Hello everyone,

Today has been a big day in Lwala.  We were about to leave for Tabaka, a nearby hospital with whom we are hoping to develop a provider agreement for referrals.  Omondi called the district Minister of Health, Dr. Gitau, to tell him we would be visiting him tomorrow, and he said he was on the way.  He showed up with each of the important district officers – public health, nursing, etc.  They took a tour of the facility and had some small suggestions, but were very impressed and very complimentary.  In contrast to previous behavior by the district officers, who have emphasized getting every detail of our facility right before we provide any service, the district minister of health’s attitude was that you do what you can with what you have, and you focus on the service before the details.  In response to an inquiry about getting a safety cabinet in the lab, which is one of those technical requirements, he said “Even at the district hospital we don’t have safety cabinets in the lab!”  He was very complimentary, and very eager to assist us.  He said repeatedly that we’re doing the work of the MOH, that we’re out in places where they can’t reach, and that they are responsible to support us.  He emphasized providing us with things we need, from drugs to personnel, and providing our staff with mentorship and training.  I took a significant chunk of time to explain the history and organizational structure of the LCA and clinic to address misunderstandings about the clinic being a profit-making institution.  We requested a number of things, a new road and electricity plus all of our medical needs, and sent him away with a packet of information and a letter asking for his assistance.

Before they left we settled on several things:

a)       They will have our MEDS recommendation letter by Wednesday morning.

b)       They will provide us with vaccinations immediately.

c)       They will provide us with family planning supplies and maternal and child health supplies, including prevention of mother to child transmission (PMTCT), as soon as one of our nurses gets a one week training.  That training starts today, so nurse Olivia is on her way there now.

d)       They will provide out lab technician with the supplies necessary to diagnose TB, and they will provide us with TB drugs

Dr. Gitau recommended we just start providing maternity services, because whatever we offer will be better than home deliveries.  The Rongo District has just been provided with an ambulance, and in the event of an emergency we can call them and they will come pick up the patient.  For AIDS he recommended we start PMTCT and Voluntary Testing and Counseling (VCT) first, then move on to treatment.  Before he left he categorized us as a category 3 health center, which is the same level of service that was provided at the Rongo hospital before it became an independent district.

For those of you who have been following the saga with the MOH, this is a huge turnaround and a tremendous boon to us on many levels.  We prepared them a nice chicken lunch but they just took off before we could feed them, so we just celebrated the success of the visit ourselves!

Other accomplishments of the last week thanks to Omondi and the LVDC executive committee:

1) We have a new financial system in place and the LVDC executive committee has been trained on its use.  They are very pleased with it, and will be practicing a lot while I’m here.

2) We have a host of financial policies decided, from spending approval levels to travel policies to vehicle use policies.

3) We have job contracts ready for our employees to sign.  These are management tools, not binding documents, but are important to get our staff invested in the work and the clinic.

4) We have a staff time sheet in use – again for management review purposes rather than payroll purposes.

5) We have hand washing taking place in between patients.

6) We have decided on a timeline and order of operations for getting the land title issue finished.

7) We have a new pharmacy record system almost complete that will allow us to order drugs based on use rather than on guesswork and keep adequate stocks of all drugs.

8) Omondi’s proposal for management education is in the works.

9) We have a plan for getting running water at the clinic and the beginnings of a plan for water in the community.

Of course there’s a very long list of things still to do, but we’re ahead of schedule, which is easily a Lwala first!

Today there are probably 150 people outside awaiting service.  One baby with a serious case of malaria came to the clinic in convulsions.  Our clinicians are working hard.  This place is a necessity here in the community.  Thanks for your good work.

From: Joel Wickre [mailto:joel.wickre@gmail.com]
Sent: Tue 9/18/2007 2:02 AM
Subject: A Cautious, Measured Rollout of Maternity Services