Small Changes..

Hello & welcome to our latest blog.

Having been here in Chad for over 18 months and now looking forward to our first official home assignment in April we have been reflecting on our time spent here. The time has gone so quickly, so much has happened and we seem to have been in constant work mode with rarely time to stop and think. We have had to try and learn a new language here in county, with limited success, whilst also having to work at the hospital at the same time. A time for a break can't come quickly enough.

When we arrived we knew there was a general role mapped out for each of us to undertake but the finer details of what that was and how to start was unclear. We remember the first time we walked around the hospital thinking how basic, dirty, smelly and chaotic it all seemed, but also amazed that there was actually a functioning hospital here in the middle of nowhere.  There was obviously much that needed to be done to improve things but due to the lack of resources and limited time in the day, as dealing with the many patients was the priority, forward planning and organisation was difficult. Malcolm started work almost immediately as the existing administrator was due to leave within a few weeks and the finances needed urgent attention.  

Organising Containers

French Lesson

For myself it was prioritising the language study, trying to keep Malcolm focused on it! and observing the hospital in general to help where possible. Initially my role was limited, due to my lack of language, therefore spent many hours and weeks in extremely hot containers, used for the hospital stores, sorting and putting them into a more organised state.  Not what I had imagined my nursing skills to be used for but never the less a much needed task to aid the overall function of the hospital.

In  June 2013 I started to work full time on the wards alongside the Chadian nurses to observe and identify training needs and assist in assessing  their skill levels. There is quite a difference in the role of a nurse in the UK and here, some of the technical skills are quite high but basic nursing and cleanliness appears not to be a priority, nor is the general administration tasks. By constantly tidying and cleaning of work surfaces and patient areas and completing appropriate documentation I hoped to instil some of this need into those with whom I work. It is paying off and has generally improved.

When the hospital was built, European toilets had been installed on all the wards. Unfortunately these were not suitable for Nomadic tribe and local people who simply don't know how to use them appropriately. So they were a constant source of smells and needed to be replaced. We managed to obtain funding to enable us to close the worst ones and build more appropriate pit latrines outside for the patients to use. The space this generated on the wards enabled us to transform these 2 rooms into a private examination room on the maternity ward and a small in patient malnutrition room in another. In time we hope to close the remaining 2 but for now the overall smell and cleanliness has been improved dramatically.

Privacy Curtains

An area which needed change was the lack of privacy on the wards for the patients. All 4 wards were open wards where everybody can view each other's treatment and problems. For a very private people this was obviously an issue. By installing a metal rail structure hanging from each wards ceiling has enabled us to hang simple curtains to provide much needed privacy for each patient.  Sounds a simple task, but finding a suitable welder, obtaining material and then a tailor to make the curtains and finally finding a suitable method with which to hang them was all problematic and timely, but well worth the effort.  

Triage

Through the Gate

Another area which needed attention was the overall patient flow and collection of fees from patients arriving here as all have to pay for treatment received. This was a major undertaking requiring new systems to be implemented, staff to be convinced and trained, plus working with staff members in each area, and all with limited French. Over a few weeks, involving tweaking and amendments, some suggested by the staff which was encouraging, all was implemented and is now working well. This has resulted in a much more organised flow of patients into the hospital and onwards to their designated treatment area and has also improved our hospital receipts  which has helped place the hospital on a more secure financial footing. This in turn means we have more funds to make further improvements in the future.

Entry

Once in an orderly que

So on reflection my nursing and organisation skills have been well utilised within the hospital setting, but not necessarily as I had imagined before arriving here. At times I have doubted my worth here as anticipated using my years of acquired nursing skills in a more practical way to help save lives. It doesn't sound very dramatic or exciting installing basic nursing practices or procedures but realistically has been greatly needed in improving the overall working environment of the hospital for other staff and the patients who come here. Little by little with many simple improvements the overall workings and appearance of the hospital has been greatly improved.

God clearly has a plan for each one of us but we don't always see or necessarily agree with it, but learning to trust in Him is an important lesson I have learnt.

Blessings Malc & Sue