I think it is generally true that hospitals breed projects at astonishing rates. Mission hospitals, like HAH, are no exception. Here, besides normal wear and tear, we work with heat, humidity, dirty air/water/fuel, and wide fluctuations in power; serving up conditions seemingly bent upon destroying or disabling machinery of any type. Pipes break, filters clog, the part is out of stock and so forth. It has become even more clear to me that for medical work to be efficient and effective, whole systems are required.
If you know Tim, you know that Tim loves projects. Let me rephrase-Tim needs projects. I did not quite comprehend the depth of this need when I married him, but this truth was revealed to me one day, early in our marriage, when I came home to find a partially build cornhole set on our coffee table. In any home I think this would have been arresting, but we lived in under 1000 square feet. And he’d been sanding. We didn’t have a garage at the time (and it was cold outside, what, oh lovely wife, was he supposed to do?), so we got him a membership to a maker space so that he could have a place to go and work on “stuff”. After that there was less sanding in the living room, more cornhole sets, and a steady stream of cutting boards, boxes, and other things. He dreamt of building us a house out of shipping containers-one Sabbath we spent a happy afternoon laying out the hypothetical floor plan. What do you think, oh wife, about us buying a house to fix up? Wouldn’t that be fun?
In Haiti, we’ve been oh-so-excited to set up an Orthotics and Prosthetics (O&P) clinic. It is going to be so good and I will write lots more about it-but in order to be able to build prosthetic legs and braces, Tim needs some large, bulky equipment and supplies (think industrial oven and bags of plaster). The best way to get those to Haiti is via a container, and Haiti Adventist Hospital (HAH) has been planning to ship one down. In August 2020, the purchased O&P equipment and supplies were loaded onto said container, and Tim and I loaded onto a plane. We hoped to see the container by Christmas. In reality (2020), it’s nearly February and the container is still not in country, let alone through customs. So after Tim set up all that he could for the O&P clinic, he dove into project work.
The projects themselves have been quite varied. Tim learned (thank you youtube) how to rekey locks and has rekeyed the hospital. Seems like a small thing, but it has decreased all sorts of frustration and increased efficiency. He’s fixed a fair number of small engines (pressure washer, lawnmowers, chain saw) for the maintenance crew, cut down a few big trees, supervised the planting of others, and has facilitated a lot of trench digging and block laying. He’s happily working on remodeling two 20 ft containers into nice living spaces. Imagine the excitement! Dr. Scott Nelson loves (needs?) projects too and there are hours spent discussing the details. Mostly confined to campus, we’ve built a wellness trail. We’re building a swimming pool. To be sure, Tim is looking forward to starting an O&P clinic, but with that pending, he has immersed himself in fixing and building, figuratively and sometimes literally greasing the wheels that help the hospital run.
Admittedly, I have a soft spot for projects myself, but mine usually don’t involved brick and mortar. I have been working with the team at HAH on process improvement in a variety of ways. The eventual goal is to build up the hospital so that it could support the opening of an intensive care unit. This will be difficult-a 2019 survey noted “124 reported ICU beds” (Losonczy et al., 2019, p. 5) in Haiti and cites the familiar barriers of lack of supplies, training, and so forth. For HAH, overcoming those challenges will require many of our systems to become more efficient-in fact, that is one of drivers for undertaking such an endeavor. In broad strokes, we are examining and implementing new ways to facilitate more timely patient care and waste less (supplies, equipment, and money). We’ve done a couple of things over the last bit:
-Charge Sheet Implementation. We did a QI project around how medications and supplies arrive to the bedside, and then how patients are billed. We made and submitted a nice poster about that, which I’ve attached here for your viewing pleasure. The poster is neat and tidy (thank you Dr. Jeff Cho), but the reality involved cleaning out some terribly dirty storerooms to make space for supplies to be stored closer to patients, and explaining the ideas and steps with our clumsy creole and lots of hand motions.
-Supplies inventory. We did a physical inventory of supplies at HAH. We sorted through, among other things, cubic feet of ETTs, several years supply of speculums, and PPE left over from Ebola scares. This first step is groundwork for changes to our supply acquisition process.
-Biomedical inventory. Similar to supplies, we needed to know what we have (and what works) in order to inform our purchasing and requests down the road.
We also have a nice education room set up and in use-which brings me great joy. All in all, it has been busy, rewarding, and we look forward to more projects over the next months!
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