Looking at the small groups of white-clad nurses and doctors milling around me–some pushing purposely in one direction, others glancing down quizzically at the papers in their arms– I could feel the sense of urgency in the air. Despite this, the usual pleasantries still abounded and conversations were full of laughter and jokes as they always seem to be here. It’s the Mexican way.
It was “SIS day” here in the this hospital-turned-administrative building and four pasantes, one nurse, and I had traveled from the Compañeros En Salud office in Jaltenango to the small town of Villa Flores which lies about 1.5 hours away. “SIS” stands for Sistema de Información en Salud and for the pasantes, it meant a seemingly endless amount of paperwork. Alas, the bane of many a medical professional’s job was made worse in a region where electronic medical records and fully modern computing systems were as nonexistent as the funds needed to support them.
Outside of the Jurisdiction’s Secretary of Health Office
With no paperwork to turn in myself, I accompanied Marina on a quick tour of the building and a round of introductions before attempting to do what I could to help the pasantes as they practically ran past us with their folders and clipboards in hand. By mid-afternoon I had stationed myself in one annex of the building, which had been divided into 22 different “stations” where the nurses and doctors had to bring their clinic’s paperwork and get a signature from each departmental supervisor in order to proceed. Sweating buckets though my thin yellow top, I helped Liz, one of the pasantes with a particularly large patient load, enter pregnancy data into a spreadsheet on her small orange Lenovo laptop. Wiping the perspiration from my brow, I tried to forget about the suffocating heat and willed myself to work faster. After all, my physical discomfort seemed like a small sacrifice in comparison to the stress I could see bubbling up within Liz and filling her eyes with shallow pools ready to fall. She was on the verge of tears.
Ah, but who is to blame for what seemed to me to be a clearly inefficient and poorly run system? The people who designed it with the funds they had available to them? Or the funders who had chosen to allocate their resources elsewhere? Thus the word “inefficiency” alone seems like a surface-level descriptor in this case, one that hardly gets to the root of why the Secretary of Health had instituted a system that required medical professionals from the surrounding jurisdiction to spend almost one full day per month here running through myriad numbers and trying to arrange their paperwork for submission. It seemed to me to be like an office version of musical chairs, full of shape shifting and station-changing as the pasantes ran from one room to the next in this paper warehouse.
The fact is, however, that paperwork is a necessary (albeit mundane) part of a doctor’s job. I have heard the same complaints from doctors I have shadowed in the United States, some of whom have told me that they estimate spending about 50% of their time with patients and 50% with their papers. It seems like wasted time to say the least, but automation of the system is still something that is out of reach for many public health officials. In places like Villa Flores, especially, the promise of automation seems like a far-off wish, rather than an achievable goal that is on the horizon. Though I have been living in the Sierra Madre for many weeks now in far less than glamorous conditions, the day I spent at the Jurisdiction office opened my eyes to a wholly different aspect of healthcare that seemed more torturous than anything else. As we left the office that afternoon, I couldn’t help but feel relieved that I would be returning to the clinic in Honduras soon, where patients and not paperwork awaited. I hoped, too, that the administrative challenges and hiccups that make turning in paperwork such a laborious process would be resolved in the not-so-distant future–but until then, sweating buckets it is.