Over recent years, for one reason or another, I have become accustomed to spending an occasional entire night at Mater Dei’s Accident and Emergency Department. Along, I would think, with quite a number of people.

The state of the A&E has become a national talking point, and also a political battleground especially in the cold days of winter when the department tends to be overwhelmed, given the Maltese penchant for driving there rather going to the health centres in their area.

This may be the low point of the year where A&E recoveries is concerned but I am happy to report that the recent all-night stays did not evidence the massing, the confusion, the patients on stretchers in the corridors we used to see before.

A person with no previous experience of A&E would still be impressed with the amount of people waiting, people moving about and some people apparently being called in before others. The system is maybe not really explained, so I am giving it my best.

Any person who enters gives his particulars and is then asked to enter a small room where a doctor is told what the ailment is. The patient’s name is then entered into one of three queues according to the ailment. There is no guarantee that the first one in will be attended to first as the aim of the first check, called Triage, is precisely to sift who is most urgently in need of care.

This second stage can then take a long time, many times the better part of a night as blood tests are done and other tests conducted and results take time to come.

This is where the patient, or rather who is with him, gets a chance to look around and see what’s going on. My first impression was of confusion, with doctors, nurses and others milling around. At first I was struck by the number of nurses. They are young, and would probably prefer to be elsewhere, such as Paceville, rather than at A&E, and there are times, say at around 4am, when the noise levels escalate, possibly due to tiredness.

In the end, the doctor who has taken charge of the patient gets hold of all the relevant details and holds a conference with the patient, outlining the results of the tests, the diagnosis and possibly the therapy.

So far, as I could see, the sheer confusion and overcrowding at A&E has lessened. The presence 24/7 of security guards helps bring order (and even more: yesterday week there was an Arab couple – she in a shawl and he in shorts. The woman began to weep silently. The security guard noticed and got them to jump the queue).

So here, as much as I could see, progress has been made in that people are dealt with and there is no disorderly crowd waiting for hours, as used to be the case.

But that ‘public order’ aspect is only one aspect. The rest is still lacking or not in place.

The question is what happens after A&E. To my surprise, I noted there was no onward referral to Outpatients. A doctor later confided that there are so many people on the Outpatients lists that doctors at A&E have stopped referring patients there.

An even bigger surprise is that in many of the cases I personally witnessed, the patient was not kept in the appropriate ward but was sent home. I am not a doctor so in such cases it is the doctor who finally decides, however in at least two of the cases I was involved in, the decision to send the patient home (in one case, me) was patently the wrong one. In each case, it involved further hardship and also substantial expense.

Our health services are frequently the subject of political controversy but many times it’s all about management, and I am not too sure that it is the politician’s remit. For instance, many years ago, Chris Fearne, a brilliant paediatrician, helped cure my nephew. But that does not necessarily mean that Chris Fearne as politician and minister is good enough as a manager, though he has been better than some of his predecessors.

Again, all we seem to hear concerning the hospital is about manning, or about trade union conflict. But we are rarely told facts that regard our nation’s health in general. For instance, these recent experiences have opened up to me the fact that we have a lot of respiratory problems in our country, maybe due to the intense heat, the massive development taking place and the fact we had little rain last winter. We are rarely told how to prevent such ills.

And I am also told that in summer there are usually many occurrences of gastric infections.

Hopefully, the influx of new health institutions will bring with it improved procedures with regard to public healthcare, breaking up the still existing pressure on the patient and his family to seek private medical care.

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