Delusions & Dialysis Machines

 From the little experience I've had over the years, one thing has become clear: politicians and doctors in charge of hospitals share a uniquely complex relationship.

Doctors often complain—sometimes justifiably—about the lack of political support or the inability of politicians to understand the nuances of healthcare. Yet, every now and then, a politician does help keep things honest. Like it or not, meaningful progress in peripheral hospitals doesn't come from medical staff alone. It often takes a committed local leader—someone who genuinely wants to improve healthcare for their constituents—to drive change. This becomes especially important when the medical officer in charge is slow to act, which, to be fair, isn't uncommon—particularly when the doctor isn't from the community they serve.

That said, not all politicians are driven by public welfare. Some are more interested in headlines than health outcomes, especially when elections are around the corner. These individuals can become major obstacles to meaningful improvements in peripheral healthcare.

Out in the Wilderness

Years ago, I worked in one such village. Wilderness Hospital (name changed) had significant potential as a government facility. Its location made it ideal to serve a large population, and the hospital complex itself had ample space for development.

But the reality on the ground was starkly different. Facilities were basic, and staffing was minimal. The hospital had an operating theatre, but no surgeon or anesthetist to make use of it. The laboratory shut at 2 p.m. daily. For years, there was no functioning X-ray or ECG after 8 p.m. The nearest major hospital was 17 km away, and the main tertiary care centre was twice that distance. Transporting patients—especially at night—was difficult due to a lack of ambulances.

Under these conditions, clinical judgement became paramount. Investigations were limited, and over-referring patients risked losing the community’s trust. Yet, sending someone home and missing a serious diagnosis carried its own dangers. Striking the right balance was a daily challenge.

A Misguided Push for Dialysis

There was always room to improve care incrementally—with leadership, vision and perseverance. But then came a sudden announcement from the local politicians a few months before elections: they would be inaugurating a dialysis unit.

On paper, it sounded like progress. In reality, it was a publicity stunt.

None of the doctors or staff were trained in dialysis. There were no technicians. Buying a machine is one thing; building a system to safely and effectively use it is quite another. Despite this, the politicians pushed ahead. A grand inauguration was held, even though the unit wasn't functional.

Soon after, they began blaming the doctors. “We gave them the machine. It’s their fault it’s not being used,” one politician said on a local radio broadcast while I was out on a field visit.

To be fair, the medical team wasn’t particularly enthusiastic about the dialysis plan, especially given the staff shortages. But the bigger issue was a fundamental misunderstanding of how healthcare systems actually work.

If you’re trying to build a hospital, you must first get the basics right. Without regular lab services, X-rays, or ECGs, introducing dialysis is like buying a sports car while your house is crumbling. In fact, even the OT complex remained unused due to lack of specialists.

Bringing in a full-time surgeon and anesthetist would’ve made a significant difference to the healthcare provided to the village. Making the lab run longer hours and ensuring 24/7 availability of X-rays and ECGs would have dramatically improved patient care. But unfortunately these aren’t the kinds of upgrades that grab headlines.

Hope vs Delusion

The real heroes of Wilderness Hospital are its staff. The nurses, ambulance drivers, and support workers—most of whom are from the area—carry the hospital on their shoulders. They work tirelessly, day and night, through every crisis, including the COVID-19 pandemic. Without them, the whole healthcare infrastructure in the village would have collapsed years ago. 

And yet, without better leadership—and more importantly, genuine collaboration between political leaders and hospital teams—true progress will remain elusive. Hope, no matter how sincere, needs to be grounded in reality. Otherwise, it becomes just another form of delusion.

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