A Sleeveless Errand

A SLEEVELESS ERRAND* PETER QUINCE As my title suggests, this is not a success story: it is quite the reverse. Recently I was invited tojoin a hospital in the Southern hemisphere and help organise a rehabilitation unit there similar to the one I had been running for the past eightyears in Great Britain. This is the story of how, during my five months' visit, I failed to achieve this objective, together with my excuses as to why this happened, and how I had my eyes opened to many facts about rehabilitation which I had never appreciated in Great Britain, so blindly had I taken so many things for granted. A nasty, sinking feeling that I was destined to fail came over me as soon as I set foot in the hospital and learned that they had set apart a couple of wards within the hospital buildings for my activities. This, ofcourse, was ridiculous. The setup ofa rehabilitation unit must approximate to the conditions ofreal life in the world outside. The vast majority of the patients are very soon fit enough to be up and about all day, fully dressed, rising and going to bed at reasonablehours. In addition to dormitories, they need a dining room, a day room, and ample space outdoors for open-air exercise . These wards did not even have lockers or cupboards for the patients' day clothes. You cannot rehabilitate people in dressing gowns. There is another much more basic reason why a rehabilitation unit cannot function within a hospital, or even within the hospital precincts. Patientshave got to beweaned from thehothouse atmosphere ofsurveillance and caution, granted increasing independence, and induced to accept more and more responsibility for their own welfare. Ifin a generalhospital ward or corridor a patient slips and sustains a fractured neck ofthe femur, all hell is let loose. Somebody or something, as well as the patient, has to be blamed: careless nursing, insufficient supervision, or the wrong sort of * No reprints available. 429 flooring. The matter reaches the house committee, the area management committee, and maybe the regional board. The entire floor may have to be ripped up and replaced with expensive non-slip plastic tiles. At the back of it all lurks the fear of litigation and the hope that the local newspapers won't get hold ofit. Now, ifthe same accident happens in a rehabilitation unit, the attitude taken is, "Well, thank goodness you did this here and now where we can deal with it promptly, instead ofwaiting until you got home and maybe had to lie two days on the scullery floor before your neighbours found you." For, as I shall emphasize repeatedly, risks must be taken: calculated risks such as those only too likely to occur in real life; and the climate of opinion must permit them, must encourage them. Patients must obviously, therefore, also be weaned from their hospital doctors, who are impregnated with the prevailing overcautiousness and, perhaps worse still, are apt to be jealously possessive. They would still regard the patient as being their responsibility and would unfailingly butt in, throw spanners in the works, and frustrate the whole business—ifthe unit were within easy walking distance ofthehospital. No. Transference to the unit must make as clean a break as ifthe patient were being transferred to any other special unit. Few patients, ifany, leave a general hospital feeling really well. Theyare not encouraged to. Having been kept unnecessarily recumbent so long, they usually feel weak and wobbly and below par; but in addition they are too often indoctrinated with black spells—"It is going to take you some time to get over your trouble. You are not out ofthe wood yet." "You certainly must not dream ofdoing this, that, or the other for the next three months, next six months." "You had better go on taking your pills, and come up to my outpatients in a fortnight's time." And so on. Contrarywise, the aim ofa rehabilitation unit is to send people home, wheneverpossible, not only iooper cent fit but confident that they are fit— and not until. This, I assert, can be achieved in about 75 per cent ofcases; and it takes, on an average...