Six weeks in and I am very settled at work. I have developed mixed feeling about what I have and can achieve. There is definitely a lot of apathy in the system which is self perpetuating. Like within any large organisation, it is difficult for the individual to feel like they can make change happen. However, it seems even more of an issue in Lesotho as change is very much needed. A lot of the nurses and doctors have accepted that the system is flawed, which is probably needed for them to be able to cope. If I can provide a few examples to illustrate... drugs and other consumables often run out of stock. As I understand it this is because when stock run low, the orders have to be made, processed and paid for before they can be delivered. This takes longer than the stocks last. Also a lot of the equipment is old and breaks down; we have been without an autoclave (to sterilise theatre equipment) and an x-ray machine on a number of occasions. It is unlikely that this equipment is going to be replaced as a new hospital is being built which is due to open next year. When there is so much need for your skills and attention, it is frustrating when administrative matters get in your way of achieving what the system could otherwise achieve. I feel like the rest of the staff though, that if I tried too hard to get things changed, I would burn out. I have therefore decided to focus on making little changes within the sphere of my influence.
From a clinical perspective there remains a large volume of sick young people coming through our doors. Last week I found particularly taxing. On Thursday the ward was overflowing, with all 30 beds full and 12 on mattresses on the floor! Assessing patients on the floor and when there is no room around the bed is very challenging, never mind trying to do procedures like lumbar punctures! Fortunately things have since calmed down a little. I also managed to keep tally of the number of patients I saw in diabetic clinic... in 4 hours I saw 80! It didn’t feel like the busiest clinic I’ve done either. I understand attempts have been made in the past to cap the number of attendees, but this proved impossible. I don’t see a solution to this.
It is not all depressing work though. I have been trying to make careful assessments of patients within the limits of the system. This has allowed me to make diagnoses despite the lack of investigative tools, which has been rewarding. I am also hopeful that this is rubbing off on the rest of the staff, to try and reverse some of that apathy I mentioned earlier. I have also been taking a critical look at prescriptions, especially for antibiotics. It is an easy improvement to make both in patient care and drug expenditure if I can stop unnecessary prescriptions. Related to this I have looked at developing new charts for prescriptions. This was in part due to the fact that the hospital had run out of the old prescription charts.
I have had a useful meeting with Dr Cooper (the consultant) since his return. I am now looking at running the educational aspects of the firm as well as developing protocols for use in casualty, and such like. I have also taken over supervision of the TB ward which felt a little isolated under the old system with only a weekly visit from a doctor. I am also looking at freeing up one day a week to undertake my research, go to the TB and MDR-TB clinics, which are located out of town.
I must now get ready for work... hopefully more positive news for you all in due course.
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