Healthcare Assessment

8/2/2019 Healthcare Assessment

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Planning Assessment

Healthcare Domain

HELP Inc.

April 6, 2012


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Planning Assessment

Egbe ECWA Hospital

15/3/2012

Egbe

A meeting was initiated between HELP Local Administrator Mrs. Sunday, HELP

volunteers Dr. Tom Conner, Scott Beebe, and the heads of departments (HODs) at

Egbe ECWA Hospital. The meeting was hosted by Pastor Alabi, Administrator of the

Spring Of Life HIV/AIDS Clinic. The purpose of the meeting was to assess current

progress of the ECWA Hospital and regionally related services along with future

strategic opportunities for partnership in the future based on the vision of the

Hospital administration in concert with the Healthcare Domain for HELP.

We began the meeting explaining our purpose as stated above, with an open mindfrom our host, and a willingness to share from many of the participants.

The current state of affairs as relayed primarily by Medical Director Dr. Shaibu, was

not a complete surprise when you consider the overall state of healthcare within a

third-world environment. Due to extreme poverty, healthcare is a problem as there

are very limited resources for pharmaceutical treatment, transportation to and from

appointments, payment for services, and for well balanced dietary habits. Education

could aid in helping the local population to understand its need for a diverse diet, yet

without the resources (agriculture or fiscal) to procure a healthy diet, the education islost. Culturally, the local diet is made up of 60-70% carbohydrates, according to Dr.

Shaibu, which leads to the overwhelming number of diabetics, many of whom go

undertreated and under-diagnosed causing serious long term personal and

population health issues.

This lack of resources and education leads to widespread noncompliance, which we

know in the West, is a great predictor of hospital admissions and readmissions.

Currently, 5 out of 10 admissions into ECWA Hospital in Egbe do not pay for

services rendered. Collections and lawsuits will not serve purpose to assist in this

problem due, in part, to local poverty.

There is an educational protocol setup at the Hospital around the primary disease

states; diabetes, hypertension, and malaria. Also, perinatal care and education are

solidly in place and provided for. HIV/AIDS is a known problem in the area with

approximately 1 out of every 10 people succumbing to this disease. Ironically,

treatment is free and widely available; yet transportation is the biggest barrier to

access for patients. They simply cannot afford to pay a taxi to come to Spring Of

Life and be administered the proper, and free, anti-viral treatments.


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The answer to these problems is not necessarily in reducing cost burdens to the end

patient; that has been attempted with consequential results. ECWA Hospital in Egbe

is less expensive than most, while the staff is paid around 75% of optimal salary.

Working environments and benefits are a noted factor in the Hospital being short

staffed. The cost of a Cesarean Section was 12k Naira (around $60-70 US), andeven that cost they reduced to try and relieve patient burden in caring for newborns.

Community perception of ECWA Hospital, largely propagated by poor patient

customer service (not necessarily patient care) and by local leaders speaking ill of

the institution, is poor. The HODs have pleaded that a local forum be setup to

reeducate the leaders and the general public on the excellence and services of the

Hospital.

The current leadership structure of the Hospital is unique. The Medical Director is

also the head of the Hospital, while sitting with a management team consisting ofhimself, the Hospital Administrative Secretary (non-University trained), along with

each of the HODs. There is no one on site who has been trained in strategic

management and development.

Opportunities for the future:

Introduce agricultural techniques that will help diversify the local diet to

include broader access to fruits, vegetable and meats. Regular forum of local leaders to shift the community perception and to gain

local buy in

Education to show the long term value of preventative healthcare

Build a strong Family Medicine residency program

Develop a staff development and orientation protocol to help build knowledge,

excellence and morale

Protocol for accountability with all staff to ensure adherence to Hospital

values and goal-setting; for example, to improve prompt attention to patient

needs, rapid service, relentless and accurate record keeping, and personalresponsibility

Fly the flag for

o Family Medicine Residency

o Psychiatric Center of Excellence

o Excellent Nursing Program

Leadership and Strategy training for professional development

Focus on four things

o Communication both internal and external

o

Quality patient care, educational prowess, administrative/leadership


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o Leadership not fear, but motivation, staff training, procuring the right

staff, building an ECWA culture, accountability

o Center of Excellence disciplines, trials and studies, Nursing, Family

Medicine and community education

In our observation, Janet seems to have both passion and knowledge for providing

excellent healthcare for the locals. Her passion however seems to be slightly

tempered by her veiled frustration at the lack of some key resources. Also, we see

real opportunities for the Egbe Hospital and outside teams to provide local support

and partnership in the areas listed above in concert with a comprehensive healthcare

strategy

Follow Up:

Scott Beebe will be following up with the HELP Board and the eventual HealthcareDomain Coordinators (both local and global), to transfer knowledge and set goals

and objectives going forward.

HELP is a non-governmental organization who partners with local entities on the

ground around a variety of domains; health, education, business, agriculture, and

social/civil.


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Planning Assessment

Okoloke Clinic

13/3/2012

Okoloke

We initiated a meeting between HELP volunteers Dr. Tom Conner, Raye Elerson,

Scott Beebe, and HELP staffer Janet; Community Health Nurse and overseer at the

HELP Okoloke Clinic. The purpose of the meeting was to assess current progress of

the Okoloke Clinic (OC), future plans of progress, and to identify opportunities for

partnership in the future based on the vision of the OC within the Healthcare Domain

for HELP.

The meeting was held out under the tree between the Okoloke Guest House (site of

the OC) and the Good Shepherd Primary School campus. We began the meetingexplaining our purpose as stated above, with an open mind from our host.

As of this meeting, the OC treats 2-5 patients per week. These cases are generally

outpatient, with the most common disease states being malaria, upper respiratory

infection, and perinatal care which include mosquito nets for all new babies and all

pregnant ladies. Janet noted that she believes a real opportunity for the clinic, for

discipleship, and for payment increases, exists in providing a best in class and

clean birthing suite complete with private bed and toilets. The market for a birthing

center is palpable and real, as is the general healthcare market. Education,treatments and finances are barriers to market access.

Janet treats any patient who comes into the clinic, and is willing to admit patients

overnight when needed. Common pharmaceutical treatments for patients include

tetracycline, simple analgesics, and anti-diarrheic for acute patients. For chronic

diseases, common treatments are generally limited to antibiotics such as ampicillin,

amoxicillin, ciprofloxacin, erythromycin, and gentamicin injection.

Currently the clinic is unable to provide consistent immunizations (TB, DPT/Tetanus,

Oral Polio) due to the lack of adequate and continual power. Also, procuring

payment is typically very difficult from the Fulanis, however is much more standard

among the town-people in Okoloke. Janet also pointed out that the local government

clinic did not see as many patients as she does suggesting an alarming number of

disease simply going untreated.

Opportunities for the future:

Go to the point of service rather than having patients solely come to the clinic

Simple laboratory with microscope and diabetic screening testing supplies


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Developing population health education and treatment management around

Hypertension, Acute Pain, Diabetes and Wound Care (typically a result of

diabetes)

Build a clean, best in class birthing suite complete with power, private bed

and private toilets Develop a protocol and deliverables around health/hygiene education that can

then be deployed out into the bush via the HELP Outreach Team complete

with public demonstrations and education around malnutrition, hygiene,

anemia, skin diseases, etc.

Solar powered refrigerator for year round inoculations and biologic treatments

HIV/AIDS protocols and clinic

In our observation, Janet seems to have both passion and knowledge for providing

excellent healthcare for the locals. Her passion however seems to be slightly

tempered by her veiled frustration at the lack of some key resources. Also, we see

real opportunities for the Egbe Hospital and outside teams to provide local support

and partnership in the areas listed above in concert with a comprehensive healthcare

strategy

Follow Up:

Scott Beebe will be following up with the HELP Board and the eventual Healthcare

Domain Coordinators (both local and global), to transfer knowledge and set goals

and objectives going forward.

HELP is a non-governmental organization who partners with local entities on the

ground around a variety of domains; health, education, business, agriculture, and

social/civil.


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Planning Assessment

Dr. Laura Smelter at ECWA Hospital

15/3/2012

Egbe

A meeting was initiated between HELP Local Administrator Mrs. Sunday, HELP

volunteers Dr. Tom Conner, Scott Beebe, and Dr. Laura Smelter, the new missionary

Doctor and acting Medical Director of the Egbe ECWA Hospital. The meeting was held

in the Medical Directors office at Egbe Hospital.

Dr. Laura had just recently arrived (within that past couple of months), for her stated

goal of providing both healthcare to patients, and training to Family Medicine Residents.

Upon the pending departure of Dr. Shaibu (current Medical Director and Resident), Dr.

Smelter was asked to fill that spot. She was clearly overwhelmed by the assignment

and related responsibilities given the infrastructural and management inconsistencies

that have become common at the Hospital, and are noted in the Egbe ECWA Hospital

assessment write up.

We opened the meeting with introductions as to who we were, what HELP provides,

and our intention to both learn from the Hospital personnel, and partner with the

Hospital going forward. From there we provided some of the key learnings from our

previous healthcare meetings with the Hospital department heads to offer context to the

discussion.

Dr. Smelter immediately dictated to us that she has a desire to see an increase level of

quality, training, utility and sustainability at the Hospital. In partnership with Samaritans

Purse and Don Campion, they have a goal, going forward, of a mirroring leadership

structure; CEOs, CMOs and COOs. The mirrored roles for each category would

require one local/national, and one ex-patriot working collaboratively.

When asked a general idea of what a 30/60/90 day plan might reflect, her response

included:

Regular department meetings

Comprehensive asset analysis

Training on Biblical rationale for a missions Hospital

Comprehensive needs assessments

Budget analysis

Staff analysis, remodeling and repurposing


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Currently, the expatriated Healthcare Professionals who will serve at the Hospital will be

coming via the conduit of World Medical Missions.

The immediate and intermediate needs that have currently been identified by Dr.

Smelter include:

Host experts within each area of the Hospital (pharmacy, lab, OR, X-Ray, etc.)

who would observe, analyze, offer solutions and ongoing accountability based on

cultural appropriateness

As a side, we asked specifically about the Spring Of Life clinic directed by Pastor Alabi.

With her understandably limited knowledge due to insufficient tenure, she was able to

provide us with this assessment:

Lack of funding

Unaware of the infrastructure (although she knows that they have one)

Medicine must be dispensed by licensed provider Would be benefited by a consultant champion; an individual who can provide

consulting and accountability to find innovative ways to achieve objectives

What would make this program successful?

o Appropriate treatment and utilization

o Support groups

o Ongoing discipleship

HIV/AIDS care and treatment is a priority to Dr. Smelter

Follow Up:

Scott Beebe will be following up with the HELP Board and the eventual Healthcare

Domain Coordinators (both local and global), to transfer knowledge and set goals and

objectives going forward.

HELP is a non-governmental organization who partners with local entities on the ground

around a variety of domains; health, education, business, agriculture, and social/civil.

Documents

Healthcare Assessment