Planning Assessment Healthcare Domain

HELP Inc. April 6, 2012

Planning Assessment Egbe ECWA Hospital

15/3/2012 Egbe

A meeting was initiated between HELP Local Administrator Mrs. Sunday, HELP volunteers Dr. Tom Conner, Scott Beebe, and the heads of departments (HODs) at Egbe ECWA Hospital. The meeting was hosted by Pastor Alabi, Administrator of the Spring Of Life HIV/AIDS Clinic. The purpose of the meeting was to assess current progress of the ECWA Hospital and regionally related services along with future strategic opportunities for partnership in the future based on the vision of the Hospital administration in concert with the Healthcare Domain for HELP. We began the meeting explaining our purpose as stated above, with an open mind from our host, and a willingness to share from many of the participants. The current state of affairs as relayed primarily by Medical Director Dr. Shaibu, was not a complete surprise when you consider the overall state of healthcare within a third-world environment. Due to extreme poverty, healthcare is a problem as there are very limited resources for pharmaceutical treatment, transportation to and from appointments, payment for services, and for well balanced dietary habits. Education could aid in helping the local population to understand its need for a diverse diet, yet without the resources (agriculture or fiscal) to procure a healthy diet, the education is lost. Culturally, the local diet is made up of 60-70% carbohydrates, according to Dr. Shaibu, which leads to the overwhelming number of diabetics, many of whom go undertreated and under-diagnosed causing serious long term personal and population health issues. This lack of resources and education leads to widespread noncompliance, which we know in the West, is a great predictor of hospital admissions and readmissions. Currently, 5 out of 10 admissions into ECWA Hospital in Egbe do not pay for services rendered. Collections and lawsuits will not serve purpose to assist in this problem due, in part, to local poverty. There is an educational protocol setup at the Hospital around the primary disease states; diabetes, hypertension, and malaria. Also, perinatal care and education are solidly in place and provided for. HIV/AIDS is a known problem in the area with approximately 1 out of every 10 people succumbing to this disease. Ironically, treatment is free and widely available; yet transportation is the biggest barrier to access for patients. They simply cannot afford to pay a taxi to come to Spring Of Life and be administered the proper, and free, anti-viral treatments.

The answer to these problems is not necessarily in reducing cost burdens to the end patient; that has been attempted with consequential results. ECWA Hospital in Egbe is less expensive than most, while the staff is paid around 75% of optimal salary. Working environments and benefits are a noted factor in the Hospital being short staffed. The cost of a Cesarean Section was 12k Naira (around $60-70 US), and even that cost they reduced to try and relieve patient burden in caring for newborns. Community perception of ECWA Hospital, largely propagated by poor patient customer service (not necessarily patient care) and by local leaders speaking ill of the institution, is poor. The HODs have pleaded that a local forum be setup to reeducate the leaders and the general public on the excellence and services of the Hospital. The current leadership structure of the Hospital is unique. The Medical Director is also the head of the Hospital, while sitting with a management team consisting of himself, the Hospital Administrative Secretary (non-University trained), along with each of the HODs. There is no one on site who has been trained in strategic management and development.

Opportunities for the future: Introduce agricultural techniques that will help diversify the local diet to include broader access to fruits, vegetable and meats. Regular forum of local leaders to shift the community perception and to gain local buy in Education to show the long term value of preventative healthcare Build a strong Family Medicine residency program Develop a staff development and orientation protocol to help build knowledge, excellence and morale Protocol for accountability with all staff to ensure adherence to Hospital values and goal-setting; for example, to improve prompt attention to patient needs, rapid service, relentless and accurate record keeping, and personal responsibility Fly the flag for o Family Medicine Residency o Psychiatric Center of Excellence o Excellent Nursing Program Leadership and Strategy training for professional development Focus on four things o Communication both internal and external o Quality patient care, educational prowess, administrative/leadership

o Leadership not fear, but motivation, staff training, procuring the right staff, building an ECWA culture, accountability o Center of Excellence disciplines, trials and studies, Nursing, Family Medicine and community education In our observation, Janet seems to have both passion and knowledge for providing excellent healthcare for the locals. Her passion however seems to be slightly tempered by her veiled frustration at the lack of some key resources. Also, we see real opportunities for the Egbe Hospital and outside teams to provide local support and partnership in the areas listed above in concert with a comprehensive healthcare strategy Follow Up: Scott Beebe will be following up with the HELP Board and the eventual Healthcare Domain Coordinators (both local and global), to transfer knowledge and set goals and objectives going forward. HELP is a non-governmental organization who partners with local entities on the ground around a variety of domains; health, education, business, agriculture, and social/civil.

Planning Assessment Okoloke Clinic

13/3/2012 Okoloke

We initiated a meeting between HELP volunteers Dr. Tom Conner, Raye Elerson, Scott Beebe, and HELP staffer Janet; Community Health Nurse and overseer at the HELP Okoloke Clinic. The purpose of the meeting was to assess current progress of the Okoloke Clinic (OC), future plans of progress, and to identify opportunities for partnership in the future based on the vision of the OC within the Healthcare Domain for HELP. The meeting was held out under the tree between the Okoloke Guest House (site of the OC) and the Good Shepherd Primary School campus. We began the meeting explaining our purpose as stated above, with an open mind from our host. As of this meeting, the OC treats 2-5 patients per week. These cases are generally outpatient, with the most common disease states being malaria, upper respiratory infection, and perinatal care which include mosquito nets for all new babies and all pregnant ladies. Janet noted that she believes a real opportunity for the clinic, for discipleship, and for payment increases, exists in providing a best in class and clean birthing suite complete with private bed and toilets. The market for a birthing center is palpable and real, as is the general healthcare market. Education, treatments and finances are barriers to market access. Janet treats any patient who comes into the clinic, and is willing to admit patients overnight when needed. Common pharmaceutical treatments for patients include tetracycline, simple analgesics, and anti-diarrheic for acute patients. For chronic diseases, common treatments are generally limited to antibiotics such as ampicillin, amoxicillin, ciprofloxacin, erythromycin, and gentamicin injection. Currently the clinic is unable to provide consistent immunizations (TB, DPT/Tetanus, Oral Polio) due to the lack of adequate and continual power. Also, procuring payment is typically very difficult from the Fulanis, however is much more standard among the town-people in Okoloke. Janet also pointed out that the local government clinic did not see as many patients as she does suggesting an alarming number of disease simply going untreated. Opportunities for the future: Go to the point of service rather than having patients solely come to the clinic Simple laboratory with microscope and diabetic screening testing supplies

Developing population health education and treatment management around Hypertension, Acute Pain, Diabetes and Wound Care (typically a result of diabetes) Build a clean, best in class birthing suite complete with power, private bed and private toilets Develop a protocol and deliverables around health/hygiene education that can then be deployed out into the bush via the HELP Outreach Team complete with public demonstrations and education around malnutrition, hygiene, anemia, skin diseases, etc. Solar powered refrigerator for year round inoculations and biologic treatments HIV/AIDS protocols and clinic

In our observation, Janet seems to have both passion and knowledge for providing excellent healthcare for the locals. Her passion however seems to be slightly tempered by her veiled frustration at the lack of some key resources. Also, we see real opportunities for the Egbe Hospital and outside teams to provide local support and partnership in the areas listed above in concert with a comprehensive healthcare strategy Follow Up: Scott Beebe will be following up with the HELP Board and the eventual Healthcare Domain Coordinators (both local and global), to transfer knowledge and set goals and objectives going forward. HELP is a non-governmental organization who partners with local entities on the ground around a variety of domains; health, education, business, agriculture, and social/civil.

Planning Assessment Dr. Laura Smelter at ECWA Hospital

15/3/2012 Egbe

A meeting was initiated between HELP Local Administrator Mrs. Sunday, HELP volunteers Dr. Tom Conner, Scott Beebe, and Dr. Laura Smelter, the new missionary Doctor and acting Medical Director of the Egbe ECWA Hospital. The meeting was held in the Medical Directors office at Egbe Hospital. Dr. Laura had just recently arrived (within that past couple of months), for her stated goal of providing both healthcare to patients, and training to Family Medicine Residents. Upon the pending departure of Dr. Shaibu (current Medical Director and Resident), Dr. Smelter was asked to fill that spot. She was clearly overwhelmed by the assignment and related responsibilities given the infrastructural and management inconsistencies that have become common at the Hospital, and are noted in the Egbe ECWA Hospital assessment write up. We opened the meeting with introductions as to who we were, what HELP provides, and our intention to both learn from the Hospital personnel, and partner with the Hospital going forward. From there we provided some of the key learnings from our previous healthcare meetings with the Hospital department heads to offer context to the discussion. Dr. Smelter immediately dictated to us that she has a desire to see an increase level of quality, training, utility and sustainability at the Hospital. In partnership with Samaritans Purse and Don Campion, they have a goal, going forward, of a mirroring leadership structure; CEOs, CMOs and COOs. The mirrored roles for each category would require one local/national, and one ex-patriot working collaboratively. When asked a general idea of what a 30/60/90 day plan might reflect, her response included: Regular department meetings Comprehensive asset analysis Training on Biblical rationale for a missions Hospital Comprehensive needs assessments Budget analysis Staff analysis, remodeling and repurposing

Currently, the expatriated Healthcare Professionals who will serve at the Hospital will be coming via the conduit of World Medical Missions. The immediate and intermediate needs that have currently been identified by Dr. Smelter include: Host experts within each area of the Hospital (pharmacy, lab, OR, X-Ray, etc.) who would observe, analyze, offer solutions and ongoing accountability based on cultural appropriateness As a side, we asked specifically about the Spring Of Life clinic directed by Pastor Alabi. With her understandably limited knowledge due to insufficient tenure, she was able to provide us with this assessment: Lack of funding Unaware of the infrastructure (although she knows that they have one) Medicine must be dispensed by licensed provider Would be benefited by a consultant champion; an individual who can provide consulting and accountability to find innovative ways to achieve objectives What would make this program successful? o Appropriate treatment and utilization o Support groups o Ongoing discipleship HIV/AIDS care and treatment is a priority to Dr. Smelter Follow Up: Scott Beebe will be following up with the HELP Board and the eventual Healthcare Domain Coordinators (both local and global), to transfer knowledge and set goals and objectives going forward. HELP is a non-governmental organization who partners with local entities on the ground around a variety of domains; health, education, business, agriculture, and social/civil.