Ending the Isolation: Creating an Epilepsy Hub in Sierra Leone

In the last in our series of blogs about health partnership projects in Sierra Leone, THET's Communications Officer, Timur Bekir, visits an epilepsy clinic and training session to document the work of the Basildon-Lumley Partnership.

A health partnership between Basildon & Thurrock NHS Trust and Lumley Government Hospital in Sierra Leone, working closely with The Epilepsy Association of Sierra Leone, is improving epilepsy care by training healthcare workers around the country and creating an epilepsy hub to reach rural communities.

Connaught Hospital in Sierra Leone’s capital, Freetown, sits to the north of the city, not far from the Cotton Tree, a famous landmark that is over 200 years old and marks the spot of a settlement built by freed African American slaves in the late 1700s. 

It’s first thing on a Thursday morning and I’ve been invited by project leader Dr. Radcliffe Lisk, a Consultant Neurologist at Basildon, to sit in on an epilepsy clinic. Patients quickly fill the room and a queue snakes out of the door. The service is obviously much needed.

The clinic starts with patients and health practitioners singing and praying then a Q&A follows. Patients asks questions about their condition and any issues they are having trouble with. For many, this is the first time they are seeking treatment for their epilepsy.

Epilepsy clinic at Connaught Hospital, Freetown, Sierra Leone. Photo: Timur Bekir/THET

50 million people have epilepsy worldwide, but around 80% are found in developing countries. Dr. Lisk explained why:

‘The reason why epilepsy is more common in developing countries than it is in developed is because of additional causes such as poor obstetric practice. A lot children are born with brain damage because of prolonged labour and these are the children at risk of epilepsy in later life. And cerebral malaria has been shown to be one of the main causes of epilepsy in children. Trauma from war and high levels of road traffic accidents also contribute. Most of the prevalence studies that have been done in Africa show that epilepsy is about 2-3 times more common than it is in Europe or America so it is a big problem.’ 

The most reliable data suggests 60,000 people in Sierra Leone have epilepsy. But inadequate health provisions and long-held views among the population that epilepsy is a result of witch craft or demonic possession means that 80-90% of people with the condition will never receive the treatment they need.

During the session I get a chance to speak with some patients who have benefitted from the project. When describing their experience of having epilepsy, patients describe similar difficulties they’ve faced such as stigma, isolation and the general belief that they are ‘crazy’. Jeneba Kabba has had epilepsy for 14 years now and described her ordeal:

‘They gave me kerosene to drink and said that is the way to treat epilepsy. I had this treatment for three years. People were laughing at me and saying I was crazy.’

Jeneba found out about the work of the partnership three years ago and has been able to manage her epilepsy ever since. She is a mother and teacher, and works with the partnership to raise awareness and reduce the kind of stigma she faced for so long.

A health worker administers drugs to epilepsy patients at a clinic in Connaught Hospital. Photo: Timur Bekir/THET

As well as the sessions at Connaught, the partnership is expanding its activities across the country. The project, currently funded under the health partnership scheme, is creating a national epilepsy hub to reach isolated rural communities. Previously, rural patients had to travel long distances or wait for the monthly provincial visits to access any sort of epilepsy service.  To reach the vast majority of patients, the project is training all levels of rural health worker in epilepsy diagnosis and management. Training health workers in the Peripheral Health Units (PHUs) that serve the villages and chiefdoms is a key activity for the project and essential to increasing access for patients.

To see the training first-hand, I travel to Moyamba District in the north of the country. The two hour journey takes five. Slowed down by a never-ending caravan of traffic coming out of Freetown and terrible road conditions once into the district. This helps to highlight how difficult it is for rural communities to access services in Freetown, add to this the cost, and some individuals and families have no chance of accessing healthcare.

Once at the workshop, I watch as Dr. Lisk and his team run through a full days teaching, covering everything from diagnosis, clinical treatment, and breaking down the traditional beliefs that claim epilepsy is demonic possession or witch craft.

To date, 439 health workers have received training, including 6 district medical officers, 89 Community Health Officers and 254 Community Health Nurses & Community Health Assistants. Trainees have reacted positively to the training with the majority acquiring new knowledge such as different types of epilepsy, its association with depression and recognising that the majority of seizures can be controlled with medication. Many trainees are now local focal points for the project.

Along with the training sessions, the partnership has produced a handbook that includes protocols on the management of various aspects of epilepsy. In tandem with this, the partnership continues to raise awareness about epilepsy through TV and radio appearances and newspaper articles. All essential activities in breaking down the long-held but misplaced beliefs about epilepsy in Sierra Leone.

‘The advocacy work is extremely important,’ states Dr. Lisk, ‘because that's how you get them into the clinics in the first place. If you don't change their beliefs you won't get them to the clinics. It's a slow process but our programme also goes into schools so we can educate the new generation. We talk about epilepsy and have our posters in schools too.’ 

Patients receive drugs from a health worker at Connaught Hospital. Photo: Timur Bekir/THET

Back in Freetown, I sit in on an EEG session in the neurology department of Connaught Hospital. The EEG machine used by Dr. Lisk and his team has been acquired with funding from THET. The project has been able to purchase three machines and train four technicians to perform EEG recordings. 

A technician carries out an EEG test for a patient at Connaught Hospital. Photo: Timur Bekir/THET.

A technician assess the EEG reading. Photo: Timur Bekir/THET.

A patient receiving an EEG test. Photo: Timur Bekir/THET.

A patient receiving an EEG test. Photo: Timur Bekir/THET.

I ask Dr. Lisk about the sustainability of the project and he explains that the programme has worked closely with the Ministry of Health from the start to help ensure the future of the project:

‘One of the keys to sustainability is integration into the Ministry's programme. That's why, from the onset, we made sure this wasn't a parallel programme. So by actually training the staff employed by the Ministry of Health they then have the knowledge to carry on the work after the project ends.’ 

In fact, epilepsy has received further recognition from the government and a focal point for epilepsy in the Ministry of Health has been appointed. This is an important development for a project that is really gaining momentum and, from the amount of patients I’ve seen attend clinics, is much needed.

One thing is for sure, the partnership has already been able to produce strong advocates for the project. Over just a couple of days I’ve met health and social workers, teachers and patients who have responded positively to the training and are now advocates engaging in awareness raising and sensitization in their districts. A great example of how training and education can have life changing results far beyond the classroom. 

Find out more about the partnership at www.thet.org

Find out more about epilepsy in Sierra Leone on the Epilepsy Association of Sierra Leone website. 

THET has produced a short film documenting the work of the project. Dr. Lisk, trainees and patients are interviewed about their experience of epilepsy in Sierra Leone and the impact of the project. Help support the work of the partnership and share the video with friends, family and colleagues.

Giving Children a Chance: Reducing Child Mortality in Sierra Leone

In the second in a series of blogs focusing on THET funded health partnerships in Sierra Leone, THET's Communications Officer, Timur Bekir, visits Ola During Children's Hospital in Freetown to document the work of the Global Links project. 

It’s a stifling November day (the locals will later laugh and tell me that November is a cool month) and at Ola During Children’s Hospital in Sierra Leone patients crowd the corridors waiting patiently by the Emergency Room. In the Special Care Unit babies struggle to adjust to their new world. And in the ICU a mother tenderly reassures her child. In each of these vital wards is a volunteer from the UK working with local staff to help improve healthcare for Sierra Leone’s youngest residents. 

The volunteers: Paul Gibson, Liza Waldegrave & Gareth Lewis are part of the THET funded Global Links project, a health partnership between the Royal College of Paediatrics & Child Health and the West African College of Physicians. The THET funded Global Links project places long-term volunteers in five African countries: Sierra Leone, Ghana, Kenya, Nigeria & Uganda. The partnership is working with staff and institutions in each of these countries to establish a consortium of UK and East & West African central and district hospitals that will work to reduce child mortality and help meet Millennium Development Goal 4.

The 8 Millennium Development Goals.
Global Links seeks to address MDG4.

The volunteers work closely with the staff at Ola During, the main referral hospital for the whole of Sierra Leone, to provide clinical support, develop protocols and train staff. And, by all accounts, the relationship between the volunteers and their Sierra Leone colleagues is strong. Gareth Lewis, a Paediatric Registrar and Senior Resident at Ola During, highlights the relationship between volunteers and local staff:

‘All the doctors have been great. I’ve been working with one doctor in particular in the Child Protection Unit and she has been really helpful in teaching me bits of Krio here and there. They’ll help with translation. In general they have been very supportive and you never feel excluded as an outsider here.’

Walking around the wards I can see this inclusivity first-hand. The local staff and volunteers have a professional, but easy manner with each other, undoubtedly vital in ensuring a positive and productive working relationship.

Gareth Lewis in the SPU. Photo: Timur Bekir

Gareth Lewis with House Officer. Photo: Timur Bekir

There’s a huge need for support at Ola During, as Dr. Baion, Medical Superintendent, highlights starkly:

‘We have nine wards which means, at the least, we need nine doctors, but we have only two doctors in this hospital. So even having just one person from Global Links helps a lot. They are covering so many areas that we cannot do on our own.’

Paul Gibson, a Consultant Paediatrician in Lancaster, is midway through his twelve month placement. He kindly spends the day showing me around the hospital and introducing me to staff and patients, his energy and enthusiasm doesn't flag for a second. Dr. Gibson is well aware of the need he’s here to address:

‘When last measured, the mortality in Sierra Leone was approximately 170 per 1000 so about 17% of children died before their fifth birthday. What that means at Ola During Hospital is that approximately 10-14% of our admissions die, which is tough on the staff and the whole operation.’

Dr. Paul Gibson. Photo: Timur Bekir

Dr. Gibson and local team. Photo: Timur Bekir

Typical cases at Ola During include malnutrition, malaria and respiratory tract infections. And it’s a constant numbers game – not enough skilled health workers to deal with the cases that come in on a daily basis. As Dr. Gibson notes:

‘One of the features of health and healthcare in Sierra Leone is simply a shortage of numbers of health workers. Then there’s also the quality of skills those health workers have. If you start with the nurses, often they feel poorly paid and unrecognised. And training isn't just about giving people new knowledge and new skills, it’s about giving people a reward. So one of the things that external people like Global Links, funded by THET, can do is bring that in and send a message to nurses or nurse aides that what you do is valuable,  and it’s important to invest in you and your training.’

Emergency Room. Photo: Timur Bekir

Local nursing staff. Photo: Timur Bekir

Nurse attending to a patient in the ER. Photo: Timur Bekir

Patient in the ER. Photo: Timur Bekir

During my two days at Ola During it’s encouraging to see the emphasis placed on evaluating and measuring impact. Away from the wards and in the classroom I sit in on the weekly Mortality & Morbidity session. These meetings are not only a chance for the team to analyse and improve mortality rates in the hospital, but are also the start in rebuilding a much needed medical postgraduate life for the institution.  

The addition of ‘speed learning’ at the end of each day on ICU is helping to supporting and nurture leadership, team working, and improvements to clinical governance, team development and clinical leadership too. Led by the local Staff Nurse, these fifteen minute sessions are a chance for staff to get answers to questions that come up on ward rounds. The sessions foster a culture of sharing and learning as each member of staff contributes by imparting the knowledge they have to answer daily queries.

In addition to these sessions, the volunteers are helping to deliver more training, including twenty hours of undergraduate lectures and a regular, weekly, Continuing Professional Development programme for paediatric staff, including sessions on HIV testing, clinical assessment, and treatment of shock and dehydration.

Liza Waldegrave with nurse in the ICU. Photo: Timur Bekir

Dr. Gibson with patient in the ER. Photo: Timur Bekir

A mother feeds her child in the ER. Photo: Timur Bekir

Dr. Gibson tends to a patient. Photo: Timur Bekir

As my time at Ola During draws to a close, I reflect on spending the day with a really motivated team who clearly care passionately about their role. The challenges are numerous and can sometimes seem overwhelming. But the local staff, with support from UK volunteers, are making gains in a large number of areas. The RCPCH Global Links project is forging a relationship with Ola During and other hospitals around Africa in order to work together to train health workers and improve healthcare for children far into the future. As Dr. Gibson states:

‘Success for colleagues in Sierra Leone would be that in five years there would be an internal self-sustaining confidence that nurses, doctors and midwives actual felt that they were the leaders, that they could control things and come up with ideas. And that the workforce is self-sustaining.’

It’s that emphasis on long-term, sustainable healthcare that is fundamental to the health partnership approach, and why training and developing the skills of local health workers, not just delivering services, is key to realising that approach for real in hospitals in Sierra Leone and around the world.

Dr. Gibson with nurse and mother in the ER. Photo: Timur Bekir

Record keeping in the ER. Photo: Timur Bekir

Patients rest in the ER. Photo: Timur Bekir

House Officer in the SCU. Photo: Timur Bekir

A mother with her child waits to be seen in the ER. Photo: Timur Bekir

To find out more about health partnerships in Sierra Leone and around the world, visit www.thet.org 

To find out more about Global Links and how you can volunteer, visit the RCPCH website.

Self-reported change in practice: a monitoring tool for health partnerships

In this blog, THET's Evaluation & Learning Officer, Emily Burn, shows how the introduction of a self-assessment tool is key in demonstrating the impact of health worker training. 

Trainee nurses at Kambia District Hospital, Sierra Leone. Photo by Timur Bekir

Imagine this situation: A team of doctors were trained in palliative care by their UK partners in a one-week course. There were 30 trainees in the group and the partnership plans to train another cohort of the same size.  The trainee doctors received a certificate of competence at the end of the course if they performed well enough in the final written assessment.  Once they completed the course, the doctors returned to their places of work in the hospitals and clinics both in peri-urban and urban areas. For many of the doctors, they will be the most senior or only clinician at their place of work and they will also be the only ones responsible for delivering palliative care.

What can the partnership do to gather data on the doctors’ practice in palliative care once they have returned to their places of work? In this scenario, the trainees are spread widely geographically making it difficult for those responsible for M&E to visit each of them.  The doctors do not have an appraisal system or a senior colleague who can provide objective feedback on their practice. The doctors do keep practice logbooks but it may not be feasible to retrieve data from all of those logbooks.  The partnership does not have enough funds or supervisors available to visit each doctor in their place of work to assess their skills, and in any case, how thorough an assessment can be made in just one visit?  So the partnership faces various issues in data collection but they do need to come up with ways to gather data on practice that are reasonable given the context they work in.  

The case for self-assessment

This scenario is typical of many health partnerships’ experience of monitoring change in a rigorous way: they have limited staff, time and funds available to monitor and evaluate each health worker’s performance yet they still need to gather evidence that could demonstrate the impact of the training on the health worker’s practice.  Given the context that health partnerships work in, there is a strong case for using a self-assessment tool, such as an online or paper questionnaire.  The obvious issue is the lack of objectivity or external verification of the claims made in a questionnaire and indeed the aim should be to combine it with other sources of information (e.g. clinical records) yet the questionnaire can overcome some of the difficulties health partnerships face in data-gathering to provide interesting insights to trainees’ experiences in their own places of work.    

How can you design a questionnaire for use in your own work? I asked THET’s community of practice for examples of self-assessment tools that they use in their projects. Interestingly, I received several examples of workshop evaluations, which looked at things like knowledge gained, course relevance, and overall satisfaction with the training, all gathered at the end of the course. I had far fewer examples of questionnaires that trainees complete further down the line on if, or how, they applied their training. 

Although any questionnaire must be tailored to the specific techniques taught, the following generic topic areas are a useful starting point for designing your self-reporting tool:

Evaluation of the training

·       This is to understand if the training targeted the right cadre of candidates so the questions should ask how relevant the trainee has found the training to be once they returned to their institution.

Knowledge retention

·      A set of multiple choice questions (MCQs) can directly test how much knowledge the trainee has retained since the training.  You could compare results from a final assessment at the training with this later MCQ assessment.

Confidence to practice

·      How confident does the trainee feel to carry out procedures or new techniques, learnt on the training course?  A Likert scale (e.g. Very confident – Fairly confident – Not really confident – Not at all confident) is the commonest format for this type of question.  Include a comment box to give rationale for their answer.  It could be interesting to compare confidence answers across three points in time: pre training, immediately post training, and 6 – 12 months after training. The comments box could help to explore reasons for notable dips or peaks in confidence.

Change in practice

·      With what frequency does the trainee now practice a set of techniques, bearing in mind what is reasonable for a given context?  Always provide comment boxes for these questions as it is important to understand any barriers to practice, such as lack of equipment or adequate supervision.

·         Include text boxes to gather narrative examples of practice such as cases where they have used the skills gained in training; if appropriate, request that the answer includes any information on the outcomes for the patient.

Lastly, what response rate would you be satisfied with?  It is unlikely that you will get 100% of trainees to complete and  return the questionnaires so make it as user-friendly as possible (test it out on some colleagues before you distribute it), consider creating it online if local bandwidth allows – THET  uses the online tool Survey Monkey because it is easy to use and has useful reporting functions – and review your M&E plans to determine other data-gathering tools so that you are not reliant on just the questionnaire for data on change in practice.

If you have an example questionnaire that you would be happy to share with us, please send it to emilyburn@thet.org or post it on the community of practice.  I am also interested to hear about people’s experience of using self-reporting to gather evidence.

Useful Links

http://betterevaluation.org/

http://www.tools4dev.org/resources/online-based-survey-software-5-pointers-to-look-out-for/

Mama en Pikin welbodi in Kambia District, Sierra Leone

In the first of a series of blogs focusing on THET's work in Sierra Leone, THET's Communications Officer, Timur Bekir, visits Kambia District Hospital to document the work of two THET funded health partnerships. 

Health partnerships are improving the lives of women and children in Kambia District, Sierra Leone. 

I’m in Sierra Leone to document two health partnerships that are engaged in project work at Kambia Government Hospital, helping to improve maternal and child healthcare. Our journey to Kambia Government Hospital takes my colleague and I along red clay roads peppered with pot holes the size of bath tubs, past acres of dense green forest, and pass neighbourhoods with families going about their daily lives. The lush, rural and often idyllic setting of Kambia Government Hospital belies the challenges the institution, and the community that rely on it, face.

Sierra Leone currently sits at 177 (out of 208 listings) on the Human Development Index, life expectancy at birth is 48[1], under five mortality is 185 per 1000 live births, and maternal mortality is 890 for every 100,000 live births.[2]

We are given a warm welcome when we get to the hospital from some of the UK volunteers currently on placements at the hospital. We are introduced to their Sierra Leonean colleagues and get ushered into a workshop for Volunteer Nurse Assistants (VNAs) and Maternal & Child Health Aides (MCHAs). The workshops are part of the training delivered by the partnership between Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) and Kambia District Health Team (KDHMT). The partnership has been funded and supported by THET and managed by the charity The Kambia Appeal. The partnership is helping to reduce maternal & child mortality by training MCHAs to deliver primary healthcare.

Workshop training. Photo by Timur Bekir.

Workshop training. Photo by Timur Bekir.

The passion and commitment of the students is showcased as each one gets up in front of the class to teach what they have learnt. Confident delivery is met with insightful questions and, although my Krio isn’t quite the best in the room, it’s clear that all the students will be passing with flying colours, going on to provide much needed healthcare in the local community.

Role reversal. Photo by Timur Bekir.

My next stop is to accompany some of the long-term volunteers doing ward rounds in the children’s ward. The Kambia Appeal Volunteer Programme is the second partnership funded by THET and managed by The Kambia Appeal. Again, working closely with the Kambia District Management Team, the partnership uses skilled UK health volunteers to train and teach local healthcare workers and improve the quality of care for women and children in Kambia.

UK volunteers on ward round. Photo by Timur Bekir.

Patient being attended to by VNAs. Photo by Timur Bekir.

During the round patients and staff greet me with a smile, and are extremely accommodating when I ask if I can take their picture. The pleasant disposition of the staff is in contrast to that of the hospital. As I make my way around it becomes clear how under resourced it is, with next to no medical equipment. To highlight the point, a local health worker tells me about the time a patient came in bleeding severely. They didn’t have the AB- blood needed and went about asking patients and colleagues if anyone had that blood type. With no one in the hospital having a suitable match the health worker rushed to the local radio station to put the word out to the local community, but no one responded. The patient died that day unable to get the blood they desperately needed. This story shows the fine line between life and death in a hospital that is so lacking in equipment and skilled health workers, emphasised all the more because if I had arrived a few months earlier perhaps I could have been a donor, as AB- is my blood type. 

Later that day, I interview the District Medical Officer, Tom Sesay, who explains that, despite the many challenges faced, maternal and child healthcare is improving and the future looks bright, ‘I’m very optimistic because we are putting in place a lot of strategies and we are getting support from partners like The Kambia Appeal. The Kambia Appeal volunteers coming and conducting this training has really helped to strengthen the capacity and skills of many of our staff. I think there is light at the end of the tunnel. We now have a lot of training institutions in the country so I think gradually the human resources situation will be improving.’

As the sun sets over the hospital and I take my last few photographs, I reflect on the extraordinary people I’ve met. But most of all I am inspired by the unique way that health partnerships bring like-minded, passionate individuals together from around the world to help improve healthcare for women and children in places such as Kambia, helping train health workers who will provide essential care for years to come.

Patients wait to be seen. Photo by Timur Bekir.

Photo by Timur Bekir.

Photo by Timur Bekir.

Photo by Timur Bekir.

 Where the training took place, Kambia Government Hospital. Photo by Timur Bekir.

For more information about the work of these two health partnerships, please visit www.thet.org or www.kambia.org.uk

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[1] http://hdr.undp.org/en/statistics/hdi

[2] http://www.unicef.org/infobycountry/sierraleone_statistics.html

What you need to know about monitoring, evaluation & learning.

In this blog, Emily Burn, THET's Evaluation & Learning Officer, walks you through the key monitoring, evaluation and learning issues health partnerships should be addressing when planning projects. 

Recently I attended an M&E workshop held by INTRAC which brought together many M&E practitioners from the NGO and public sector to share challenges and solutions to common issues in M&E.  The detailed discussions led me to think about the over-arching principles that we should return to when we plan our M&E. Here I summarise the components of a good system for monitoring, evaluation, and learning, which health partnerships should think through when planning their projects.

Your Monitoring & Evaluation needs a rigorous system underpinning it

Your monitoring and evaluation activities need to be underpinned by an efficient system that enables you to focus your efforts and translate data into evidence and lessons.  An efficient system is particularly important to health partnerships which are operating with limited resources for M&E but which need to meet reporting requirements, and make the most of opportunities for learning.

So what does an efficient M&E system look like?

It is thoroughly planned

The project plan clearly articulates the change you want to achieve.  A Theory of Change approach will help you to see the logical flow of your objectives. For more information and a tool for using this approach see: http://www.thet.org/hps/resources/good-practice-guidance/project-planning-theory-of-change-1

You have discussed who your stakeholders are and the types of results they will be interested in, which means that you can plan the analysis, focussing on a limited number of questions that the data could answer, rather than all possible questions.

Each objective has ‘indicators’ (also known as signs of success or measures of progress) that are appropriate and feasible given the time, funds, expertise, and data (etc.) that you have access to.  Also, you know who will gather the indicator data, with what tools, and how frequently.  You know if the data collector has the expertise to do this or you have a plan in place to provide training. You know if you need to create a new data collection tool or if an adequate system is already in place that you can use.

You know how the data will be brought together in a central place. For example, you have an M&E focal person in each project site whose responsibility it is to submit health worker logbook data on a monthly basis (via email ) and then you have a central site where these data are entered into a spreadsheet, ready to be analysed.

M&E planning tool: http://www.thet.org/hps/resources/good-practice-guidance/monitoring-evaluation-plan

It is carried out consistently and in partnership

All those who are part of project implementation understand the objectives and buy in to the indicators.  This may require on-going review and adjustment of the indicators and milestones. 

You have a process in place to disseminate the project’s progress regularly so that those affected by the project understand what is going well and what is not.  The channels for communicating the results take into account the different project stakeholders, from NHS board members, to the staff on the ward, where the former may be most receptive to a presentation from the UK partner, and the latter may prefer to see improvements in practice displayed on a poster or mapped out on a chart in a staff area.

Lastly, an efficient M&E system facilitates learning by making full use of the findings to question how things are going, pinpoint problems, and so make changes based on evidence. At THET, our M&E system includes an analysis process that aggregates qualitative data into a simple spreadsheet where we group findings thematically. We see the benefits of this: when we write reports for our donors; when we need evidence of how best to support health partnerships; or when we need examples of, for example, positive changes in practice. In this way, our system for analysing and recording the data from health partnerships helps us to make use of it, in multiple formats, and for all our stakeholders. 

Discussing protocols at Kambia Government Hospital, Sierra Leone.

Anaesthesia training in Zambia - a volunteer perspective - part 2

Dr Lowri Bowen is currently in a 6 month volunteer post with the Zambian Anaesthetic Development Project (ZADP) working at University Teaching Hospital, Lusaka. In this blog she reflects on her time in Lusaka so far and the importance of not taking things for granted. 

My last blog centered firmly on the educational role of the Zambian Anaesthetic Development Project (ZADP), so this time I thought I would cover a different aspect of my work, which runs alongside the teaching and clinical supervision aspects.

I am sure that most people are familiar with the United Nation’s Millennium Development Goals – essentially a blue print of areas that’s been agreed on by all the world’s countries as essential to improve upon. There are eight of these but I wanted to focus on number 4 – decreasing child mortality.

There are many different ways to combat child mortality and there are many fantastic programmes going on all over Zambia and the world to this very end; however this is the start of our contribution towards getting to the goal of making University Teaching Hospital, Lusaka a safer and better place for children to have their anaesthetics. This is a particularly important topic, so why have I chosen to talk about this now, almost 4 months into my time here?

Well…..   Last week highlighted some of the most exciting times for me as a ZADP trainee. Despite plenty of interesting clinical work and really fulfilling teaching sessions over the course of that week I got incredibly excited about a door.  It does seem like quite a crazy thing to get excited about – I mean it’s something we use on a daily basis – it opens and it shuts and it serves it purpose but it’s hardly the highlight of anybody’s week usually.

So what type of a door was it?

The door in question is a plain, brown wooden door which I confess does not fire up the imagination. So why have I become so excited by this particular door?

If you think about it carefully a door is actually something that appears quite a lot in children’s stories and they are significant not by their appearances, but by what they contain behind them:

There is the wardrobe door to enter Narnia in ‘The Lion, the witch and the wardrobe”, the changing room door where Mr. Ben disappears into his various different worlds wearing his fancy dress outfits and, of course, who could forget the Alice in Wonderland door down the rabbit hole!

Behind my featured door is the new anaesthetic store room for the paediatric (children’s) theatre block.  It is where we will be able to safely store and register all the required equipment for the safe delivery of anaesthetics to children in UTH.  It means that we will no longer have to scramble around searching to find items that may or may not be present or kept elsewhere. We will be able to keep a detailed inventory of all the equipment which will allow timely ordering of things before they run out and also allow the theatres to have less equipment strewn around them and become a more ordered place to work.  This is a project that was started over a year ago. The main focus initially was to secure a storage area in the main theatre complex as there was nowhere for anaesthesia equipment to be kept apart from a small toilet block that regularly leaked and caused damage to vital equipment.

After much work and tireless negotiation by my previous colleagues, this was finally secured last June and since then has become well stocked and ordered with 2 of the anaesthetic MMeds in charge of it. Since this time we have secured a similar area in the emergency theatres and so when I arrived in August my remit was to focus on getting a safe area of storage for the paediatric theatre block. We quickly identified a store area but required a door to serve as a secure area for us to develop. Since this time (3 and a half months) it has taken painstaking negotiations with more people than I could ever have imagined being linked with the hanging of a door! Many a letter and meeting and cajoling visit to the workshops and purchasing departments all added to the momentum that could also be called just plain nagging! The help of the theatre matron was critical and with her additional nagging I think we managed to get the ‘project’ up and running. Initially the victory was getting a door frame placed, as there wasn’t one.

The frame getting placed and held up by batons as the concrete dries.

Once the frame was placed there was then the inevitable three week wait to get the plastering dry and the door frame procured  – no such DIY shop down the road here! So Friday was the celebration of conquering the beaurocracy and of all those frustrating weeks of doubt by the visualization of an actual door sitting in it frame!

The door! I am hopeful there may be a paint touch up at some stage, hopefully after the lock appears. 

There are still things to do – the little problems of a lack of a lock, clearing the space out as it has accumulated lots of ‘junk’ over the years, sort out some shelves, stock up and make an inventory are all in front of us… but this is most certainly a step forwards and a great achievement for the improvement of patient safety in UTH. To celebrate, we managed to decorate the walls of the recovery room and holding bay with some wall stickers that some friends had brought out for me – ok, this is not strictly a UN MDG 4 goal but it is important to provide stimulation and create a child-friendly atmosphere in the theatre block whilst the children wait for their surgeries. It was great to get all of the staff – from theatre porters, nurses, trainees, consultants and surgeons to give their opinions and to help in placing the decorations and become enthused over such a simple but important aspect of emotional care for the children.  As you can see from the snaps below the place looks a lot brighter now! I think both children and staff will enjoy being in the department a lot more now!

To find out more about THET's programme work in Zambia please visit our THET.org