More Good Discussion

I got a lot of work done today, cooped up in my hotel room with air conditioning and blazing fast wireless. I also stumbled upon a cool discussion on the GlobeMed discussion board about a recent article titled, "Doctors Without Orders" by Josh Ruxin.

Check out the article here and the discussion here.

Here are some of my thoughts after reading the article and thinking about it in relation to my experiences in Ghana and at the HOPE Center:

After spending the past 3 1/2 weeks at our health partner, the HOPE Center - a rural medical clinic in Ho, Ghana - I've gotten a very small glimpse of some challenges very similar to those Josh Ruxin mentions in his article: challenges of management. The HOPE Center currently is staffed by four full time nurses, all of whom do an incredible job treating sick patients, but none of whom have had any formal management training. To no fault of theirs, the medical records files are largely kept in rather disorganized stacks, there is little constant daily routine or schedule, and there tends to be too much (in my, obviously limited opinion) idle time between patient visits. On days of child welfare clinics or nutrition workshops, the Center is abuzz with activity as hundreds of local mothers come to learn about proper, balanced nutrition and to have their children weighed, immunized, and treated for infection. On other days however, a slow trickle of patients come to be treated primarily for malaria, respiratory infections, and diarrheal diseases. There are certainly sick people in the community: Why don't they come in droves? I think there could be two main causes: 1) barriers to receiving care for the poorest, and usually sickest members of the community, such as long distances to the Center, or lack of money and insurance and 2) lack of services demanded by people in the community such as a path. lab, imaging, maternity ward, etc.

Unfortunately, there is no way that the Center's current clinic management systems could handle a large influx of new patients. Our team from GlobeMed at NU talked often about how, what the HOPE Center really needed was a medical director - someone good with computers, scheduling, budgeting, and effectively allocating the precious human resources provided by the nurses. Unfortunately, right now, we do not have the resources for a professional clinic manager. So, what can we do in the mean time?

Here is where, I think, GlobeMed health partnerships have the exciting possibility of going beyond boring old fundraising. Depending on the type, size, and nature of the partner organization, I believe that students could take on roles similar to consultants. Basically, consultants are hired by companies – and increasingly both large and small nonprofits – to analyze and create solutions to business problems. Consultants add value to businesses by bringing in a fresh set of brains with different problem solving and analysis tools. While staff members and management must juggle many balls, consultants are able to narrow their scope and focus on a smaller subset of problems at one time. Although students are not professionals, I do believe that we have valuable skills, analytical minds, and a growing body of knowledge fueled by our university education. Exactly as Victor just mentioned in “Recruitment for GlobeMed Chapters,” we should be engaging students from a wide variety of fields – engineers, economists, sociologists, and anthropologists. Each of these unique perspectives will allow health partnership projects that go deeper than fundraising, allowing students to use their growing specialty knowledge to improve the systems that ultimately allow the expansion of health care capacity.

In Ghana, I tried to improve the way the HOPE Center managed their patient records by installing an open source medical records software on one of their computers. I was semi-successful. I probably underestimated the challenges posed by the infrastructure and overestimated my own computer abilities. The open source software didn’t work, but we set up a functional excel database which will hopefully act as a stepping stone to a more permanent system.

As a next step, I think that this project could be awesome to think of in terms of consulting. Here is one where we could engage some of our computer science whizzes at NU in using their expertise to build a more formal EMR system for the Center. I think that it would be very possible to assess the needs and limitations of the HOPE Center context and then use the knowledge and enthusiasm of students to fit those needs and limitations with a functional solution.

Of course, students need the tools to enable them to effectively analyze problems and then apply that analysis to developing solutions. While working with the HOPE Center, I often drew from my experiences with campusCATALYST (check it out: www.campuscatalyst.org). CampusCATALYST gives students the opportunity to work in teams on a consulting engagement with a small nonprofit. Each team works with the leadership of the organization, identifies a problem of appropriate scope, applies consulting analysis, and uses that analysis to create a viable solution. The brilliant thing that campusCATALYST does is that they pair the consulting work with an actual class through Northwestern which teaches the fundamentals of the consulting problem solving process. That way, students are well prepared and can more effectively analyze and solve the problems. I’m excited to see the “resource packets” that the Central staff will be unveiling this year to all of the chapters. Perhaps also though, a partnership with campusCATALYST could be struck in which some of their teaching materials and lesson plans could be morphed into modules or “resource packets” specifically designed to teach the basics of consulting analysis and problem solving strategies.

It is always important to realize that we are students and not professionals. It’s a frustrating position when we all want so badly to just jump in and help, but are prevented by our lack of medical training. Although not as “sexy” as going on “medical missions,” I think that students can really make a huge impact analyzing and proposing solutions to management issues. Here are problems that we can engage with less fear of breaching medical ethics.

Sorry for the rambling rant, but these are just some ideas – spurred by that interesting article and discussion – that I’ve only started to piece together. I’m still here in Accra, waiting to get on a plane after being bumped due to Delta overbooking my scheduled flight. All of my thoughts and emotions are still very fresh and unprocessed, so I’d love responses to this.