Designing systems

Another busy week for us (yay!); we’ve run out of health records folders, having bought out the store’s whole stock. Our 1-room clinic is starting to be too small, as despite the fact that there are 2 or 3 MDs in clinic each morning, we only have 1 room and the few times we have more than 1 patient in there, it just doesn’t work.

While Pr Nacro has done an amazing job at caring for 300 kids with few resources, things aren’t very systematic. I think if you asked him, he’d say he’s too busy to be organized. The HIV counselors keep track of the patients by date of visit in notebooks they have, and he has a pile of the last 6 months of CD4 results in random order. And the rest is in his memory. One of the neat things is that the HIV counselors have decided they like our index card system and are adopting that, so with time we’ll have all of the kids recorded at least on an index card with name, date of birth and whether they’re on ARVs. That’s a start!

So, we’re trying to systematize things to create better flow of information between the various doctors and health care workers caring for these kids – in a health care system which doesn’t have a culture of keeping chronic health care records. The challenge is, we’re trying to do it without any real experience in a resource-poor setting or guidance. So, while I know what’s in the literature, what’s taught at public health school and have some idea from that, I am – we all are – learning lots of things from our mistakes…. Creating patient care forms that are comprehensive but as short as possible… figuring out our own adherence plan and disclosure strategies that are culturally appropriate… figuring out how to get things done in a system that seems to be designed to be as difficult as possible.

On top of that, there are lots of clinical lessons… how to manage things with few tests and fewer drugs. And most importantly, not very much experience. (Our PAC colleagues in the other countries have had 8 months of clinical work to get a handle on that issue but we’re getting there now too). But the experience will come with time, and each day we are in clinic I am thankful that we have gotten this far.