What Have I Achieved?
on Shona in Sierra Leone (Sierra Leone), 06/Aug/2011 14:08, 34 days ago
That’s it. I don don. I finished my placement at Ola During Children’s Hospital yesterday. When I was interviewed for the BBC by Fergus Walsh he asked what my legacy would be when I left Sierra Leone. I gave him a very blank look before answering. This, of course is the question which I have been asking myself all year. What have I been doing here? What have I achieved?I can write a long list of patients I have treated, families I have spoken with, students I have taught, doctors and nurses I have worked with, health care workers I have trained in triage, nurse anaesthetists I have trained in neonatal resuscitation, audits I have completed and meetings I have attended.These are of course quite personal achievements for me, things that I have done (and in NGO speak– would probably count more as “activities” than “outputs” or “achievements”). So perhaps it is better to ask what has changed at the hospital in the time I have been there.On a day-to-day basis it is very difficult to see change. Especially with daily frustrations of staff coming to work late or not at all, patients presenting very late, babies being brought to S-C-B-U hours after they were born, the incredibly annoying pharmacy system (you have to re-prescribe all medications every day; it’s the bane of my life and the biggest waste of time), patients not receiving their medications, babies not being fed, patients not having regular observations, patients not being reviewed and asking people to do things again and again and again (only to find later it is not done).However, over the time I have been here, I think that standards have improved.“Small small” as we say in Krio. Some (subjective) examples: many nurses are incredibly hard working, motivated and eager to learn. More children are receiving more of their medications. Observations are taken more regularly. The lab has certainly improved. The doctors are holding (more or less)regular morbidity and mortality meetings and other educational meetings. A perinatal meeting with the midwives has started. Children are prescribed quinine three times a day instead of twice a day. Standards of history taking and documentation are better. The under-5s clinic is now triaging their patients so the sickest children are seen first and transferred to hospital as soon as possible. ICU and ER have moved to a new location and there are now saturations monitors for children in ICU. There is more oxygen available for children in respiratory distress. There is running water more regularly (not all the time though!) Clearly there’s still a lot to do, but one step at a time.(NB. Most of these changes have nothing to do with me being here but as a result of lots of people working together).In reality I have not achieved very much in terms of change that can be measured. The mortality rate in the hospital is the same as when I arrived. It takes longer than a year and more than one person to make that sort of change.So what did I say to Fergus Walsh? What is my personal“legacy?” The answer I gave him was the work I have done with the medical students. Twenty seven medical students who I have helped to train in paediatrics. They will graduate next year and become house officers here in Sierra Leone, rotating through the Children’s Hospital. Hopefully some ofthem will decide to become paediatricians, and to stay in Sierra Leone, and to share some of the skills I have taught them with others.