Tuesday, December 6, 2011

The Honeymoon Phase

Courses can be a great way for an NGO to use up its Budget, and they sound good in the Annual Report
I’ve just finished reading “Three Famines” by Tom Keneally, an amazing author who might be best known for the book that was made into the movie “Schindlers List” I downloaded “Three Famines” to my Kindle before I left Australia. The three famines he compares and contrasts are the famous Irish potato famine of the 1840’s, a famine in Bengal around the time of the second world war, and the famine in Ethiopia barely 25 years ago. In relation to Ethiopia he mentions Bob Geldof of course but not my father, which is not all that surprising though he also was part of the world wide response to that famine . My father, a marine engineer, came out of retirement in his mid 70”s to be the “Chief Engineer” on a ship called “Ngahere” which with an entirely volunteer crew sailed  from port to port in New Zealand collecting the tons of  food, clothing  and equipment that was donated by Kiwis. It then sailed to Port Sudan in the Red Sea to unload it all. But I digress.

All three famines were utterly devastating and horrific.- "well yes David they were famines! " I hear you say! Millions of lives were lost and it was ghastly to read about people being reduced to eating grass,bark, rats, dogs that fed on corpses, and even the corpses themselves: cannibalism. The view expressed by Keneally and many others, which was new to me was that in all these famines , domestic extremes of ideology and political interference was not just an impediment to the relief of famine – something we probably all accept – but to a large extent it was a cause  of the famine in the first place. Thus for example in Ireland – which was controlled from London – food EXPORTS continued to England where politicians either refused to believe there really was a famine in Ireland, or else believed  that market forces were at play and shouldn’t be interfered with. In Ireland starving people who couldn’t pay their rent were kicked out of their dwellings which were then pulled down so the occupants would leave the estate they had lived on, so they died of starvation and exposure in ditches and on the roads. In Ethiopia the psychopathic communist dictator  Mengistu destroyed the traditional way of life with a policy of soviet Russian styled Villagisation, and then when it failed, denounced news of famine as anti-government propaganda. Much western aid was diverted to feed his army and his support base in Addis Ababa, which was defended by troops who brutally turned back the thousands of starving who tried to go there for help.
Monument erected in Motta during the reign of the psychopath Colonel Mengistu
I know this is a fairly long bow to draw but its occurred to me lately that in a similar way its not so much the reduction in resources that’s the problem in our hospital but the way in which the resources are distributed and managed, and I am sure it will be the same for most if not all hospitals here in Ethiopia. In Australia the huge difference that a good manager makes to the way an organization like a hospital functions is obvious, even though resources there seem unlimited, but here, with so few resources I am beginning to realize, excellent managers are vital. Unfortunately so far I haven’t found one.

Take bed sheets and blankets for example. And yes, I know this is a long way from cannibalism and death in a ditch but we continually run out of clean sheets and blankets. On a recent cold morning on the ward round I came a cross a woman and her baby lying huddled under a thin cotton garment on a cold plastic mattress – no sheet, no blanket – and the baby had been born at about when lately the temperature drops to about 10 degrees at night. I asked myself what kind of hospital doesn’t have a sheet and blanket for a mother and newborn baby? The point is we do have these things but the laundry system is dreadfully inefficient  and the staff utterly resistant to changing its work rate and practices, with the result that  over the weekend, and at night piles of sheets and blankets are locked up in the .laundry and inaccessible. The reason I know they are inefficient and resistant to change is because I went there to find out why we kept running short – everyone there started shouting at me at once, waving their arms around and shaking their heads and when I shouted back and told them all to shut up I just wanted to talk to their Boss – well that got me nowhere as well!

Another example : Staffing. I think I may have already mentioned that there are six midwives on the books, three junior and three senior, one of whom almost never bothers to turn up – so effectivley there are five. There always used to be eight but the acting Hospital Manager tells me they are not advertising for replacements – and then, when the already depleted staff request leave for study courses or whatever else, they seem to be given it almost automatically and without any regard to who else may or not already be on leave with the result that on occasion we have had only one staff member in the entire town available to work. And if someone or someones baby dies because a single midwife can only do six things at once – is the manager going to accept responsibility for allowing the hospital to be so depleted of professional staff that it was inevitable?

The other day the hospital had no water! And Ive already mentioned the fact that the Xray machine has been “non-functional” for now 7 months. And for the last three weeks  the Lab guy tells me hes been waiting for the chemical reagents needed to enable him to do Liver Function tests. Well my question is why did he run out? In maternity if someone needs an IV cannula for fluids, or medications or a urinary catheter, a midwife has to write out a sort of shopping list, and while we wait a family member has to be found to take it to the dispensary and buy it all and then bring it back to us . Why, I have asked, couldn’t we have a supply of everything we  might need in maternity so we can have immediate access to it and then later have the family replace what we’ve used?  No-one seems to know!

Initially when faced with these unusual ways of doing things, one tends to find them curious and quaint but eventually the cuteness wears  thin and they just seem absurdly inefficient wasteful or ridiculous. Yes folks, the Honeymoon is definitely over!

1 comment:

  1. With great interest I am reading your Blog, as end of february I am going to work in Moota myself as an gynaecologist (fom Holland. I wonder how you are able to make this wonderfullBlog, as Iheard there is no internet in Motta except one little shop? pleas let me know about it! Adrienne Blankhart