Coordination and clinical work

A lot of the work the Welbodi Partnership does is to coordinate and facilitate projects and training programs within the hospital. Our aim is capacity building – helping others to improve their skills rather than coming in to solely provide patient care. We believe that in the long run more patients will receive high-quality treatment and have better outcomes if we focus our current efforts on improving the services delivered in the hospital. That is why we have engaged in projects like electricity and water supply, the medical records/data collection and reporting system, the laboratory services, nursing care, the triage and emergency process, and training for the doctors.

This does mean that my job as a medical coordinator, although diverse, does not leave much room for clinical work. As I am trained as a doctor, that is not always easy. Fortunately, for my own professional development and to see how hospital systems are or aren’t functioning, I try to do some clinical work. However, usually my role as coordinator keeps me so busy, I don’t make it to the wards. If I do make it, it’s usually just to see a few patients. I decided that for now it is best not to do ward rounds on a ward because it is unlikely that I will be available to the nurses and patients for the rest of the day due to meetings and other responsibilities.

The last few weeks have been so busy, I have really only been able to see a few patients on the ward adjacent to our office, so it has been good to be able to be involved with patients a bit more on other wards.

It started one evening when I happened to be at the hospital and ran into a family with a very sick child looking for the Emergency Room. The child was admitted and stabilized but unfortunately remained in a very critical condition. Sadly, the infant died in the course of the following day. I was again hit by the reality of the mortality figures in this country. And I realized again that although it can be very rewarding to do clinical work, it is also pretty tough.

I was also involved in the case of an infant admitted a few days ago. With a hemoglobin of 3.5 g/dL, the child needed blood urgently. Fortunately there was a relative who was able to donate and the child received blood soon after admission. After that it was a waiting game. Thankfully, the next day the child looked much better. However, unfortunately the child had not received all of the prescribed medication within the first 24 hours of admission because something went wrong with the supply. So, I wrote a prescription for the missing medication and later checked up on the child again again. The child was stable and I expect will make a good recovery. Now, if I can only convince the mother to stop giving the child hot water and encourage her to exclusively breastfeed I will be really happy!

I love the clinical work and honestly do miss it, but I also have to admit that it can be quite frustrating. Yes, there have been many improvements over the last few years, but there is still a long way to go. I think all of the clinicians in the hospital would agree that clinical work in the hospital is challenging. The patient numbers can be high, working hours can be long, (once a week when on-call overnight the doctors work for about 30 hours straight) and the cases coming to the hospital are often quite severe, which means that on a daily basis one is faced with children dying. For doctors and nurses alike this can be very demoralising. Yet somehow, everyone must continue. Despite the frustrations, spending time on the wards gives me more insight into how the various systems (pharmacy, lab, blood bank, nursing, medical records, doctors) work (or not) and how they have improved (or not) over time. The barriers and delays to achieving good patient care become more apparent. This information can in turn re-start the thought process and refinement of how Welbodi continues to work alongside hospital management and other partners to improve systems within the hospital with the overall aim to improve pediatric care. And that is when I put my coordinating hat on again!

First posted @ http://blogs.bmj.com/bmj/2011/05/31/sandra-lako-coordination-and-clinical-work/

#4 Photo of the week: Ward 3

“Ward 3 - Ola During Children’s Hospital”

© 2010 Sandra Lako

Happy birthday Sierra Leone - and happy birthday free healthcare!

Believe it or not, it was one year ago that the Government of Sierra Leone launched a new free healthcare initiative for pregnant and lactating women and children under five. This photo essay in the Guardian shows some of the patients and health facilities that have benefited from this policy.

This week also marks Sierra Leone's 50th anniversary of independence. As the country honors this occasion with reflection, patriotism, and lots of celebration, we at Welbodi celebrate along with Mama Salone, and hope that the next 50 years will bring continuing improvements in the lives of her many children, young and old.

World Malaria Day 2011...

Today is World Malaria Day and unfortunately, although a preventable disease, malaria still kills many people in the developing world. At the children's hospital I work at, we see malaria cases everyday. Some cases are very severe; the children are literally on death's doorstep and other cases are mild and improve with oral medication. As you can imagine, the disease has a major impact on child health in Sierra Leone.

In November of last year, we had 999 inpatients in the hospital and in that month (as often is the case) malaria was the most common reason for admission, followed by chest infections, diarrheal disease and anemia (unrelated to malaria). Sadly, children die at the hospital on a daily basis. In November, 54% of the hospital deaths were attributed to malaria. In November 67 children died at the Children’s Hospital as a result of complicated malaria. We obviously have our work cut out for us. Having said that, I do believe that the staff at Ola During is working hard to do their part in combating malaria. The staff, management and partners of ODCH and the Ministry of Health and Sanitation must be commended for their ongoing efforts to improve healthcare. The laboratory has definitely improved and more blood smears are being examined for malaria. Thanks to one of the partners in the hospital, malaria treatment is readily available. Improvements in the triage and emergency system mean that children receive their treatment more promptly. There is still a lot to be done, but progress is being made.

The theme for the fourth World Malaria Day is Achieving Progress and Impact. The theme recognizes the international community's renewed efforts to make progress towards near zero malaria deaths by 2015. We’re not there yet, but I like to believe that things are improving. Hopefully the country of Sierra Leone can tackle issues like: distribution and use of insecticide treated nets, prompt diagnosis, appropriate treatment, etc. Various barriers play a role, such as: cultural/traditional ideas impacting use of nets and quick presentation of child to a health facility, lack of experienced laboratory technicians, lack of rapid diagnostic tests, inconsistent supply of ACT medication or quinine, etc.

Hopefully, health education in the communities, training in health facilities (lab and medical staff), and improved supply chain will decrease the number of deaths related to malaria in Sierra Leone. The day that there are near-zero malaria deaths in the country will be a day to celebrate for sure. Count me in…

(see: http://www.worldmalariaday.org)

#3 Photo of the week

"Emergency Triage Assessment and Treatment workshop with the nurses at Ola During Children's Hospital - a partnership with ABM in Wales"

© 2011 Sandra Lako

Oxygen for the feeding center

Last week Monday the final four oxygen concentrators from the “Operation Oxygen” campaign made it to Ola During Children’s Hospital. Thanks to all of you who contributed generously to this campaign. Of course, it was a bit of an epic journey to get the shipment from the airport to the hospital, but after many phone calls, negotiations, and bribe avoiding tactics we managed. Unfortunately getting shipments out of the airport or port is still a big hassle for most non-governmental organisations (NGOs).

This past Saturday I went to the Children’s Hospital, to deliver large bags of leftover bread rolls that the Africa Mercy wanted to give away. Fortunately there was plenty to go around for all of the patients and staff. While I was there, I thought I would assemble the oxygen concentrators, label them, and test them to make sure they were in good working order. All of the units worked, and so four more oxygen concentrators were ready to roll.

Today, I thought it would be good to bring a concentrator to the therapeutic feeding centre. After all, they have never been able to give oxygen there and they do often have severely malnourished children with severe pneumonia, or other illnesses causing respiratory distress. Up until today, malnourished children needing oxygen were sent to the ICU for admission; meaning their feeds were (unfortunately) not monitored as well as they would be in the nutrition unit.

After checking with matron in the morning, I went to the feeding center to tell the nurses they would receive a brand new oxygen concentrator, and they were delighted. They have been asking for oxygen on their ward for their patients for months now.

Since there is an oxygen concentrator in the feeding centre, it means that the malnourished children in need of oxygen can remain there and receive both oxygen as well as 3 hourly feeds of F-75 or F-100 milk, along with the other medical care they need. Being able to keep these children in the nutrition unit will hopefully improve care and will prove to be yet another small step in the right direction. We do realise of course, that in some cases children may need to stay in the ICU for more intensive monitoring.

Unfortunately, when the power went off later in the day, we realised that the feeding centre is not yet connected to the back-up generator provided by Welbodi and so the oxygen concentrator stopped working. Our next aim is to make sure the feeding centre gets connected to that generator. Small steps. One at a time. We’ll get there someday.

First posted @ http://blogs.bmj.com/bmj/2011/03/30/sandra-lako-oxygen-for-the-feeding-centre/

#2 Photo of the week

"Five children with Burkitt's Lymphoma receive treatment on the ward"

The Burkitt's Program is a partnership between Ola During Children's Hospital and Mercy Ships.

© 2011 Sandra Lako