On Tuesday I was standing in the garden when a security guard from the hospital came with a note. It was addressed to 'Roberts Charrautte'. He looked appealingly at me in the hope that I could identify this bizarrely named person. I tell him that this is me. He doesn't believe me but doesn't want to argue. I realise quickly the confusion - he's expecting a man! He hasn't realised that Roberts is a surname. This is the same difficulty that Geoff has in Theatres - Prof Robert and Dr Roberts are easily confused!
The note is brief 'We have received the items. Would you come to Pharmacy today? Jeremiah'. [I always think of a bullfrog when I think of his name (if you are too young to understand the reference - ask your mum) - and in some respects he does look a bit like a bullfrog!]. So I make my way over to the Pharmacy to find out what's going on.
The Stores boy (although he's about 25) shows me how he raises orders retrospectively and receives the goods. He has been putting the prices in so my next challenge will be to work out why the ones on the system aren't right! We work through the day's receipts together for a while before I get frustrated at the inefficiency and tell him I'll do it myself. The 'problem' is that what's written on the invoice doesn't match the name in the system, now, you'd think that Sande had been helping me with this but no. A typical interaction went:
Sande: Zinc Oxide Tape
I would then try Zi for Zinc and Ta for Tape - neither of which would work
Charlotte: Sande, I can't find it!
Sande: Try Strapping
OBVIOUSLY! How silly of me...
Repeat over and over with different permutations of names or trade names or reinterpretations. So I am better off doing it myself and collecting a list of things I can't find!
Foolishly, I suggest to the Pharmacist that the best way to fix the prices is to go back through all orders for the last year and manually adjust the prices on the system. Sande brings the book of goods received (in triplicate). However, we have only the copies which are at times illegible. Oh well, I've got all day and all of the following day if necessary...
There is an upside to being left alone with the system though. It means I can poke about - look at the stock levels, prices and what orders have been left in the system accidentally. I might have deleted some things... but then again I might not :). I noted that when I booked in the Ringer's Lactate it was already showing a stock of 3,453 litres - given that we know the hospital had completely run out this seemed a little optimistic. I mention it in passing to the Pharmacist who immediately draws up the page and then becomes cross - goods are only ever received, no one has booked any out.... The Stores boy gets an earful and faithfully promises to come at the weekend and do a full stock check.
I know this sounds dire but there's really a very simple cause for all of this. The hospital shouldn't have got this system. It doesn't need it, the software is too complicated and the day to day staff aren't computer literate enough to use it easily. So all the computer work is left to one person who is too overworked to do it and it doesn't matter anyway because no one checks the output. I feel sorry for Sande, he's having to use the computer system and paper system in parallel and do his job plus that of the dispensary. The computer made his life harder, not easier.
But, there is still hope. Abraham and the Pharmacist seem to have been impressed with my work and I've broken the problems down into little pieces that we can tackle a day at a time. Hopefully by Wednesday the stock levels and prices will be accurate for all products. The chap in charge of dispensing a selection of the products from a separate store (only on Fridays) has been taught how to use the system and told he must do it every week. So that leaves just the Inpatient and Outpatient Dispensary to tackle - 5 staff in all.
This is the first week where I've managed to make a significant difference to the running of the hospital. It feels good but it was a little frustrating. I've decided I can only do 2 hours at a time in the Pharmacy, so 4 hours a day. Otherwise I get too wound up by the lax attitude of some of the staff and illogical things that happen. We lost half an hour trying to work out why the goods received books go 5001-5050 then 5451-5500 - answer: someone in stationery can't count.
But I've been using the downtime to chat to and amaze Abraham some more. One afternoon a Sister (of the Nun type) came to the office to drop off a small bag of shopping for him. I said it was like in the UK when you can order your food online and a man brings it to your door! 'What? So you don't go to the shops anymore?' And you can buy lots of other things too. 'Even clothes?' Yes. Then he was baffled by the idea that we have the broadband on all the time and it's pretty much always working.
At one point we are sat in the Pharmacist's office (all 3 of us) and a lady arrives at the doorway. I don't recognise her. She hands over a letter that the Pharmacist has written with loads of corrections and tells him to do them. He says he did exactly what she asked and if it's wrong she can do it herself. She snorts at him and says that she's far too busy. After a couple of seconds Jeremiah says 'I know that you are too busy but I'm going to come and see you later anyway.' The face the lady pulled as she turned on her heel and clicked off was amazing. Abraham and I exchanged a look but nothing was said. A little while later I summon the courage to ask who the lady was. 'She's the Head of HR. She wants us to discipline one of the staff so he needs a letter. She's told us what to write but it's not right and she won't help us make it right.' :) That's funny, I've only ever known HR in the UK to be supremely helpful and keen to get hands on when there's that sort of issue...
I know that I've gained their trust when we need to go to a store room and Abraham says 'Today you can drive me!'. I try to point out that this is a really bad idea - I've never pushed a wheelchair before and I'm not that coordinated at the best of times (coxing aside). The corridor from Pharmacy is narrow and has a dog leg in it right by the dispensary window where lots of people are loitering. Several people nearly lose feet. Then we rattle along the uneven concrete and Abraham has to lift himself up in the chair to get comfy. Shortly I discover why there are regulations in the UK about the width and incline of wheelchair ramps. We go down one that's barely wider than the chair and I risk upending him into the flowerbed. Then the ramp to the store starts with a foot high step up and is ridiculously steep. I get him halfway up before it's clear the doors aren't open wide enough and I have to hold him there! He's really very trusting - I think he thinks I'm joking when I tell him I'm going to invest in L plates for our next trip!!
When we return to the Pharmacy I need to pop into another office. There's a little girl of maybe 3 years with her mum. She hides behind her mum's Chitenga when she sees me (I assume this is the usual shyness). I try to smile at her but this makes the situation worse. She becomes more agitated so I retreat to the corridor. Her mum tries to leave the office but the girl has grabbed her hand and dug her heels into the ground, refusing to move. I hide in a different office out of sight. When they pass the doorway with the girl now on her mum's back she starts to scream!! What did I do? The theory is that she's been treated on the Paediatric ward where the white people have stuck needles in her so she associates us with pain :(
In a break I have returned to Medical Records to see the 'Assistant Hospital Information Officer'. As an ice breaker I ask him why he hasn't been promoted yet :). He shows me how the database works by using himself as a dummy patient - he claims to be 39. On this particular day he's wearing a Hawaiian shirt, his ringtone is of a screaming cat and his desktop picture is of his wife looking grumpy (as usual) sat at his desk. None of this, nor how he looks, supports the assertion that he's 39 so I fall about laughing. Then he gets out his ID card to 'prove' it. I tell him that I know for a fact one of the nurses has lied about his age on his passport so I'm not convinced!! While we are going through all this he does admit that he's thought about what I said last time and I'm right, they are not capturing every patient that comes through the door like they should be. Good! Because now I don't have to get up at dawn to stake out OPD!! Pride was going to make me do that but it was going to be tricky without access to a loo or drinking water or food :-D
We get back to the matter in hand - he needs some help manipulating data and getting reports out of an Access database. I had training on this on the first day of my year out - I'm sure I can work it out - but why hasn't he asked Abraham? 'Abraham won't know how to do this!' That's funny because I'd just been talking to Abraham about the database he was about to make and the reports he was going to generate in Visual Basic... (so Abraham knows far more than I do!)
[Later I mention this exchange to Abraham 'Oh but he can't ask me!' Why not? 'Well, because then he'd have to admit to not knowing something. I've worked with him before.' But he admitted it to me the first day I met him?! 'Ahh but you are Muzungu.' Yes, but I thought that was worse. That no one would want to admit that the Muzungu can help them with anything. Because everything is just fine without the Muzungu running the place. Abraham smiles 'Yes but this is a matter of facts and everyone knows the Muzungu knows how to do things']
As I get up to leave Adamson says 'You asked me why I haven't been promoted.' Yes but I was teasing you. 'There is a reason, I don't have the qualification that I need. You have to have a diploma in information and I only have a certificate in IT but I've been doing this job for 9 years. The hospital was supposed to send me on training in January, then they said June, now they say January again. I don't think they will pay for me to go...'. This is the second time I've been asked this question [being - will you pay for my training?] The first was by the legend of a nurse Emmanuel who wants to train to be a nurse trainer. For now I am using the African approach to this (here's a tip for you) - when you are asked a difficult question remain silent as if you never heard the question. It's really uncomfortable for a British person to do, it feels awkward, but it's perfectly normal here.
On my way home I pass one of the little boys that comes to my door demanding pens/toys/biscuits and calls me stingy when I refuse. He's the brightest one with the best English who has to translate all the demands. He's with his mum. As soon as we draw close he says very clearly 'Excuse me, what is your name? I have forgotten it'. I answer him but all the while want to point out to his mum what he gets up to when she isn't supervising him!! Cheeky little blighter!
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