(Slow) Progress

 It’s been a fairly productive week here in Harar. Since we finished the medical student exams a few week ago, I have been able to spend more time with my GP (UK SHO equivalent) colleagues, sharing ideas for the way the ward should be run. They have been very proactive in designing a new work plan for the ward, which has been made possible by the arrival of two new GPs from Addis and Jimma. The GPs are really good, with great knowledge and clinical acumen. By necessity they are very independent and manage most of the patients without any senior support which is just as well really because I’m all the senior support they have!! Sometimes I am really apprehensive that these relatively inexperienced doctors on their first and second years out of med school run the entire ward, but mostly I am seriously impressed by their abilities not just for patient management, but increasingly for the other managerial tasks they take on such as undergraduate training, chasing up UNICEF when we run out of F100 (special formula milk for the management of malnutrition that UNICEF provide), or reorganising the way the paeds ward is run to make it more efficient.  They have assigned leads for different clinical areas including neonates (me), critical care, the nutrition unit, and one for infection control!! Result- Now I know exactly who to bug about getting some facilities to wash your hands into the ward!

We still have a lot of work to do though. One of the things that frustrates me most about the neonatal unit is the number of patients (parents) who self discharge before their children are really ready.  I know it is difficult for them –  if members of the family are in hospital there are less people to look after the animals, do the cooking and house work etc. Also many families come for a long way away. They can’t afford accommodation in the city so they camp outside the hospital.  Every night in hospital costs money – not just for hospital fees and medication, but in terms of lost revenue at home. So if they see that their baby looks better, explaining the need to complete the antibiotics course to ensure any infection is fully treated is often difficult and for many families it’s a risk they have to take. With this is mind I often discharge babies long before I ever would at home but this is often still not early enough for the parents. Consequently the 900g 32 weeker we had a few weeks ago was taken home while I was away in Addis, at about 10 days old and weighing about 1kg. I’m really not sure if anyone tried to dissuade the parents . When I asked the nursing staff if she had been feeding prior to discharge they said she was trying but they didn’t think it was sufficient. Unfortunately there is nothing that I can do in these cases except cross my fingers.

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