First Day of Work

Woke up around 6:30 this morning, had some toast and peanut butter for breakfast, then headed over to the office with Suzanna and Sarah. We walked there on what is quickly becoming my usual route. It's up one of the ubiquitous dirt paths in this country. I'll try to remember to take some photos on my way up some day.

We had a staff meeting with Lisebo, Teboho and Senate where we discussed what they did last week, and what everyone's plans for this week are. At 10 a.m. we headed up to the Berea District Hospital, about 45 min north of here. Upon arriving for our 11 a.m. meeting, we went directly to the hospital administrator's office, who was not there, but the assistant admin. was, so she showed us to the conference room. We sat there for about ten minutes, until in apparently usual Lesotho fashion, no one showed up for the meeting. We were expecting 10 participants who had partaken in the October Problem Solving for Better Health workshop. After several phone calls, and thirty minutes, 7 of them showed up. The plan was to meet with them for an hour, and follow up on the work they had been doing, and to action plan for future steps. Then the management team of the hospital (the District Medical Officer, the Head Nurse Matron, and the Hospital Administrator, along with some heads of departments...who are all women) were going to join us to bring together all levels of problem solvers, and to let the "lower cadre" see that the management was on board with supporting their independent plans for solving their own professional problems.

It sort of went as planned, though it was curious to see the interaction between the levels of hierarchy once everyone was brought together. It was as expected, I suppose. No one really wanted to talk in front of the people in charge, though a few brave souls eventually did. And the problems they talked about were almost unbelievable by our standards. For instance, the man who works doing postmortems, told us how the refrigerators in the morgue are all broken and have been for several weeks. An orderly talked about how she wanted to have been sanitation because the nurses in the maternity was don't dispose of the placentas properly, and the orderlies have to clean them up and bring them to the incinerator.

We then met separately with the management team with the goal of helping them bring about a hospital-wide mind shift on the process used to dealing with problems. To date, it has been ingrained in the Basotho that they have certain job responsibilities and if things aren't working, if the problem is not within the scope of their work, it is not their responsibility to do anything about it...even if the problem great affects their work. For instance, because the maternity nurses are supposed to package up the placentas as part of their job description, the orderlies felt that they should not be the ones trying to set into place any sort of actions to improve sanitation, even though the rates of infection for these orderlies was high. So, we spoke to the management team for a long time, and moving forward we are going to be working with them so they can create a grand scale Problem Solving for Better Health (PSBH) process for the hospital as a whole.

So over the next several weeks and months, I'll be meeting with various hospital administrators and department heads to carve out these policies and procedures for what happens when the staff encounter problems that they need support solving.

I'll also be following up more with the individual participants from the October workshop to spur their progress along. And if they feel they have solved the problem they first elucidated at the workshop, then we'll talk about new ones.

We got back to Maseru around 4, met to hash out all of the above, and I got home at about 5:30. Suzanna and I went for a walk, then ate some leftovers and now I'm going to start writing up some documents from our meetings today. We'll go to three more hospitals this week to do just what I wrote above, and then I'll have about a zillion follow-up meetings with all the constituents.

This alone could be my entire scope of work for the next six months. Alas, it's only a piece of it. There's going to be another PSBH workshop in mid-March that I'll be coordinating with new participants. I'm trying to refine and add to the intern orientation document. There is a large grant report to be submitted to the International Finance Corporation that I'm going to be looking through with a fine-toothed comb, and I have to go to the QEII next week to begin introducing the physician satisfaction survey. There are other things, too, but I can't seem to think of them right now....

I'm not checking for typos, so sorry.