Do You Have Oxygen?

Today, I will like to share two stories with you. Please read on:

Courtesy: Wikipedia

1.

On Wednesday June 24^th, I was called out of a church service by a well respected High Court Judge. He wanted me to help take a look at a little girl. Diane (not her real name) was a sweet looking two-year old. What struck me when I first saw her was how frail she was. She clearly had growth retardation and was about half her expected weight. She was in severe respiratory distress, cyanosed and febrile. Her parents said she had being admitted about 5 different times since birth for ‘pneumonia’. I didn’t have a stethoscope to listen to her heart. But, I immediately thought of a congenital heart disease.

I placed a call to a very good friend who is a Pediatric Resident and sent Diane to him for evaluation and management. After examination at the hospital where he works, he confirmed my fears. She had a Congenital Heart Disease. He promptly proceeded to admit her into the ward prior to investigations and further review. But alas, the oxygen cylinder in the ward was empty! And there was no oxygen in the entire hospital. Since her condition required oxygen as part of the immediate management, Diane was referred to another hospital. She died as soon as she got to the entrance of the emergency pediatric unit of the second hospital!

2.

About two years ago, a very close relative suffered a CVA and was admitted into the medical ward of a hospital. He was comatose for about a week and in that period, he needed oxygen to remain alive. The hospital didn’t have enough to go round all the patients. I wanted to keep him alive long enough so all his children could come visit him before his imminent death. As a result, I had to ‘borrow’ oxygen from several private hospitals in town to supplement what the hospital could spare for him.

The stories above are not fictional. They are real stories that involved real people who needed something as basic as oxygen. I am sure similar scenarios play out daily in hospitals and clinics all over the developing world. I have seen so-called emergency ambulances used to convey critically ill patients that lacked oxygen canisters/cylinders! Sadly, what Physicians in developed countries take for granted is now a luxury in many developing countries like mine. There is an urgent need to restructure and revamp the healthcare system in developing countries. We must put in place an organized system to prevent the absence or shortage of vital materials and equipment.

Oxygen alone certainly cannot treat all illnesses and diseases. Diane probably would have died even if she had received oxygen. My close relative also died despite my best efforts to provide oxygen. But that is beside the point.

The simple question is: Do you have oxygen and other basic live-saving equipment in your hospital?

It could mean the difference between life and death. If you currently lack oxygen and other basic life-saving equipment in your hospital, the time to get it is NOW! You would be saving lives.

Cheers!

Two Public Health Issues (plus one)

Two days ago, I was driving my daughters to school when they spotted a lady on a motorbike. She was smartly dressed in a white shirt on a beige colored skirt. Her shirt had epaulets on them signifying she was a ranked member of a uniformed organization. Ruby, the older of my two daughters asked “Daddy, which organization does this lady work for?” Tara replied “she is a special mobile police woman”.

I couldn't help laughing as I told them that she was a Sanitary Officer/Inspector. Nowadays, they are also referred to as Environmental Health Officers (EHOs). I went further to explain the functions of EHOs to include monitoring and inspection of restaurants, eateries and other establishments to ensure that they adhere to the prescribed standards of public hygiene. My daughters were surprised that such an organization existed because in their combined 17 years on earth, they had never seen anyone performing such functions.

The next question from Ruby was: “why don’t these people inspect our school canteen? It is always so filthy and has flies all over the place.” “I guess that is why children who eat there are always going to the toilet.” Tara contributed.

How true! We do have EHOs but they don’t really do much to earn their pay. When they do inspect and monitor public establishments, many of the EHOs end up collecting money from offenders without actually penalizing such offenders. This is a danger to our collective health because an epidemic can break out from such unhygienic facilities.

That incidence reminded me of another public health disaster noticed in our neighborhood about a year ago. We woke up one morning to find that a newly constructed house had a drainage pipe which was emptying waste water directly into the street! The water consisted of bath water and kitchen waste. Guess who owned the house: a (dis)honorable member of the State House of Assembly. The health hazard posed by this impudence was immeasurable. Several hundreds of school children and others walked across that puddle of water daily. Imagine if a child had fallen right into that watery bacterial mess. For those of us who drove past it daily, it was quite an eyesore. Several months and multiple visits later, the legislator finally constructed a proper drainage system to handle the waste water.

The above scenario plays out in so many cities across Africa and the developing world every day. Little wonder that we still have people dying from cholera and other diarrheal diseases.

After dropping Ruby and Tara in school, I decided to see my Auto Mechanic to fix a minor fault in my car. At the workshop, I saw a well dressed and apparently enlightened middle-aged man having a pedicure. I wasn't fascinated that he was having his toenails trimmed and cleaned in such a public place. Rather, I was shocked at the manicurist/pedicurist who was doing the job. The chap was barely literate and knew nothing about infection control nor the proper use of sharp objects. He had a rusty scissors that was razor sharp and a few other sharp things. (These traditional manicurists/pedicurists are ubiquitous in Northern Nigeria). I tried unsuccessfully to educate both the manicurist and the ‘manicuree’ on the dangers of using sharp unsterilized instruments. When I wasn't making any headway and it looked obvious that I was a busy body, I shut my trap, did my business and left the scene.

As I drove to the office that day, I realized that we still had a long way to go to ensure public health and safety. While the developed countries have progressed to producing cutting-edge medical technologies, the developing world is still struggling with basic public health issues like personal hygiene, clean school canteens and unregulated practitioners.

Though the future may appear bleak, healthcare professionals should not despair. We must continue to partner with both the government and the public. Our role remains to educate the public in our consulting rooms, at the market, in our homes, neighborhood and yes, even in the auto mechanic workshops. We must also hold the government accountable to ensure that relevant agencies inspect and monitor public facilities, enforce the laws, eliminate (?) corruption, punish offenders and reward exceptional compliers.

The journey to a safer public health seems far, but each determined step taken will lead us closer to our destination.

See you soon….

My Apologies

Dear Readers,

I will like to apologize for the long silence on this blog. I have been on the road handling several family issues. I will certainly write something fresh soon.
Thanks for your constant readership.

Cheers.

Ohi

HEALTHCARE IN AFRICA

I initially wrote this article 20 months ago. I wrote from a hospital ward where a dear family member seemed to be taking his last breaths as he battled with a second episode of stroke. At a point, it became expedient to move him for a CT scan. But the closest center was at least 3 hours away and it was quite risky to move him out of the hospital. I wondered how he would survive when the hospital even lacked a basic patient monitor though it was the best in town! 

As I watched him helplessly, I pondered the healthcare industry in Nigeria and indeed the world over. Here are my thoughts.

Healthcare is a largely fragmented industry with so many players doing their "own thing". In the hospital setting, we have so many small practices incurring multiple administrative costs and making healthcare expensive to the majority of Citizens. At least, I can afford a good standard of care for my loved ones. Not many can say that.

Having many small practices has been the norm for a long time. But the effect is that we miss out on economies of scale. Economies of scale help us to spend less money per unit of good produced. This happens when we pool our resources together and produce in large quantities. i.e., the larger the production plant, the cheaper the cost of production. Economies of scale is a proportionate savings in cost gained by an increase in the level of production. However, a point may be reached when an additional unit of output does not add to the savings in cost. Rather it leads to a further increase in cost.

Let’s take a simplistic healthcare example:

 Hospital A (GP) sees 12 patients pay day and spends N 10,000 maintaining its facilities daily. Hospital B (ENT) sees 5 patients and spends same N 10, 000 on daily overhead. Hospital C (OBS/GYNE) sees 15 patients and spends N 10,000 daily.

 It will make more economic sense if these three practices operate under one roof. That way, their overhead cost will reduce because each practice will bear part of the overhead cost. The unit cost of processing each patient will also reduce making it possible to charge less money from patients.

At several fora where I have had the opportunity to speak, I have often advocated that doctors pool their resources together to create mega hospitals instead of having mushroom clinics all over the place (my apologies).  If the hospital that admitted my relative had a CT scan, he may have lived longer. If we have mega hospitals that possess quality facilities and skills, we will definitely do better as a healthcare professionals.

It is my opinion that having bigger and better managed hospitals will help increase the standard and quality of healthcare in Africa.. We need to save more lives; we need to reduce patient morbidity. There is work to be done!

The fragmentation in healthcare is not the only problem we have. There are lots more. But I just want to highlight this issue for now. 

What is your opinion? Can doctors partner successfully? Can we come together to grow bigger and better? Think about it and send in your comments.

2015: A YEAR LIKE NO OTHER

I welcome you to a brand new year-2015! It is a year filled with possibilities, potentials, challenges and victories for you and your facility.

Towards the end of every year since I have been married, my lovely wife (being the planner in the family) starts "harassing" me with questions about the coming year. She wants to know my plans (not resolutions) for our family in the New Year. I must confess that I am quite lazy when it comes to planning (at least compared to her). However she forces me to put on my thinking cap (!) and think the coming year through from January to December.

If you have not done so, that is what I want you to do immediately after reading this post. Get a pen and paper and write your plans for 2015. And if you have already written your plans, read on because you will learn a few new things.

First, just write whatever comes to your mind no matter how absurd it may sound. It is important to write out your plans because the written document will serve as a reference point or road-map for your facility in 2015. Next, categorize those plans into the following categories:

-Financial plans

-Marketing plans

-Production plans

-Administrative plans.

Or you could departmentalize your plans viz

-OPD plans

-Pharmacy plans

-Theater plans 

-Ward plans etc

The next thing you need to do is to scrutinize each of those plans based on the feasibility or otherwise of the plan. Don't be over-pessimistic or over-optimistic. Be realistic and futuristic. Eliminate the ones that aren't workable, and then build on the ones that are workable. Think of new and better ways to serve your patients this year. Think of better ways to motivate your staff.

Following this, outline the plans you are going to implement. Set a target for how soon you want to implement them. After you have done this, communicate your plans to your staff. You need to discuss those plans and get the input of your personnel. This is important because a plan that is not accepted by your staff can never work. If possible modify them after the brainstorming session with your top level staff. 

Then go ahead and implement them. Please note that no plan is set in stone. Plans should be flexible and you are free to change your plans if they are not working.

On a final note, your plans should emphasize SMART goals.

S-Simple

M-Measurable

A-Acceptable

R-Realistic

T-Time Based

Enjoy 2015

WELCOME!!!!

Welcome to my blog.

Hospital Management is a blog that focuses on helping medical personnel to become better managers of their healthcare facilities. This blog will highlight topical issues that are relevant to the African Hospital Entrepreneur or Medical Manager in managing a facility in an African setting. However, we will also not hesitate to bring to the fore important global innovations in healthcare management which are adaptable to Africa.

I will like to begin by telling a simple story.

The Good Old Days 

Patrick, Ohi, Ayo, Uvie, Bawo

Can you recall your pre-clinical days? The days when you were a wide-eyed and easily excitable Medical Student? The days you used to strut around campus in your white coat and dream of when you'd eventually become a doctor? Looking back, I'm sure you would laugh at some of your impetuous ways. Arguably, those were the times you had the most fun in Medical School. The days when you had no care in the world and was not saddled with the responsibility of actual patient care.

I can still recall doing the basic sciences in my first year pre-med and how I often wondered what medicine had to do with CHM101, BOT107, PHY124, and GST104 etc. Moving on to the second year pre-clinicals, we all faced the basic medical sciences of Anatomy, Biochemistry and Physiology. These were the building blocks for the Clinical classes.

Can you remember the first time you saw a Cadaver? What was your emotion? Was it fear, shock, awe or excitement? You may probably have felt like a Surgeon during the Dissection Sessions! I can still recall my colleagues, Ayo,Bawo,Uvie,Patrick, Chris and others. Then, there was Peter who used to eat groundnuts in the Anatomy Lab!

What was the point of your pre-clinicals? It was to prepare you with adequate foundational knowledge to tackle the rigours of the Clinical classes. Your pre-clinical days prepared you for the day you'd eventually practice as a Doctor.

In the same vein, I would like to ask; what preparation are you making for the day you'd own your Practice? Or the day you'd leave Government service?

Let me state three important facts.

Fact#1: Over 90% of health professionals will engage in private practice at a point in their careers.

Fact#2: Though intelligent and skilled, most health professionals lack a basic understanding of business and public management.

Fact#3: You need a solid knowledge of business management to succeed in private medical/dental business.

The Hospital Management blog is committed to improving the quality of healthcare in Africa. I am concerned about the quality of management in our health facilities (both private and public).Having realized that most medical personnel are too engrossed in improving their clinical skills to pursue a formal training in hospital administration and management; this blog will put together vital and helpful information that is practical and easy to read.

It is appalling to note that a lot of private practitioners struggle to succeed in their practice. The few who seem to be doing well also struggle to sustain their practice. I have discovered that this is not because they are unskilled or unintelligent professionals. Rather, it is because there is a void in the knowledge and practice of modern hospital management skills (as a recent study showed*).

Hospital Management is committed to filling this knowledge-practice gap. This blog will provide relevant and current information about hospital management to help you move from where you are now to where you want to be.

As a Nigerian adage says "it is only a dead man that possesses all knowledge". It is not too late to learn new things!

Once Again, Welcome Aboard!