Even as he drew up into the car park, Dr Ignatius Jones knew that he was going to be in for another frustrating day. There was already a long queue in the Casualty department, but he would be lucky if he managed to see more than a dozen people. The problem, as always, was that wretched code of practice, the one that insisted that every day the medical staff should first attend to the patients on the wards. Sometime in the distant past there had been a serious case of medical neglect and the trustees at that time had imposed their well -intentioned but misguided decree. Ever since, physicians like Dr Jones had been living with its consequences.

At least the wards were not full to bursting. Male and female wards had plenty of spare capacity and the children's ward was nearly empty. Geriatric ward was the only one that was nearly full. The district hospital in the next town attracted people from far and wide, and there was even some talk of St Martha's Community Hospital being closed down. But the district hospital was big and impersonal and not everyone could afford the bus fare to get there. For all its faults St Martha's was local and very friendly.

The problem, Dr Jones had long since concluded, was the patients. He didn't at all mind the ones that came in for a few days or weeks and then left looking much healthier. He especially didn't mind the ones who insisted on forcing chocolates on him. No, it was the other ones who were the problem, the ones who never seemed to get better. Take Mrs Charles for example. No sooner had he sorted out her hearing problem, than she was having difficulty with her knees. When he had suggested discharging her to the care of the district nurse, within half an hour she had begun complaining of unbearable migraines. And incredibly there were probably another fifteen or twenty just like her in the hospital. By the time he had worked his way round each of them, there was never enough time to see everyone in Casualty and Outpatients. No wonder then that people were choosing to make the long journey by bus to the district hospital.

Locking his car and walking towards the main entrance he thought yet again of resigning and finding somewhere else to work. He had such grand ideas about what could be done, plans for community outreach, strategies for health education. But there were never enough hours in the day. The only possibility for change that he could see, and a slim one at that, was in the appointment of Mrs Truro, the new hospital administrator. Now there was someone with radical ideas and the strength of will to carry them through. He had really had to work hard to secure her appointment in the face of strong resistance from the more conservative members of the trustees. Still enough of future matters, thought Dr Jones, each day has enough problems of its own, and all that ...

... As he ambled across the car park, Dr Ignatius Jones was in a jubilant mood. Today saw the launch of his new health awareness initiative, with two very capable educators visiting the schools, the toddler groups and even the working men's clubs in the community. There was a definite buzz about St Martha's these days - what a contrast to the time before the formidable Mrs Truro had joined the staff. Almost single-handedly she had taken on the trustees and drawn up a new code of practice, placing the priority of care on the critically ill and on new patients. Over the months that followed, the wards were constantly full and Dr Jones felt as if he was meeting himself coming backwards. But he drew considerable satisfaction from seeing patient after patient restored to glowing health. So many grateful patients had offered to do voluntary work that the hospital had had to appoint a full-time volunteer co-ordinator. And now there was even talk of securing the required funding for a further doctor post.

Of course not everyone had approved of the changes. Mrs Charles had been the first to shift her residency to the district hospital and the last he had heard she was still there. Sometimes he experienced doubts and feelings of guilt, but in all honesty Dr Jones did not regret the changes that had taken place at St Martha's. They were now unapologetically outward looking. There was a new positive spirit that was seen in staff, volunteers and patients alike. And they were definitely having a positive influence of the community. No, he concluded, they had done the right thing. And it was going to be a very good day.

A different way of looking at St Martha's

Did you notice how a change of vision and priorities brought meaningful change to the hospital? The same lessons need to be learned in many of our churches. Church leaders often feel obliged to spend most of their time on the people within their congregations. They recognise that pastoral care is vitally important and they are concerned to build faith and character in their people. But the excessive demands of individuals like Mrs Charles can leave little time or opportunity for anything more than a token effort at evangelism. Where a congregation is prepared to place priority on those outside the church - as difficult and controversial as such a decision may be - only then does fundamental change truly become possible.

Gregory Kane
(c) March 2002