June 08, 2009
Making an Impact: Patients First
This past Friday, we had an office-wide meeting at the headquarters in Kigali. It was a refreshing and inspirational time for me. One of the biggest reasons why I decided to join the Access Project and come to Rwanda despite my qualms about living in the villages was its mission to increase access to and quality of healthcare in Rwanda by increasing knowledge, skills, and capacities of healthcare management staff. This meeting certainly spurred me on even more.
In our work, we evaluate 8 core competencies of health centers and make recommendations -
1. Management of Human Resources
2. Management of Physical Infrastructure
3. Management of Finances
4. Management of Mutuelle (a national insurance plan for non-military personelle and those without private insurance)
5. Management of Pharmacy
6. Management of Health Services Statistics
7. Supervision and Community Involvement – Planning and Coordination
8. IT Management
Some of the challenges that we face at that Access Project is not a government/authoritative identity. A little background on the government: Since the inception of the new government, Rwanda runs a decentralized government and health care system. Each province, district, sector, and cell are delineated clearly (although I am still unclear as to whether power is also clearly delineated as well).
The District Health Advisors (DHA) are employed by the Access Project to conduct these audits and make recommendations. Thus, the DHA are often required to build relationships with the district authorities. When district authorities are uncooperative, it makes our job 10 times harder. Rwandans are very much an obedient culture (one of the reasons contributing to the “success” of the genoside in 1994). They also do not like people coming in and telling them what to do. It takes a lot of people (besides the intellectual elites) a long time to change their practices. Often times, I have to spend hours demonstrating one basic skill and in about 10 minutes, they’ll return to their old habits.
Recently, I’ve found my niche in my work. Although patient flow isn’t one of the areas that we measure, I am in the process of helping the health center in my umudugudu (village) - Nemba Centre de Sante with decreasing wait time for consultation. Although I have anecdotal information from patients that they’ve waited up to 6 hours for consultation, I recently started having the staff at the receptionist table collect data for me. It’s astonishing that not only is there no organizational system in which patients are seen by order of arrival, there’s no clinical triage system as well! A quick look at the Fiche D’inscription (Patient sign-in) that I developed, I noticed that someone with a simple flu was seen in 20 minutes while someone else with a gapping wound did not receive a consultation for 4 hours.
Dr. Blaise is completely on-board with my work and he thinks it’ll be very valuable to implement in different districts. Therefore, I will be moving from my current village – Gakenke to another one – either in Musanze or Bugesera in the coming week. It’s always a waiting game in Rwanda. You have to be EXTREMELY flexible – ready to pack up any moment and leave and do something else. But his intentions are for me to help plan a new health center that the Access Project is building in Goshora (Bugesera) in July and work at head quarters with planning and coordination between all of the DHAs. I will definitely like the big-picture view of the organization and the opportunity to work so closely with Dr. Blaise.
For this coming week, my goal is to make a tangible impact at Nemba health center, which is directly next to the hospital. They see more than 300 patients a day from 7:30 – 4pm. Even though that might seem like a lot, there are many more that are turned away at the end of the day or sent to the hospital’s emergency services. My goal is to increase this total number of patients seen in a day and decrease their wait times.
Posted by khytam at 05:38 AM | Comments (0)