More work in Mbarara

Goodmorning!

There is so much to update on since our trip to Mbarara began, and so little free time to blog and limited time to access the internet! I wish we could convey more details (and in a more coordinated manner); however, here is a brief overview of the last day or so in Mbarara. As we mentioned before, our first day at the Mbarara Hospital(Tuesday, August 3rd) consisted of meetings with key university faculty members and leaders, hospital administrative leaders, as well as a few of the clinicians that we would be collaborating with during our trip. Specifically, we met with Dr. S. Ttendo (SJHS IOP Coordinator), Dr. F. Kayanja (Vice Chancellor – MUST), Mr. P. Mihayo (Hospital Executive Director) and Dr. J Kabakyenga (Dean – MUST). We felt very welcomed and had the opportunity to receive a detailed update on the progress made since our last visit, as well understand a few key issues and problems that require work and collaboration. A few of the particular interesting environmental/external factors that came in up in several meetings include;

-Drug and medical supply distribution. A change in the Ugandan drug and medical supply distribution system, which is now completely centralized (National Medical Stores) has resulted in issues with coordinated distribution and access to critical medications and supplies at various points in a month since distribution only takes place once per month.

-Staffing. The hospital has noticed a strain on health human resources due to a ‘brain drain’, particularly of physicians who leave the country or the hospital after training to practice medicine elsewhere. While the hospital has no problems recruiting individuals to residency positions, they lose them after training and have several staff positions vacant.

-Funding. The current government has defined three key priorities for the country, which are security, infrastructure and energy. Healthcare is lower on the agenda and funding is allocated accordingly. In Uganda only 9%. Of government funds are allocated to healthcare (compared to close to 50% in Canada).

On Wednesday (August 4th, 2010), we arrived at the Mbarara hospital quite early to start a day of work. Saramin spent most of the day in the operating room observing and teaching. Marnie spent the day with the Head Nurse and the Nurse Educator working on educating staff and understanding process flow in the labour and delivery department. I (Jessica) spent the day working with one of the OB/GYN physicians working on setting up a data base, entering and analyzing data that has been collected in detail on each maternal death in 2010. Although the database still needs to be cleaned up, I think there is much promising information to be gained on the causes and factors associated with Maternal Mortality from the data collected so far. In addition to helping to set up a data base, we also discussed the PDSA framework used for quality improvement. There was a great deal of enthusiasm to learn more about this simple framework to test change and improvement. We also discussed various QI tools (Root Cause Analysis, Affinity Diagrams, Run Charts, Control Charts etc) that can be used during the PDSA framework. A next goal is to be able to support the Mbarara team to implement a PDSA cycle of change.

I hope this provides a clearer picture of the type of work that we are doing here in Mbarara.

Until tomorrow,

Jessica

p.s. Our apologies for any duplication / disorganization in relaying this information though this blog!