Last night I stayed in a Malawian district capitol following a long day of work with the data people at the District Hospital. While the skill levels for data management are low compared to comparable people in US hospitals, I learned, like many times before, that you find "stars" everywhere: creative individuals who teach themselves how to solve important practical problems everyone else think are either trivial or impossible. The visit started by seeing if we could streamline the manual data tabulation of maternity discharges; it ended when John showed me that he enters the data directly from the ward register into Epi-Info, a well known public-domain statistical software package he had taught himself how to use. Using the software skips over the tedious and error-prone process of manual tabulation and calculation. It probably saves ten hours of time a month. All I could do is cheer. He gave me a copy of his data and the software. Perhaps I can find someone to automate the reporting for him.
The other good news from the trip is the joy of working with my Malawian colleague, Charles, the quality improvement officer for this project. Prior to working with our project on reducing maternal deaths he was the quality improvement officer for a large cement manufacturer. Watching him use sharp logical reasoning with a group of nurses and clinicians to get to the bottom of a clinical problem is amazing. In yesterday's example he led a group of nurses and clinicians through an analysis of several medical charts of babies who had died. The common wisdom is that these are babies born outside the hospital with traditional birth attendants. They become infected and are brought to the hospital when it's too late.
Contrary to expectation, about 80% of the deaths were associated with vacuum-assisted delivery, not community acquired infections. The interventions to fix this are very different from a campaign to discourage people from using traditional birth attendants.
There are very few people in the world who can do this well. I am so lucky to be witnessing a master.
Driving home reminded me of a project I haven't got around to doing yet--taking pictures of the signs in front of coffin workshops. What reminded me was a black sign with white letters that said: "Energy Coffins, 24 hour service." Most of the names are straightforward, e.g., "Jones coffins" or "Smith's Coffins and Joinery". There is a big demand. The HIV prevalence rate in Malawi is about 15%. Lots of people die. Near the Central Hospital in Lilongwe there's a street with a dense concentration of 20 or so such shops. They turn out coffins ranging from plain wooden boxes to elaborately carved items with shiny brass or chrome handles and hinges. It's just an example of how the landscape tells you what's really going on.
Reading
Since Helen tells you her book list I'm offering mine here. Since the middle of August I've discovered Victorian novels. Up to now I rarely read novels. But in theh last six weeks I've read four by Thomas Hardy "Tess...", "Mayor of Casterbridge", "Far from the Madding Crowd" and most recently "Jude the Obscure (my favorite) two by Dickens ("Bleak House" and "Great Expectations", and five by Trollope ("Warden", "Barchester Towers", "Framley Parsonage", "Small House at Allington" and "The Way we are Now"). I can barely put them down. There are several common themes: love and marriage, suffering, charity, greed and corruption; all the usual stuff. I don't know what took me so long to find these. I plan to continue. "Bleak House" is very modern. I see it in today's America, and certainly here in Africa.
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3 comments:
Roger, that is a prodigious amount of reading. Wonderful. Your comment about the relevance to today's world was interesting. I recently read a book written in the early 1960's by Monica Dickens, great-granddaughter of Charles Dickens. Her novel The Heart of London reflected many of the race relations problems that we are reading about in the newspapers of today.
Janet, I forgot to mention Jude the Obscure, my favorite. The book's editor says that the heart of the book is about suffering and charity, the only two things that aren't in the "letter of the law." Hardy was reading Job and Corinthians when he wrote the book. It's caused me to go back and re-read them. The Job dialogs are difficult, but you almost have to laugh at the hurt his interlocutors do in the name of sympathy. They mean well, but it's hardly charity.
How ever did you manage to read four of Hardy's novels together? I would have needed to read something very jolly between each of them. My mother was a great Hardy fan and she persuaded my father to read one: he read Jude and was so stricken that he never read another. He still shuddered thirty years later at the very thought. Actually, I haven't read one for a while... maybe it's time for a re-visit.
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