Good news this week

The first good news is that Theo got a job in Denver doing what he wants to do at almost double his old salary. When I sent him a note to say that his deceased grandparents would be proud (present tense), Helen noted that I’d been Africanized. Here in Malawi, ancestors are just around the corner, perhaps in the next village. You don’t see them, but they’re always there; they’ll make mischief if provoked.

The conference I came to lead went swimmingly. Twelve out of twelve respondents in the evaluation said that the meeting and the presenters met their expectations. The comments said that the things they liked are the things we wanted them to like.

The audience was mostly the data clerks in the hospitals we work with. They are one or two levels above housekeepers in the pecking order, and are usually marginalized because most people think their work is unimportant. Our mission this time was to tell them how important they are to reducing the number of women who die in pregnancy. As our paradigm says: “how will we know if a change is an improvement if we don’t measure what we have done?”

We talked through the implications of bad data. It means, among other things, that the hospital budgets its money for the wrong things. It can be fatal if we under-budget for drugs and supplies and run out (this happens all the time). If we don’t count neonatal sepsis correctly, the hospital may think that there’s no problem when babies are dying.

We started with an exercise based on an excerpt of a delivery ward register with only 15 admissions; each participant had to count the number of live births, deliveries, caesarian sections, etc. From a single on-page document the live birth number ranged from 8 to 14, and deliveries ranged from 7 to 11. They all laughed when I asked how we could possibly get these kinds of results from the same piece of paper. That led to defining rules, definitions and the need for standard procedures so that we get the same accurate count every day. When I gave them a standard procedure for counting, everyone got it right the second time. It also went faster.

They were hungry for this attention and coaching. Many felt this was the first time someone had recognized their roles. They are a smart and eager group and will make important contributions. They just need encouragement, continuous coaching, some technical guidance and training. Seeing these kinds of transformation is the best part of working here.

Finally, I’ve been invited to participate in an assessment of a rural hospital in Guinea, West Africa. I have to brush up my French, but the work I’ve been doing here and in Mozambique has prepared me well for this trip. The client appears serious and that bodes well for additional work.

I never imagined work could be like this. Many years ago I read a book by someone who had figured it out. He said, “What is not fun should not be done.” Some of my friends would get huffy at proverbs like this, saying you couldn’t play all the time. I felt sorry for them because they missed the point.