On 29th December, 2017, Naomi Musenga, aged 22, was alone at home, in the French town of Strasbourg. She found the strength to call Strasbourg’s ambulance service, despite suffering from severe stomach pain, and bleeding. “I’m going to die,” she said, to which the operator replied, “You’ll definitely die one day, like everyone else.”
This is a transcript of the call. The conversation took place after the operator can be heard joking about the victim, with a colleague who had initially taken the call and noted the victim’s personal information.
Help me, Madame.
What’s the matter?
If you don’t tell me what’s happening, I’m going to hang up.
I’m in real pain.
Call a doctor, OK? The emergency doctor.
You can call the firemen [the victim had been put through to the fire department call centre]…
I’m going to die.
…But you can’t call a doctor? You’re going to die? You’ll definitely die one day, like everyone else.
Call the emergency doctor [she gives the telephone number]. Ok? Have you understood? [she repeats the number]
Help me, Madame.
I can’t help you, I don’t know what you’ve got.
It’s really hurting.
My stomach is really hurting. It’s hurting everywhere.
Yes, you call the emergency doctor [repeats the number]. Simple, I cannot do it for you. Call the emergency doctor or your family doctor. OK? Good-bye.
Thanks to relatives, an emergency medical team did arrive (no ambulance), and Naomi Musenga was eventually transported to hospital, where she later died following a heart attack and multiple organ failure. The call centre operator has been suspended, pending further investigations into the exact circumstances of the tragedy.
Public services are becoming increasingly expensive, in most EU countries. If funding doesn’t follow increasing costs, mistakes like the one described here, will occur more often. This will be partly due to lack of funding, partly to a lack of motivation and knowledge from the people who work in the call-centres. Gone are the days where you actually spoke to a compassionate and understanding person within one minute of you dialing the number. Nowadays, you have to first find your way through a multiple-choice telephonic maze, before ending up speaking to a person from the wrong department. Maybe, in order to save costs, the emergency medical call-centres will become fully automated, and provide a downloadable app that will make the medical diagnosis, without human help: press 1 if you’ve got stomach ache and, if you’re dying, press 2. To continue in Swahili, press 3.
Basic emergency care should be available to everyone, no matter what it costs. We will all, at some point in our lives, appreciate a medical service that (i) is 100% human, (ii) is not run by morons, and (iii) doesn’t ask you for your insurance card, before considering saving your life.
In her defence, the operator said to be working under conditions of extreme pressure, and that her response was “inappropriate”. Of note, is the fact that she had just come back from a two-week holiday, and that Musenga’s call was only 4 hours into her shift. The call lasted three minutes, and although the victim’s voice was very faint, the operator made no effort to find out what was going on.
If there is one thing that I have learned from my many years in a dental practice, is that patients appreciate the way that their needs are handled, when they phone the practice. I admit that dental emergencies cannot be compared to life-threatening medical emergencies, but the principles that underlie decision-making remain the same, in both fields. Questioning the patient on what symptoms he/she is experiencing plays a fundamental role in the assessment of whether the complaint needs a same day appointment, or whether it can wait. In my practice, there are well documented protocols that describe how this should be done, as a quick reference guide. Dental practitioners, in the Netherlands, take turns to be available outside office hours, and at week-ends, providing an emergency service for patients from other practices in the region, and also serving those who are not registered with a dental practitioner. It is sometimes difficult to distinguish between someone who has an acute need for treatment, and someone who can basically wait until his own dentist is back at work, the following day, or on the Monday. But all calls must be taken seriously, and no-one is taken for granted or mocked.
Even if the general rule is that patients attending our emergency service must pay cash, I often make an exception to the rule, especially concerning children, because I can directly declare the treatment costs to their parents’ insurance. On 23rd March, 2014, Awa Fadiga was admitted to the Accident and Emergency at one of Abidjan’s (Ivory Coast) main teaching hospitals. She had been attacked, and received multiple life threatening lacerations to her body. According to her agent, although she was admitted at 11 p.m., she did not receive primary treatment, until 1 p.m. the following day. The reason for the delay was, according to her family, hospital bills that had not been paid.
In France, anyone who fails to come to the help of a person in danger, can be found guilty of violating the French law of “non-assistance à personne en danger” (deliberately failing to provide assistance to a person in danger), and can face a fine and/or prison sentence. But surely, the duty to rescue does not have to be formalized in the statutes, in order to make the moral duty to help someone who falls victim of an acute situation, mandatory. Isn’t this a part of what being human is all about?