That’s how one Minnesota doctor described the presence of a digital health record in Ilula Lutheran Hospital’s (ILH) inpatient and outpatient wards. I spent the morning with Joshua, the head of Ilula’s IT department. He showed me the system and answered all my questions. Then, we toured the facility to see all the computer installations.
Medical Records registration desk today
See the changes.
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| Medical Records files today |
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| Medical Records office in 2016 |
Saturday part of our team joined the Ilula outreach group to service a village beyond the last dispensary. Nursing staff,dental providers ,lab staff,pharmacists,and physicians all went together in 3 vehicles on muddy slippery minimally improved roads. Upon arrival we were provided a wonderful breakfast at the pastor’s house before starting clinic.
The clinic is a school converted for the day to a clinic with a building for lab and a provider and a second bank of classrooms for extracting teeth,weighing babies and seeing medical patients. In about 4-5 hours we saw over 130 patients accompanied by multiple family members and weighed over 80 babies.Multiple teeth were extracted,many medical patients were seen with multiple outpatient lab tests completed and tens of drugs prescribed and filled. It could have been chaotic but the clinic was well organized,efficient and appeared appreciated by the community. Outreach is usually monthly to this village.
We received a second generous meal again at the pastor’s house before departure. Our feast consisted of rice ,chicken,greens and beans; more than ample for our adventure home.
An adventure it was! Little did we know the impact of the steady drizzle during the midday. Our roads turned to greasy,rutted paths that proceeded up and down what now appeared to be mountains! Our amazing driver used every gear on his 4 wheel drive vehicle. We made it up every mountain and drove ,not slid on the downhill side. We even drove halfway into the ditch to pass a stalled large truck. Just as everyone was breathing again and releasing their death grips on the vehicle (or fellow occupants) we came to a road jam of stopped vehicles. 2 trucks were stuck uphill including 1 with large,long timber logs straddling the road. Our calm driver got out of our Toyota and walked in the mud to survey the scene. He returned confident of our passage. While maintaining complete control he went into a puddled huge mud hole then into the ditch while barely clearing a tree on one side and simultaneously missing the large logging timbers on the other side by no more than 2 inches. It was the most incredible driving l have ever experienced! Needless to say he received much gratitude and multiple rounds of applause from the Americans. Such is clinical care in rural Tanzania.
Now for church and a slower day tomorrow.
Alan
Tanzania has a peice of my heart.
Shoulder to Shoulder has been working with leadership of the Hospital and Diocese for several years to plan a Reproductive and Child Health Center (RCH). Funding was secured by a generous donation by then Peter J King Family Foundation and many donors to Shoulder to Shoulder who made it possible to “raise the roof” of this RCH Center and projected maternity remodel. Construction started in June and is now nearly complete.
Our group toured the building on our first day and were impressed by the beautifully constructed, spacious building. There are tile floors, well-built walls, excellent doors and cabinets as well as a modern exterior. It is located near the entrance on new hospital property and is immediately next to the new Mother’s Waiting House where women near to deliver can stay.
After the RCH Center is completed, planning will focus on remodeling and expanding the Maternity ward. The architect and contractor for the maternity ward is expected to be Mr Maluli, director of FM Talents Partners. We were able to review the plan for maternity remodel with him. He needs to get updated hospital data as a part of revision of the plan.
It was wonderful for me personally meet Mr Maluli after working with him by email for the past 6 months in order to send funds after approval by the construction team from the hospital and Diocese. The result is outstanding!
Kent
Thursday and Friday were devoted to presenting our tenth annual Ilula Minnesota International HealthCare Conference. Starting in 2014, Shoulder to Shoulder has presented the annual conference for our colleagues in Tanzania. All our presenters did a great job and all the healthcare professional teams that attended gave positive feedback and will return to their hospitals with quality improvement ideas to implement based on what they learned. We are in the process of compiling the feedback from the evolutions, but the initial informal feedback has been overwhelmingly positive, both from attendees and presenters.
Our first course was presented in January 2014 with 30 attendees. Based on extremely positive feedback from the initial conference, our partners in Tanzania encouraged us to significantly expand the conference to offer this educational experience to a much larger audience of caregivers. As a result, we expanded the conference to include all 26 Southern Zone Lutheran Hospitals and the program has grown to include 130 healthcare professionals. From each hospital we invite one doctor, one nurse, one pharmacist, and one administrator.
Our conference is based on 5 principles:
1. Lifelong Learning. We believe all professionals should contribute to a culture of learning and continuously learn to improve our practice.
2. Interprofessional teamwork. We include nursing, pharmacy, administrators, and physicians in both the attendance and presentations. We emphasize teamwork throughout the conference. We each bring unique knowledge and skills to share; specifically Tanzanian presenters emphasize tropical medicine and HIV, American presenters emphasize the growing global problem of chronic and non-communicable diseases.
3. Mutual Respect. We emphasize the ability for all our participants to teach and learn from each other, in spite of our differences in practice setting, culture, and socioeconomic situation. We include local leaders in planning the conference and select topics based on feedback from participants. Presentations are delivered by both US and Tanzanian professionals. The program is based on a foundation of a longstanding and ongoing relationship. The second day of the conference was clinical talks delivered entirely by Tanzanian health professionals.
4. Continuous improvement. Learning should drive improvement in practice. This year we devoted the entire first day to learning about quality improvement.
5. Sustainable Impact. We believe that education and improvement are some of the most valuable ways to promote a sustainable positive impact on the health of our partners’ communities.
Our conference is accredited by the Education Department at the Fairview to provide participants with educational credits for participation in this program.
Funding for the course is provided through generous contributions from several foundations and individuals including Global Health Ministries, The Peter J King Family Foundation, and Fairview Health System. All funds raised go entirely to hosting the conference, and support for local Tanzanian staff to attend, including meals, travel and lodging expenses. We want to thank all our donors for their generous support. I would also like to thank fellow Course Directors Dr. Mufwimi Saga and Fr Manfred Mjengwa, Shoulder to Shoulder founders Randy Hurley and Gary Moody, Ken Olson, and all the presenters for all their hard work and critical contributions. Special thanks to Cindy Wilke, Shana Steinbeck, and Judith Kiliani for presenting on quality improvement.
We believe that fostering leaning through the conference principles is one of the important ways we can improve the health of the population in and around Ilula. Overall the conference was a great chance to learn together, build relationships, and plan together to improve healthcare in Tanzania.
On the first day we started our hospital tour at the decentralized wastewater treatment system(DEWATS). What a complex, state-of-the-art system!
Mr Kikoti, Dr Malamala and Dr Petro led us to the DEWATS site at the bottom of the hillside below the guesthouses and nursing dormitory. Oscar Mbekenga, CEO of Obsen Environmental Engineering in DAR, explained the construction and operation of the system. We learned that he had been trained in Europe so that may explain his knowledge and skills for the sophisticated 3 stage waste treatment system.
Oscar showed us the nearly completed first treatment stage. The raw sewage enters two oval biogas chambers and methane producing organisms digest the organic material to produce methane gas. A biogas outlet pipe transports gas to be used in the hospital to heat water or any other combustion purpose. Next, we could see where water will overflow into a multi-chamber, baffled settler where remaining solids settle and treated water continues.
He then walked with us to see where water will overflow into a yet-to-be-built root treatment system of a planted, gravel filter for final treatment to make it suitable for agricultural irrigation.
The result will replace the century old, minimally functioning septic tanks with a system that protects the ground and water from contamination, produces methane gas for heating needs of hospital and ends with treated water for irrigation.
Our group asked many questions to clarify details and Oscar was able to answer them all.
For me personally, I feel a bond with Oscar because he and I shared frustrating problems in getting the first wire transfer of funds to get to his bank account. We can now laugh about tens of thousands of dollars held in the SWIFT banking system for 2 weeks but at the time it was a quite a scare. Subsequent banking adventures had no drama. Meeting Oscar in person and hearing his detailed explanation of the system was a great experience!
Kent
The Ilula-Minnesota International Medical Conference, held in Iringa, Tanzania, brought together doctors, nurses, pharmacists and administrators from southern Tanzania Christian hospitals and the U.S. to talk about healthcare advancements and share knowledge. Held over two days, attendees learned about a quality improvement model, tools, and advancements in specific healthcare practices. I’ll let one of the doctors in attendance describe the specific health care practices. In this blog, I’ll talk about the specifics related to administration.
The first day of the conference was all about the quality improvement model and learning about and using process improvement tools such as pareto, run and flow charts. Most participants were new to this methodology and tools. Key themes included keeping it simple, starting small and expanding, recognizing that all improvement requires change, and viewing all work as a process.
Competition is recent in Tanzania, especially the rural area. The government built health care facilities throughout the country, often close to existing faith-based health facilities. The facilities are new and fully staffed due to the government’s higher salaries and reported lax management style.
We discussed that faith-based facilities have a competitive
advantage because the community trusts them, and they offer prayer to patients,
families, and staff. We focused on using this new competition to improve care
and service to the community. SafeCare is an internationally accredited
standard for resource-restricted settings. As members of the Christian Social
Services Commission, a SafeCare self-assessment tool is available free of
charge to the hospitals. Many of them believe they will try this new tool.
Participants shared examples of new revenue streams that
they were exploring, like adding specialty doctor services, reducing the amount
of denials from the claims submitted to the National Health Insurance Fund, and
producing agricultural products like maize, trees, sunflowers, and goats. The
discussion was especially welcome as the hospitals shared how they had worked
to overcome pitfalls in beginning and operating these new ventures.
In conclusion, the Ilula-Minnesota International Medical
Conference provided a valuable platform for knowledge exchange, networking, and
innovation, paving the way for a more collaborative and resilient global health
community.
Cindy Wilke
I had the opportunity to join the rest of the pharmacy crew—Shana, Meade, and Kent—on a palliative care home visit excursion with Happy, th...
