All those things I said in my last post were absolutely
true. Today’s experience has had a
substantial mitigating effect for me.
Sravanti has been working with Anne since Randy left. Anne has substantial experience with clinical
research and, hence, the IRB. IRB stands
for Internal Review Board. This board
keeps our patients safe from our intrusive eyes. And thus protects us from breaking HIPAA
rules. Believe me, this is a good thing. And on our better days, we all acknowledge
that.
How does this relate?
The CTC Clinic (Care and Treatment Clinic) was built in 2006 by the
Clinton Foundation and in the last couple years, as the clinic has been up and
running, USAID has been supplying medicines and testing. When Randy was here working in the CTC for HIV
positive patients, he began looking at the computerized data which go back to
2006 when the clinic was started. He
discovered some interesting things. The
rub is that the data have not been “scrubbed,” that is, the identifying data
have not been deleted. However, after
Sravanti and Anne looked at the computer program they found some summary data
that had no identifying data so they could collect some interesting information
to evaluate. This will help design a study
that can pass the IRB scrutiny. But this
is not about the study.
It is about the relationship between Sravanti and Anne and
the CTC staff who were so helpful in working with them with the day-to-day
learning that they did. Anne and
Sravanti were so happy and appreciative that they invited the group for lunch
at the guesthouse. They invited the five of them. We were waiting after lunch wondering why
they had not come. About 2 pm or so they
trickled in. All ten came! Pole sana!
Lunch was gone. Still, it was a
lovely visit, the wazungu expressing gratitude and Tanzanians sipping sodas.
There are other bright spots too. There is a Hypertension and Diabetes Clinic
weekly. They are focusing on these
diseases. We do not well know the
tropical diseases, but I promise you we are experts about hypertension and
diabetes!
Randy told our Tanzanian colleagues that they should “count
things,” the importance of which was reinforced for him by one of Atul Gwandes’
books.
Of course, counting things is the
first practice in making things better.
A couple of years ago, I suggested a run chart of sorts. It was just a visual representation of the
data reported at morning report: discharges, admissions, births, C-sections and
so forth. I got no traction.
 |
| Dr. Kawono with the run chart |
This year, I presented the idea to the MOIC, Medical Officer
in Charge, Dr. Sovelo and with a little background from hearing Dr. Randy talk
about “counting things,” I found him very receptive. Dr. Kawono was enthusiastic too. He and I
discussed what we might track. We got a
big white board, taped it all up and made dates, days and categories for the
staff to start “counting things.” We
invented some categories we thought might be of interest and left a few blanks
for the staff – all the staff – to think of more categories.
Chaplain Kikoti mentioned he had heard and
wanted the staff to know that there is cholera in Iringa. They will count cases of diarrhea to see if
there is a spike suggesting cholera has hit Ilula too. I hope a subtle spin-off might be a reminder
of the importance of hand washing.
Whatever they choose to follow, I hope they will do so for a month or
two for each new item. Then if no value,
think of a new category and replace the old one. I hope their enthusiasm does not wane. We are trying to model and instill a culture
of learning. It would be wonderful if this began a culture of “counting
things.”
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| It's a start! |
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