I’ve started to get involved now in the management of the hospital. I’m sure that there are books out there that tell you how to run a hospital in a systematic and effective way, but in the absence of formal guidance I’ve had to use my imagination and those scraps of information I retain from the Public Health course. So I spend time talking to people, the staff, the patients, other ONGs; I try and identify issues requiring action; theoretically I then come up with solutions or work with others to find solutions, and implement these; and (also theoretically) I will then evaluate the interventions and establish whether things have improved or not.
This last step will not be easy – since we do not audit nosocomial infection rates, the only means I can think of to establish whether hygiene has improved in the Intensive Care Unit is to count the number of flies per patient. Yet this work can be fascinating. We have a remarkably high rate of ‘Abandons’ – mothers taking their children and leaving the centre before the child finishes treatment, thus remaining malnourished, or even ill. I have talked to mothers, educators, colleagues, and it is clear that the reasons for this are numerous. The mothers say that they have told their husband that they will be back by a certain date (according to what they were told at the mobile feeding centre that sent them to hospital), and that if they have not been discharged by this date they will have to abandon. If they stay, the husband will become suspicious. Even if the child is very ill they will leave, because if they stay longer and the child dies in hospital, and they return home without a child, the husband will divorce them and the community will ostracise them on suspicion of infanticide.
In other words, the mother is taking a huge risk just coming to the hospital in the first place – in doing so she may save her child, or she may lose everything she has. When a mother decides to ‘abandon’, we send the ‘sensibliser’ (health educator) to talk to her. It always feels a bit late to be trying to do education at this point, and indeed the sensibiliser functions more like a bouncer as he stands there blocking the exit from the ward. If the mum gets past him she then has to take on the hospital guard at the gate who will likewise try to prevent the escape. Apparently there used to be a gap in the fence through which mothers used to escape previously. This has now been boarded up. That was the previous strategy to reduce the rate of abandons, and it hasn’t worked. I think we need a more patient-centered approach for 2009.