So I’m not going to lie, I was feeling pretty frustrated yesterday.
At work we started creating a health facility database. This is really important since it counts how many hospitals, clinics, and rural health posts are in each district and how many specialists/doctors/nurses/hospital beds they have. This will allow the inspectorate to look more closely at issues of access and manpower.
The document Dr. Moffatt gave us that was supposed to contain the data was an absolute cryptic mess. Even after we deciphered what was a town/city and what was a district and which of the facilities were clinics we realized that we needed more information. Dr. Moffatt wrote up a great little memo for the Health Statistics Office detailing what information we needed.
We went up there and met with the head of that department, a great woman who gave us a whole background on the procedures of health statistics gathering and dissemination. However, the information they gave us was still missing a lot of what we needed. There were no breakdowns by clinic or village and most of the statistics were from 2006 and districts have been remapped since then. You also can’t just e-mail a rural health post and ask them how many nurses work there, especially when you still don’t have internet access.
Which brings me to my next frustration: internet or lack thereof. My internet clearance at work still hasn’t come through and they say it probably won’t until the end of next week at the earliest. Keep in mind I work at the Ministry of Health, one of the nicest government buildings in the country. You would think I could get internet there. Also, despite her best attempts, Carol still hasn’t been able to get us internet in our rooms and I still can’t even get it in the library. Worse is that the IT office closes at 4:30, which is when I get out of work, as does the Botswana-UPenn Partnership office which has free Wi-Fi. Its frustrating to still not have it when we are told we’re supposed to and I keep having to spend my money on internet cafes which are far away and pretty slow.
But these frustrations are all ok. Actually I think they’re kind of good in a way. Internet is a luxury that I should not be whining about. I think it’s the fact that the program gave us the assurance that we would have it that irks me; if I had come in expecting not to have it I think I’d be fine. I mean I had no internet for the first 2 weeks of summer last year and at the time I also had no bed, and was not in Botswana, so I think I’m moving up in the world. As inconvenient as it is, it’s a little liberating not to check it 24/7, and I’m doing much more reading.
As for work, we’re just going ahead working with what we have and writing up a report to go along with the database, noting the discrepancies and missing information and making recommendations for further investigation. Working in policy of any kind means dealing with bureaucracy, and even when everyone’s trying their best, sometimes the numbers just aren’t there. When we analyze the data that we do have it puts a lot of things into perspective.
For example:
· Most rural health posts in Botswana have only 1 or 2 people on staff, both nurses. They also have no beds and can only provide most basic care and send people home/somewhere else.
· Clinics are usually just 4-8 nurses and maybe 1 MD. Some have beds (meaning babies can be delivered there) but many don’t.
· Primary hospitals often only have about 3-6 MDs on staff total
· There are only 2 "referral hospitals", which offer the highest standard of care: one in Gaborone and in the other city of Francistown.
Herein lies the difficulty of delivering healthcare in rural areas of a developing country. People are very spread out except around the cities and that makes it hard to reach them. I just let the fact that the assignment is a challenge motivate me more and we finished today having done the best we could J
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