Today was our last hospital improvement meeting for the week. It was at Motebang Hospital in Leribe, about 90 min north of Maseru. Or, I should say, 90 minutes with no incident. Unfortunately, we did not make it there incident free. Our first stop was by the police, who pulled us over for speeding. We were going 58 (km/hr) in a 50 zone. I should say that when you're pulled over here, it's NOT by a cop car flashing its light behind you. No, it's by a police man standing in the road waving you off to the side. And the speed check is done by a hand held radar gun. Usually, you have to go to the police station to pay your fine for speeding (road accidents are one of the major killers here in Lesotho), but we were let go without a fine.
Then, about ten minutes later, we had to slam on the brakes because of an errant sheep, which was tied to another sheep and apparently dragging him to his death. We didn't hit either one of them, but we sure came close. So, then all was well. We were about 20 min from Leribe, when, bam!, the police pulled us over again. This was a random police checkpoint, where they are looking for unregistered vehicles (mostly taxis). But since they pulled us over, they had to find something to give us a ticket for. Senate, who was sitting in the back with me, was not wearing her seatbelt, so the cop wanted to give Suzanna (the driver) a fine. He said she was responsible since she was the driver. Again, though, they let us go.
So then, we're just outside of Leribe, when the traffic was completely stopped. Off to the right, there was a car with it's front end completely smashed in and the windshield crumpled into itself (though not shattered). We then looked off to the left, and saw what had caused the damage. A cow. It was laying on the side of the road, blood coming out of its mouth and eyes, and a piece of its head laying in the road so that we almost had to drive over it when passing. Yuck, I know.
Since cows are considered an asset, this was a big deal for who ever lost the cow. Not only was it a loss of financials, but the owner of the cow was responsible for paying damages to the car. (Seems backward, I know.) *I should note here, while talking about animals, that cows are raised for milk, meat, and status. Sheep are raised for wool primarily, and chickens are a main source of meat. *
We finally got to Leribe, a larger town for Lesotho (they have a Shoprite, a nice hotel, a convent - where Sarah actually stayed for the past two nights - a gas station and, obviously, a hospital). We spoke to the PSBH participants for their follow-up first. The most interesting problem that was brought up was brought forward by the assistant accountant. She said that she wanted to fix the problem of patients not being able to get medication at night or on the weekend.
You see, people in Lesotho don't really have addresses. And even if they did, the postal service here is bascially non-existent. (It's more of a chicken/egg thing.) Therefore, there is no system for billing patients after the fact. This means that all services need to be paid for in advance.
So if a patient comes in and needs medication, they bring the medication order to the accountant's office, pay for it, then go to the hospital pharmacy (the only pharmacies they have) to pick it up. But if the accountant's office is closed, they can't pay, so they can't get meds. Yeah, I know. Lots of simple solutions you're probably already thinking of. But here's the catch, Lesotho has been so centralized (our project is to move the health system away from centralization), that the Ministry of Finance has said that no financial transactions can happen after 4 pm or on the weekend. So even if this hospital wanted to bring people in after hours, their hands are tied, and patients suffer.
Or at least, that was the thinking before PSBH and LeBoHA came to town. Now our goal is to work with the Ministry of Health (MOH) in Leribe (and Berea) to make experimental policies that will lead to decentralization and hopefully solve this accountant's problem. But in the mean time, we are going to work with her to see if there is anything she can do (like have the departments keep supplies of drugs for after-hours patients in their wards) to work around the problem before system change happens.
Lunch was provided by the hospital kitchen: rice, roasted chicken breast, beets w/ vinegar, peas, roasted potatoes, carrots, Coke, Diet Coke, pineapple juice.
We'll be meeting with the Leribe Management team next week in Maseru to talk more about hospital improvement.
I finished reviewing the IFC report tonight before dinner, and then I ate leftover cabbage and carrot soup. Yum!
No comments:
Post a Comment