Saturday, July 5, 2014

Workin' it

This week I’m going to tell you a little more about the work that Hananja and I have been doing for St. James.

Let’s talk about Hananja first.  Hananja got here last Tuesday, so she was able to give St. James 8 full days of her time.  She is very generous to spend almost two weeks here on a completely volunteer basis – she even covered her own travel expenses out of her pocket.  So three cheers for Hananja and her awesomeness! 

Hananja spent her first day or so here at the hospital assessing their food-related needs.  As a registered dietician, she is qualified to do all sorts of things like teach about breastfeeding, develop specialized diets based on specific needs for particular diseases, calculate energy requirements for individuals and advise them on how to achieve their goal weight, advise about community food security, and loads of other things.  St. James doesn’t have a dietician on staff, so there were a lot of work areas for Hananja to choose from.  Due to her limited time here, I suggested that she pick one or two areas that she felt would be most beneficial to the hospital, and she chose to work closely with the domestic supervisor and kitchen staff to update the patient menu.  The menu is currently based on what is available in Mantsonyane year-round, what the kitchen staff knows how to cook, and what will be most cost effective.  Hananja created an updated menu that allows for a wider variety of healthy foods while still taking these factors into account.  She has spent the past few days working with the kitchen staff to help them learn how to cook the foods she has suggested in a way that will retain their nutrients, and she has taught the staff how to measure foods better as they cook to make sure that patients get enough to eat without there being lots of leftovers that waste precious resources.  All of this is really exciting stuff!  Hananja has also been helping me with one of my projects related to patient education.

So, what have I been working on for the past five weeks?  I’ve had four main projects here at St. James.  The first is just spending time in the various areas of the hospital and clinics to learn about health care in Lesotho, especially the areas where I have a lot of nursing knowledge like the labor ward and the OR.  It’s been very educational – you wouldn’t believe some of the things that nurses are forced to do here, just because resources are so limited and medical technology is basically nonexistent, so the staff has to make up for this by being on top of their game all the time and going way beyond what I would feel comfortable doing for a patient in the US.  There is just no choice here; if you want to save a baby, that means doing an emergency c section without an electrocautery or an ECG monitor.  I’ve also spent some time travelling to the satellite clinics and in the outpatient department (OPD) at the hospital.  I have an interest in HIV and AIDS care, so I still want to take one day to shadow in the HIV office here at St. James.

The two main administrative projects (with a clinical component) that I’ve been working on here are statistics and patient education.  Currently, the hospital turns in monthly statistics to the government about the number and types of patients they see in the outpatient department, but they don’t capture any statistics for their own use.  So, after spending some time in the OPD to get a feel for how to best capture useful data, I’ve developed a monthly stat report, and I’ve filled it in with data from as far back as 2012 so the hospital can start to look at trends in illness over time. 

Anywhere in the world, patient education is always an important part of the nursing process.  St. James’s OPD is doing most of their patient education in the morning while the patients wait for the doctor to finish his rounds of the inpatient wards.  The problem with this system is that whatever nurse or trained nursing assistant happens to have time in the morning is the one who does the education for the day.  What I’ve been trying to do is standardize the education topics so that different nurses will make sure they hit all the important points about a given topic.  In other words, I’m creating a patient education file filled with pre-printed sheets about a variety of topics, everything from HIV to burns to diarrhoea and vomiting to oral health.  Hananja was really helpful in reviewing this file for me to make sure I thought of all the most important points for each topic, and she contributed pages on nutrition and breastfeeding.  Also a big shout out to my very favourite American dentist for writing a page on oral health.  Thanks, Jen!  As part of the patient education work, I’ve also made handouts to give to patients who are diagnosed with certain conditions that are very common here.  With Hananja’s help, I was able to make information sheets for TB, diabetes, and hypertension that are simple and direct and have lots of pictures.  Now all we need is for someone to translate these sheets into Sesotho.

Finally, the other big project I’m working on here is Hands on Health.  I think I explained a bit about the HoH program before, but it’s a community engagement initiative that is seeking to empower community members to take charge of their own health (meaning holistic health – physical, mental, and spiritual).  I have sat in on HoH meetings and created a draft of a guideline for how to participate in the HoH program.  This was an exciting week for HoH – the coordination team has started visiting the local facilitation teams outside of Mantsonyane, so I’ve been accompanying them on these visits.  Basically we’ve been holding meetings with the local teams and other stakeholders like the village chiefs to talk about the HoH program and gather support for the initiative.  The meetings have been going really well, and we have more site visits coming up next week.

All work and no play makes Keri a grumpy girl, so Hananja and I are in Maseru this weekend before her flight back to Cape Town on Sunday.  Then I’ll return to St. James for one last week to finish up all these projects.  For my last two weeks in Lesotho, I’ll be doing something a little different.  I’ll be in Maseru for one of the weeks working with the Diocese of Lesotho, and the final week I’ll spend with Thabiso from HOPE Africa as he makes site visits for another project that HOPE is involved with here. 

I hope everyone had a good 4th of July!  I am celebrated by searching for American food in Maseru.  The closest I could get was a chicken burger, but it was very tasty and accompanied by fabulous South African wine.

Hananja training the kitchen staff on how to measure food.  She really got to know the staff pretty well, considering she was only here for about two weeks. 

At the HoH visit to Ha-Popa, Mapaseka had everyone trace out the acronym SALT with their feet so they would remember what it stands for.

Hananja’s mom donated a bunch of polar fleece fabric, which we cut it into 84 scarves, so lots of people in Mantsonyane will have warm necks thanks to her!

Yeah, we rode a minibus taxi to Maseru.  It was actually a lot less scary than I thought it would be, and, lucky for everyone else in this taxi, I consumed a heavy dose of motion sickness meds before climbing aboard.

Minibus taxis are rather cramped, though.

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