Patient Confidentiality, Implementing Best Practices In Southern Africa

Anyone who has seen a hospital series or crime show will surely have come across the concept of patient confidentiality at some point. It may be of interest to explore what this exactly means. All health personnel are obliged to protect the privacy of all the information, historical and primary, that comes to them during and after patient treatment. This means anyone not involved in delivering the health service has no right to access the information even after treatment or eventual death. Recently I traveled to Mutambara Mission Hospital in Zimbabwe and got some interesting insights from both the local personnel as well as visiting practitioners from Norway*.

Several inadequacies in our medical landscape have led to the conceptualization of Med – eSmart. An example of such shortcomings is the poor emphasis placed on patient confidence.  Fanuel** from Gonzoni village in Mutambara for instance, stated that he went to an HIV/AIDS counselling and testing center in Mutare, 120km away as he felt that his status would be common knowledge otherwise. ‘’At least at provincial [hospital] no one knows me and I can come back to my life in peace. ‘’ One of the harsh realities for most patients in Southern Africa is that medical care is fairly inaccessible, both financially and / or geographically. Because of this, many fail to realize that ‘The right of patients to make decisions about their healthcare has been enshrined in legal and ethical statements throughout the world.³’ This problem of patient confidence can also be traced to the training [or lack of it] of primary caregivers. Most African countries face a growing shortage of qualified medical personnel. Chen [2012] for example, found that ‘Sub-Saharan Africa suffers a disproportionate share of the world’s burden of disease while having some of the world’s greatest health care workforce shortages.໊’ Med-eSmart looks to give full control to the patient. When signing up, the patient determines the level of consent they are comfortable with. Whether it’s having patient information shared across practitioners or availing treatment history for second opinions, it is the patient’s prerogative.

Socio – economic differences also play a huge part in determining the nature of medical care one receives, and the consequent confidentiality of the treatment process. Two major obstacles to good physician-patient communication are differences of language and culture.³ Medical facilities in Southern Africa, such as Mutambara Mission Hospital, benefit from various foreign aid programs. This entails ‘visiting practitioners’ who volunteer their services to under-served communities. Matter of fact, during my trip, there was a team of Swedish dentists who had just arrived to help out at the dental department. While the significance of such projects is immense, the patient – doctor dynamic becomes rather lopsided. In most African communities it is considered disrespectful to query an elder or authoritative figure. This demeanor is evident across different institutions, from schools to hospitals. This may not be the case for an individual born in Europe or the Americas. In such instances, it can happen that a patient is passed off as being shy or unwilling to cooperate. Acquiring informed consent takes a backseat as practitioners feel they have no choice but to make the ‘best decision’ for the patient. Case studies, for example, may be used for med students on the other side of the world, without the patient’s knowledge or consent. By subscribing to Med-eSmart’s multilingual platform, patients access medical facilities in a language familiar to them. When the occasion to consult with a doctor arises, each available practitioner’s language competencies are available to the patient, meaning he / she will go through the appointment in the most understandable and comfortable manner.

Providing healthcare is a consultative process that involves the patient and the doctor. It should be emphasized that patient confidentiality is a duty to the practitioner and a privilege for the patient. Even in marginalized communities lacking in resources and skilled personnel, an effort should still be made to treat patient information with respect, dignity and discretion. It is however understandable that most institutions prioritize the actual treatment process, faced with dwindling funding sources and an ever – growing sick population. Med-eSmart provides a low cost solution that puts the patient’s rights at the fore. Should more be done to enhance patient confidentiality? Join us on Facebook or Twitter and have your say.

*Special mention and appreciation to Dr M. Gaarder for her wonderful insights on patient confidentiality and medical practice in Norway
**Not his real name
³ J.L Paleaz, Medical Ethics Manual – Physicians and Patients, CORBIS
໊C.Chen, A survey of Sub-Saharan African medical schools. Human Resources for Health.