Back to work

I am back to work… and back to the main task at hand, namely trying to seed quality improvement teams at each health center. Quality improvement can take place at any level but tends to happen in large organizations with external pressure to meet certain goals (think indicators set by insurance companies at practices with support staff at Mt. Auburn). The task here is quite different; helping small rural health center staff to identity problems that are within their control by brainstorming and collecting data, making a plan to change the process, and follow up. In my first scheduled meeting for this week, I found one midwife completely alone in the health center with two mothers in labor and a line of mothers waiting for antenatal care outside. She had been alone (except for the gatekeeper and cleaner) for 6 days. At one point in the morning, she put down the first newborn in front of me- we found the suction bulbs I had brought with me and put one to good use- prior to jogging back to the delivery room. Not only was there not a quorum for a quality improvement ‘team’ but after 6 X 24 hours on call (and often up), she was clearly not in a place to participate in my project. Thursday’s meeting at another health center was a bit more successful- we had a group, we got through the agenda, and we planned for the next step- despite the whole concept being unfamiliar, the language barrier real, and the path of finding problems that are actually in their control daunting. The pictures are of the 4^th level health center and one of my co-facilitators, Lillian, with her partner Sylvia examining a mother at a 3^rd level health center (where Lillian delivered 5 babies in 5 hours on Tuesday!)