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Earlier this week I saw a post on social media from a lady who had visited the emergency room in one of the referral hospitals in Botswana, and having arrived at 2am, she had still not been seen by a doctor at 8am. Going through the comments on her post you could see other people also share experiences of what seem to be a common theme. Overcrowding and long waiting times is a problem that is not exclusively to Botswana but is common in emergencies worldwide and worse in low-income countries.
In a study done by Siamisang and colleagues in 2020, which reviewed just over 1000 files at Princess Marina Hospital seen over a month period, it showed that 72.5% of the patients had a stay of more than 6 hours. They were also able to show that the average time from being triaged to seeing an emergency doctor was 4.5 to 27.1 hours.
The average length of stay in the emergency room was 9.6 hours to a maximum of 45.9 hours. These are particularly very long waiting times and they are many contributing factors why there are so long. One of the reasons why emergency units in the country are often overflowing is inappropriate presentations.
When patients who do not have emergencies present to the emergency unit this puts a lot of burden on an already strained healthcare system. It leads to overuse of resources and wastes money both for the patient and the government when these resources could have been better used. It is often quite difficult for the patient to decide whether they should go to the emergency unit or not.
It is impossible to right an exhaustive list of conditions that warrant one to visit the emergency room. However, the many reason people present to the emergency room is for accidents. Any accident that threatens life or limb is a good reason to see a doctor. People who have been involved in major car accidents, even when they are no visible injuries should ideally go to the emergency unit. Those that have injuries to their limbs which can include suspected broken bones or any severe cuts with profuse bleeding should also seek medical care immediately.
The list is much longer when it comes to medical conditions. Some of the medical problems that should prompt one to visit an emergency unit are; severe sudden onset of headache, weakness of the face and leg, fainting, sudden onset of shortness of breath, chest pains, severe abdominal pains, productive cough, coughing up blood, pregnancy related complications and any acute poisoning.
It is often advisable to present to the local doctor or clinic first so that they can make an initial assessment as well to stabilize the patient before they make the decision to refer to an emergency unit.
It is not advisable to come to the emergency unit for minor illnesses or chronic problems that have been ongoing for long with no acute changes. Emergency units use a triage system where the sickest patients will get priority hence why when patients present with conditions that are not emergencies, they will have much longer waiting times. Let’s all do our part to try decongested the emergency units in this country which are on their knees due to inappropriate referrals and lack of staff.