Today has been a very fruitful and significant day...
Firstly, our blog hits passed the 1000 mark, for which I thank you all for your support and interest. It means a lot.
Secondly, I need to update you on some of the recent developments. You may recall that recently we did a little audit. This was actually an idea I had on a bit of a whim, and not one of the original objectives. Improvement in the acute care of emergency admissions (which is almost exclusively dealt with by the junior doctors and nurses) has been our focus of attention for some time now, because quite simply, this is where you can save the most lives, and with basic training, it’s very easy to do. In the study, we looked at the whole hospital population and analysed their admission sheet, to see if basic observations of vital signs (such as pulse, respiratory rate, blood pressure and temperature) were being done (these of course form much of the core of the ABCDE assessment for any sick patient) and where shock/instability was recognised, was the basic treatment appropriate.
The short answer was “no” (75% of admissions hadn’t had a single observation done) and “no” (The vast majority of shocked patients were not given adequate fluids or oxygen.) Where deficits are identified, part of the audit process involves looking into the causes, and making recommendations to be implemented to improve the outcome. Part of the causes were obvious – no oxygen was given because there is none, for example. Fluid mis-management is an issue of training. Probably most significant is the workload of the junior doctors: they are spread so thin it’s hard for them to have time to do what’s necessary to optimally treat the patients in their care.
So, we took the audit to some of the Consultants, who said “this is brilliant – show the medical director.” So we showed the Dr Maker, the Medical Director, who said “this is very useful useful – we need to show this to the Ministry of Health!” So later that Monday, he drove us down to the Ministry of Health, and we presented to the Director General of Research and Development. This directly resulted in Governmental approval for the mass production of obs, drugs and fluids charts to be implemented in Southern Sudan, starting in Juba, ASAP. (Currently there are none, and this I’m sure is part of the reason for the poor results demonstrated.)
But it went further still – on our way out, Dr Maker suggested “actually we should really show this to the Minister...” so he went up and secured us an appointment for today. So that’s the story of how I came to be sat down with His Excellency Dr Joseph Manytuil Wejang, the Minister of Health for the Government of Southern Sudan with my little laptop, presenting our audit to him, and suggesting recommendations. Do not underestimated the power of graphs!
Myself, H.E Dr Joseph Manytuil Wejang and Dr Maker.
I thought that it couldn’t go much higher, but the Minister was so impressed (and also “alarmed” in his own words) that he’s arranged a further meeting on Saturday where he wants us to present it again to his entire cabinet in the Ministry of Health (i.e all the Director Generals of each of his departments) all the hospital heads of department, senior doctors, senior nurses, and as many junior doctors as possible. This is an unforeseen and very encouraging outcome, because it shows he’s taking this seriously.
The reason that the Staff at JTH are so keen that we present these findings to the MoH is because they support what they already know, ie there’s not enough doctors, not enough equipment etc. but they’ve never had hard data (and graphs) to prove it. Worse still, it proves that such deficiencies are directly having a negative impact on the health (and even mortality rate) of the people of Southern Sudan. Hence they’re very interested in using the results to support an application for more funding to improve services. We’ll leave the specifics of that to the different heads of department, but now we need to prepare for the mother-of-all audit presentations on Saturday.
David and I remain completely blown away at the magnitude that the St Mary’s Juba Link is having here - I don’t think any of us expected to shape national health policy! We’re incredibly grateful to be here as part of this project and are very excited about what the future holds. We’ve got a lot of other irons in the fire as well which we’ll tell you about another time, but it’s really rewarding to see things beginning to come together.
Watch this space!
All the best
James
Firstly, our blog hits passed the 1000 mark, for which I thank you all for your support and interest. It means a lot.
Secondly, I need to update you on some of the recent developments. You may recall that recently we did a little audit. This was actually an idea I had on a bit of a whim, and not one of the original objectives. Improvement in the acute care of emergency admissions (which is almost exclusively dealt with by the junior doctors and nurses) has been our focus of attention for some time now, because quite simply, this is where you can save the most lives, and with basic training, it’s very easy to do. In the study, we looked at the whole hospital population and analysed their admission sheet, to see if basic observations of vital signs (such as pulse, respiratory rate, blood pressure and temperature) were being done (these of course form much of the core of the ABCDE assessment for any sick patient) and where shock/instability was recognised, was the basic treatment appropriate.
The short answer was “no” (75% of admissions hadn’t had a single observation done) and “no” (The vast majority of shocked patients were not given adequate fluids or oxygen.) Where deficits are identified, part of the audit process involves looking into the causes, and making recommendations to be implemented to improve the outcome. Part of the causes were obvious – no oxygen was given because there is none, for example. Fluid mis-management is an issue of training. Probably most significant is the workload of the junior doctors: they are spread so thin it’s hard for them to have time to do what’s necessary to optimally treat the patients in their care.
So, we took the audit to some of the Consultants, who said “this is brilliant – show the medical director.” So we showed the Dr Maker, the Medical Director, who said “this is very useful useful – we need to show this to the Ministry of Health!” So later that Monday, he drove us down to the Ministry of Health, and we presented to the Director General of Research and Development. This directly resulted in Governmental approval for the mass production of obs, drugs and fluids charts to be implemented in Southern Sudan, starting in Juba, ASAP. (Currently there are none, and this I’m sure is part of the reason for the poor results demonstrated.)
But it went further still – on our way out, Dr Maker suggested “actually we should really show this to the Minister...” so he went up and secured us an appointment for today. So that’s the story of how I came to be sat down with His Excellency Dr Joseph Manytuil Wejang, the Minister of Health for the Government of Southern Sudan with my little laptop, presenting our audit to him, and suggesting recommendations. Do not underestimated the power of graphs!
Myself, H.E Dr Joseph Manytuil Wejang and Dr Maker.I thought that it couldn’t go much higher, but the Minister was so impressed (and also “alarmed” in his own words) that he’s arranged a further meeting on Saturday where he wants us to present it again to his entire cabinet in the Ministry of Health (i.e all the Director Generals of each of his departments) all the hospital heads of department, senior doctors, senior nurses, and as many junior doctors as possible. This is an unforeseen and very encouraging outcome, because it shows he’s taking this seriously.
The reason that the Staff at JTH are so keen that we present these findings to the MoH is because they support what they already know, ie there’s not enough doctors, not enough equipment etc. but they’ve never had hard data (and graphs) to prove it. Worse still, it proves that such deficiencies are directly having a negative impact on the health (and even mortality rate) of the people of Southern Sudan. Hence they’re very interested in using the results to support an application for more funding to improve services. We’ll leave the specifics of that to the different heads of department, but now we need to prepare for the mother-of-all audit presentations on Saturday.
David and I remain completely blown away at the magnitude that the St Mary’s Juba Link is having here - I don’t think any of us expected to shape national health policy! We’re incredibly grateful to be here as part of this project and are very excited about what the future holds. We’ve got a lot of other irons in the fire as well which we’ll tell you about another time, but it’s really rewarding to see things beginning to come together.
Watch this space!
All the best
James
5 comments:
Wow congratulations, that's very impressive! All the best with your presentation on Saturday - I'm sure you will pull it off as usual ;)
On the subject of blog hits, don't forget all those reading via RSS readers. This is only the second time I've visited (the first was to subscribe) but I've read every item...
Peter
Hey James & Dave,
awesome news! Just reading this prompted me to think about the observations policies we have here. Have you thought about implementing a MEWS system? It would probably require some modification for a resource-poor setting, but is very effective. I could probably find you some useful resources if you'd like. Let me know if I can help.
In my thoughts & prayers,
Han
I think that MEWS would be great to have in the future but at present the nurses aren't even trained to do basic obs, so it'd have to be a longer term goal.
On the other hand, we are looking at a model of triage for A&E/Outpatients called TEWS which is based on MEWS parameters.
We'll see how it pans out...
Wonderful stuff guys, i've said it before but i'm so proud of what you're achieving out there. All the best
Matt Dennison
Impressive stuff guys. Kind of wishing I'd have come to join you out there. Keep up the good work!!
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