Silver Linings Ledger Book

This trip was not without it’s challenges but each of these came with a silver lining. Our bags missing the flight from London to Johannesburg meant I had more justification for buying additional ‘Presidential’ shirts at the airport. Difficulties in the road trip to and from Harare and Karanda made me focus on the journey. Glitches following the MOIS upgrade made me realize that local IT staff can troubleshoot many problems.


It seems I have developed somewhat of a reputation at Karanda Mission Hospital (KMH). Readers will know that one of my prime goals was to help staff at KMH free themselves from the multiple accounting registers they were using to track their work as required by the Zimbabwe Ministry of Health. Pictured above is one of the books the lab staff had gone back to using to track semen samples. My good friends in the lab were somewhat embarrassed that they were having to use a ledger book to track this information (side note: I’m not convinced that anyone from the Ministry ever looks at this information). So it was quite satisfying to quickly add a template for this data (and remind them that Zoe in the computer office has the instructions and knows how to do this:)

Zoe running the update

One of the students visiting from Toronto commented that she heard someone saying, “Here’s a ledger book (the Antenatal one) Dr Mackey doesn’t know about” to which I replied, “Oooh yes I do” (I have a picture:). I had built a flowsheet for the Antenatal Register last time I was at KMH but I am well aware that this would be a bridge too far at this time. But it’s there in case they ever end up reaching that bridge.

There was a noticeable uptick in “data integrity” while I was there. Word on the wards was that they knew I was going around and checking so staff were being a little more attentive to putting in the information. I totally understand the reticence around using the computer. For some elements, staff are having to enter the data on paper and on the computer and thus struggle to see the point. The challenge has been to impress that, if they do the data entry on the computer correctly and diligently, then they can do away with the paper and save time. Of course it is hard to alter cherished and time-honoured habits.

I did a mini presentation to the hospital staff and was truly able to say, “My work here is mostly done”. All the elements are in place for them to record the information they are required to and they are 80-90% there in the data recording. The challenge is (as always) to make the leap and leave the paper behind.

MOIS-CON Karanda

I got great help from the Drs Sean and Nicole Ebert from Vanderhoof and their son Connor in particular. He was able to do his Excel and Visial Basic wizardy so that the raw data coming out could be nicely sorted and packaged for delivery to the ministry. It was also an incredible blessing that Zoe is now employed as IT support at KMH. Whenever the “My computer’s not working” message came to the office I was able to say, “That’s Zoe’s speciality”. It was very reassuring knowing that KMH has Zoe on site to help continue the work.

Amazingly I had never previously been to eat in the “town” of Karanda. As a group we ended up visiting the same establishment twice to enjoy Zacharia’s wife’s cooking (and appreciate the work that goes into preparing sadza, the national dish). Zacharia works in the hospital CSD department and his sister-in-law, Muguti, continues to work in the pharmacy and so immediately asked how Lori was.

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Enjoying dinner with Zacharia in my new shirt I “had” to buy because my luggage got delayed.

Not only have I experienced several figurative silver linings, but there is a literal connection with Tania’s work in wound care while we have been here. There have been some impressive advances in wound care in recent years (necessary because of the increased incidence of diabetes as well as the aging population). Silver is incorporated into some dressings for its antibacterial activity. Unfortunately these dressings are too expensive to purchase in developing countries. So even in wound care, there are great disparities between Canada and Zimbabwe. However, there were many donated dressings stored in various nooks and crannies (and scary shipping containers) that weren’t being used because there was no attached education. Tania organized the supplies and introduced and updated some practice around wound care that will have lasting benefits. She has also left behind an excellent selection of resources that will help to advance wound care at Karanda. I would again like to acknowledge the provision of prescription and non-prescription medication from Health Partners International of Canada (HPIC) and the supplies donated by uniPharm, the Vancouver-based wholesale company that Fort St John Pharmacy uses.


As with previous visits, the premier silver lining associated with all the travel hassles and the heat and the lack of sleep was re-establishing relationships and meeting new people. We are always treated with such grace and gratitude by the staff at KMH (and the people of Zimbabwe). The customs official, noticing how many Zimbabwe visas I now have in my passport asked, “When are you coming back to Zimbabwe?”.

Back in the Groove/Back on the Blog

After a chaotic start to my travels with a 4-hour delay in Vancouver resulting in less than one hour to make a connection to Johannesburg in London (which our bags did not), I (Paul) have returned to the blog. Those who have been avidly following along will recall that this is my third sojourn to Karanda Mission Hospital, now 2 & 1/2 years since Lori, Rachelle and Thea were here. This time I linked up with the team that Dr Ray Markham puts together annually to visit Zimbabwe. It was Ray and his office staff who initially installed the electronic medical record (EMR) Medical Office Information System (MOIS) at Karanda, at the request of their administration. My first visit in 2015 was inspired by a slide presentation I heard Ray give at a conference in Montreal and he had then encouraged me to continue the MOIS install.

I always have some trepidation when encouraging others to embrace computer technology in their work (particularly healthcare) as I am fully aware that it takes immense time and effort for people, especially those on the front lines here who are extremely busy. Thus each time I have returned to Karanda I am curious to see how much training has been retained and which features of the system are still being used given the demands of working here, not the least being the erratic power supply.

Once again the staff of Karanda have excelled. Some may recall that most of our efforts last time were to try and remove the need for the multiple accounting ledgers that were being used to record information, which some staff member then had to trawl through to extract the data required by the Zimbabwe Ministry of Health. Thus it was particularly gratifying to see that each department with MOIS was still “off book” except for the subset that the Ministry requires in a particular ledger (essentially HIV and TB). It was also incredibly gratifying to see the rapid and almost effortless way the staff were then able to extract the data they needed to (in a minute or two versus hours). Well almost effortless as there was a tiny (but extremely annoying) bug because of Canada being “Letter” and Zimbabwe being “A4” for printers. However after a few hours of: “I should remember how I fixed this!!” I did indeed remember.

It was also heartening to see how the staff adapted some of the workflows I had started. In some cases, they figured out that my way wasn’t working and so they came up with a better, simpler way. As usual everyone greeted me very warmly and generously, despite me being the “MOIS doctor”. It has been wonderful reconnecting with people and they are very patiently re-teaching me all the Shona I had forgotten.

Of course there have also been some hiccups. During this visit, we updated MOIS and, as expected, the update “broke” a few of my workarounds. Nothing I wasn’t expecting and the update now gives me the tools to do the local adaptations properly. However it does mean the keyboard grunt work has to be done. I do have the luxury of doing this in the computer room which is air-conditioned, unlike the other hospital departments and wards. As before, MOIS staff back in Prince George have endured my numerous requests and given me solutions.

This time of year is the rainy season and therefore “cooler” than the 40 degrees we all experienced in Oct 2016. However the fans are still required in the day and are missed when the power goes out. It does get a fraction cooler at night and I commented that this time was the first (on one night) that I actually had to pull up the bed cover. The difference in the vegetation is fascinating to see after the rain, with everything that was brown before now green. However the rains have been less than usual and the season appears to have finished early, which does not augur well for the coming dry. Already the water is being turned off at various times.

Because of rising prices, the hospital has even fewer medications available than before. For this trip, Lori arranged a substantial supply of medications through Health Partners International of Canada (HPIC). Something as basic but as essential as acetaminophen was being rationed before our arrival and the various antibiotics in the HPIC boxes were particularly appreciated.

Tania Bell, a wound and ostomy care nurse at Fort St John Pharmacy and Wellness Centre, joined me on this trip. She is very much in demand. As the Canadian Dr Thistle who works at Karanda full-time says of Karanda, ‘Pus Is Us’. Tania has been organizing all the donated dressings, developing simple protocols so nurses know how and when to use them, and teaching the nurses. She has also been adapting some of the wound-cleaning procedures. The staff at uniPharm, the wholesale company in Vancouver that supplies medications to various pharmacies throughout BC, generously donated many supplies such as eye patches, knee braces, etc. that were gratefully received.

Amidst all these challenges to provide the basics it does seem a little irrelevant to be maintaining computers and printers and training people to use software. However the staff continue to be gracious and hard working and receptive to change. Ray always emphasizes capacity building on these trips and that is our goal. I have more “help” from Ray’s team arriving this week to expand the training, which staff have identified they need. I anticipate a productive week.


Mackey Musical Reflections 2018

Musical Reflections

For our 2018 Christmas letter, we would like to offer you our playlist for the year.


An anthem for the times. “History’s been leaning on me lately”.

This year

Having already used Twin Peaks’ “It’s Been a Year” we had to find a different song with “Year” in the title. This one describes the ups and downs of life well.


It is no secret that Jeryn is a HUGE Hugh fan and that she is very disappointed that he is performing in Toronto a week after her convocation at Guelph in June. Thea has joined the fan club and this was her favourite song from the movie, which her devoted father is learning on the piano.


In October, Lori met some of her friends and Jeryn in Toronto for a fun weekend. This musical was a highlight.


We were fortunate to have Naomi Shore and Lyndsay Walker perform a house concert for us as part of our “first anniversary of living in Kamloops” house warming. One of the songs they sang was “My Peace River” by  Miss Quincy.  We felt this particular track spoke to our Peace River roots but also our feelings about settling in our new home.


When asked for suggestions for the playlist Rachelle offered this. How she came to be listening to Bobby Vinten is anyone’s guess. We suspect the choice arose because, having graduated from High School, she was adapting to moving out from the Shenton’s and into residence at Northern Lights College with a roommate who “is in the kitchen calling her friend and yelling at her. And also watching a show at 12. I totally don’t want her to shut up so I can actually sleep or anything”. Karma?


El Paso is one of Lori’s dad’s favourite songs (and we suspect it also made an appearance on JVM favourites) so this is in honour of Jerome coming to stay with us in transition from Drayton Valley to Ladner.


Continuing the Mexican theme, Jeryn suggested this in honour of Rachelle’s Mexican boyfriend Pedro.


It’s not that we hate Winnipeg it’s just there are not many songs that feature the prairie capital. Because Paul was doing a locum in Neepawa (the home of Canada’s only estate brewery) in the summer, Paul, Lori and Thea got to visit Winnipeg, notably the impressive Museum of Human Rights. Thea finally got to see some of Canada east of Edmonton but it became apparent that the landscape all looks much the same from east of Edmonton to Winnipeg.


A road show Cirque du Soleil performance in Kamloops was an event we could take our Chinese home stay student Hera to and we would all be equally baffled and amazed.


If we compiled a soundtrack of our lives, we would include Jann Arden’s music. It was a highlight to see her perform in Kamloops.


Mick and Wal are also on the soundtrack of our lives so it was fascinating to hear them workshopping this track while we were on the safari tour in Africa. Paul made a short trip home in November to attend the Melbourne Cup with family and to drive his Dad and Sandra to wineries. lt was a little surreal for Paul to say hi to Mick and Wal and hear the final product at the Merri Creek tavern.  You know you are getting on when the artists you follow are selling tea-towels as merch!


Adam came to visit. And did some fishing.


We saw Frank Turner perform in Vancouver and dragged along Lori’s sisters and brother-in-law. A sincere, high energy concert. This is his “traditional” closing track and so a fitting book-end to our 2018 playlist…

For the encore…


What would a Mackey playlist be without some Billy Joel? This one seems the most descriptive. Jeryn “moved out” of her exchange program at RMIT in June and did some travelling before heading to Fort St John and then back to Guelph. Upon graduating in April she’ll be moving back to Fort St John to work with Urban Systems. Oh and to be with Ted. Liam too will be moving out. He has been home with us in transition between UVic and continuing his studies in January at Thompson Rivers University in Kamloops. Rachelle too will be moving. In January she is moving to Saltillo, Mexico, for 6 months, to continue her studies. And to be with Pedro. Thea is moving but just up, not out. In grade 10 at St Ann’s, she enjoyed playing on the senior volleyball team but is not enjoying being the senior flautist in band. “Those grade 9s don’t know anything”. Paul has been moving around a fair bit doing rural locums: Terrace, Barriere, Clearwater, Fort St John, Williams Lake, Salmon Arm, Chase, Ashcroft and, in Manitoba, Neepawa and Thompson. As a result Lori has been moving around less. She had been doing some pharmacy stints in Fort St John, Keremeos and West Kelowna but has been focusing more on her medical editing work for David Mackey and being a m-uber for Thea.

Life moves on.