Changes and No Changes

I have been coming to Ilula since 2006, before it became a hospital when it was still Ilula Lutheran Health Center. The changes since then are visible and palpable! The most visible are the buildings. In 2006, the surgery center was new. Now there also is a new laboratory, a new casualty and x-ray building, a new nursing school with dormitories and cafeteria and guest houses. These buildings we're funded by Shoulder to Shoulder and the Peter King Foundation.

In the same 10 year period, the hospital also built an Internet cafe, converted the old x-ray buildin to serve the new Hypertension and Diabetes clinic and is in the process of rebuilding the private wards to increase revenue and serve more affluent patients.

The palpable differences are in attitude, patient care improvements and staffing. In 2006, the Health Center was staffed by 1 Medical Officer (MD equivalent), 2 AMO (assistant medical officer), and 3 Clinical Officers (equivalent to a nurse practitioner). They did emergency c-sections because it was necessary to save lives. Today there are 4 Medical Officers, 2 AMOs, 5 COs and 3 ACOs (assistant clinical officers). C-sections are routine with approximately 1 per day - yesterday there were 2.

The hospital administrator, who had no specialized training, has now received his masters in hospital administration. The hospital management team is well defined (Medical Director, nurse matron, finance director, chaplain and administrator) and meets weekly to discuss and solve issues. A quality improvement plan has been developed using a government-provided self-assessment tool.

Sanitation and infection control processes have improved, although as in the US, doctors and nurses don't always wash their hands between seeing patients. Under the leadership of Dr. Savelo, the new Medical Director, morbidity and mortality meetings have begun to enable learning from poor patient outcomes. For example, the recent organophosphate poisoning will not soon be forgotten and we suspect the Tanzanian clinical guidelines will be consulted more frequently. It is unknown whether different actions would have saved this individual or not, but it will surely save future patients because organophosphates are a common pesticide used in this largely agricultural region.

Today, as visitors, we have more available to us. Anna, a local restaurant owner, closes her restaurant while we are here and supervises a crew of 4 other women who cook for us and clean the main guest house. We have a remarkable array of food dishes, including an "out of this world" mushroom sauce are with fresh squeezed coconut milk (hand squeezed - not from a can!).

Some things don't change - the kind-hearted people, the beautiful view and cooking over a charcoal fire (even baking a yeast based whole wheat bread is done over charcoal).

********Posted by Cindy Wilke, Director of Global Health Administration Partners***********