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:)
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.
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.
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?”.