I have only needed the services provided by the NHS ten years ago. When I became unwell in the summer of 2009 I thought I had swine flu and that I would do my two weeks of illness and be done with it, back to business as usual. A few people in my company had been victims to this virus so it would not have been a surprise to me especially as I had most of the symptoms. Unfortunately it was not swine flu, and I say this because a year and three days later they are not any the wiser of what is the exact cause though the front runner is something called Sarcoidosis, an autoimmune condition. This article is thankfully not about my health but about the treatment I received from some (not all) of the doctors and nurses in the Royal Berkshire NHS Trust. 

Now after months of my 'inflammatory markers' being high with no sign of infection in my stomach etc, my consultant at the time ordered a CT Scan which is a really high radiation scan  (they actually inject radioactive dye into your body!!!) This scan showed that I have multitudes of nodules on both my lungs, the showed them to me, there are hundreds everywhere! It clear scared me to death! The doctor I was referred to to interpret my CT Scan was a chest physician I have nick named Dr Death. When I met with Dr Death to review my scans, (4months after I became unwell), he initially examined me and asked me a lot of questions about my health and past and he seemed particularly interested in the fact that my records show I am from Zimbabwe. 

At the time I had gone through a period of nausea, vomiting, stomach cramps and loss of appetite...I had lost half a stone but had not become unwell enough to be hospitalised over night of which he was aware. After his examination Dr Death announced that he thought I had TB secondary to HIV though I did not have consistent symptoms or any prior chest related complaints, not even a cough and in spite of my assurance that there was not sexual history to raise concern so I just could not see how that was a like diagnosis. He ignored this and came out with it and said that BECAUSE I am from Zimbabwe in my late 20's he felt that his initial 'gut' prognosis was right. He then went on to assure me that there have been great breakthrough's in HIV medication and one could live a long life with treatment. When I asked what else it could be, not convinced that there was a medical reasoning to his initial diagnosis, he said that he was sure and in fact he refused to treat me at all unless I have an HIV test or produce proof of a recent test.

With my agreement to do the HIV test he also scheduled a bronchoscopy to prove his TB theory with no consideration of any other possible cause. If the doctor's prejudicial behaviour was not bad enough, when I went to the sexual health clinic for the test, the nurse who took my blood sample double gloved (because of course a needle cant go through two pairs of gloves!!!) and seemed rather nervous to be taking my blood! By this point I had completely lost my temper as I felt like I was on trial and so far without evidence my only crime was being sick and Zimbabwean! Which in the Berkshire PCT seems to mean that I must have HIV or Aids! Unbelievable!!! I sarcastically asked the nurse about the the test making a point to mention how ridiculous I thought it was that this was the only test I was having when a multitude of things could be wrong with me and I'm not even sexually active! Nor have I been near a drug needle or needed a blood transfusion like ever!!! To drag out her obvious discomfort I said to her that I wanted the works! Every STD test she had on the books I wanted done to her dismay...as her face fell i turned away to hide my smile, I must admit it made me feel better to put her out after she treated me like a leper.

When I arrived for my bronchoscopy I advised Dr Death that my test results had not returned and he was talking about doing a biopsy and possibly puncturing a lung! So there I was thinking to myself, you have me here because you have decided that every sick Zimbabwean is an HIV patient and I'm playing along because you have literally withheld all other medical treatment from me unless I do, and now you want to do an unnecessary procedure that could puncture my lung because of TB which I don't have!?!?!?!?! It was one step too far so I said no! he did his bronchoscopy and l left, lungs intact. Needless to say when my test results came back I had a clean bill of health, HIV negative and not even a trace of any other type of STD infection (which is the result you would expect when you aint getting any!) By this time my bronchoscopy test results had come back clear, no TB either as you would expect from someone with no symptoms or any other indicator to suggest it other than the fact that I am Zimbabwean!!!!

 I immediately relieved this doctor of his duties and engaged a new respiratory specialist who surprisingly actually did treat me like a person and patient first rather than a Zimbabwean HIV statistic!  I honestly did feel like a victim of stereotyping throughout that entire ordeal and powerless to insist on other tests and investigations be carried out at the same time. Furthermore if I had tested positive I would not have felt comfortable returning to these people for treatment or help which creates an even greater problem and cause of concern than my sense of injustice.

Now I do appreciate that Zimbabweans have developed a bit of a reputation with good reason when it comes to HIV / Aids. Therefore it is reasonable to expect doctors to want to rule it out as a potential cause of illness when a patient presents with the relevant symptoms and history. However being Zimbabwean is not a symptom and I don't feel it alone is sufficient for a doctor to refuse much needed treatment, let alone refuse to explore other probably causes of illness, if an HIV test is not taken, is that even legal?
Image courtesy of the internet

According to http://www.avert.org/aids-uk.htm -- The UK AIDS statistics show that at the end of 2008 there were an estimated 83,000 people living with HIV in the UK, of whom approximately 22,400 were unaware of their infection.
Although HIV is often perceived to be a ‘gay’ problem, infections acquired through heterosexual sex account for the largest number of HIV diagnoses in the UK.
Gay men (and other men who have sex with men) accounted for two thirds of new cases.
Of all diagnoses to the end of June 2009, 44% resulted from sex between men, 44% from heterosexual sex, 5% from injecting drug use, 2% from mother-to-child transmission, 2% from blood/tissue transfer or blood factor, and 4% from other or undetermined routes.

If you are / have been sexually active, Get tested...

Its always better to know...

Image courtesy of the internet

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