The Last Post…

I haven’t written in a while and there is a good reason for it.  My adventures in Africa have come to an end.  Due to disagreements in management style, I decided to leave my mission early in Liberia where I returned to France to complete my contact.  So… instead of focusing on the negative things that happened to me that made me leave early, I decided that this post will be about the positive things that have come about as a result of my time abroad and living in a post-conflict setting.

When given the opportunity, I can accomplish amazing things!

I have never had my own staff before or had so much control over a single project.  When given this opportunity, I found that I was accomplishing so much more than what I expected I could do.  Even with all the limitations of the people, the government and technology, I was still able to create something innovative and revolutionary.  I am extremely proud of what I managed to accomplish in such a short period of time.

Working with local people can be extremely rewarding.

As frustrating as the local people can be, with their ‘limited capacity’ as the expatriates referred to it, coming together and finding that perfect rhythm can be incredibly rewarding.  I eventually found that perfect working format that made everything click together and, at that point, working with the people was really a pleasure. 

Even in the harshest conditions, there are great people around you.

Working in Liberia is not easy.  From the people, to the local staff to the government, to the environment, everything around you seems to be on the attack.  But even through all that adversity, there are still great people around and I met many who were doing amazing work and accomplishing amazing things. 

As much as I want to help people, I like living in a world of convenience, character and technology.

There. I said it.  I don’t want to live without.  The first thing I did when I returned to France was to watch a 3D movie, which is not possible in Liberia and I thought to myself why would I miss out on all this great stuff! Life is too short to miss out on all the fun stuff that is going on.

I am so fortunate to be born in Canada and to be able to live there.

I have never felt the fortune of being born in the developed world until I finally left this comfort zone and moved to a post-conflict country.  I have never felt so blessed to be able to live in a safe, clean and organized country.  Sure Canada has it’s problems but they look so trivial compared to what I just came from. 

I can see where my future goes from here…

I learned a lot about my capabilities and what I want from my future.   I spent most of my life hunting for what would make me happy and this experience, more than any other I have had, has put me one step closer to that goal. I can see where my career should be taking me now.

 

So this will be my last post for now.  Who know what adventure lie before me but Africa is now part of my past and working there is no longer an option.   I will soon be back in Canada where the rest of my life begins…

Thanks for all the listening and feedback over the months.

A Shift Towards New Health Information Systems in Liberia

 

Pictured above: sentinel site staff entering data by manually counting malaria cases from the ledger and entering clinical notes directly into laptop. 

In all countries, there is a need for health information.  Health Information Management Systems (HMIS) are struggling all over Africa and Liberia has been given the last chance to see the sentinel site project come to life.  It isn’t easy getting data from a developing country hospital but this has been my work.

I am back in Zwedru and I haven’t blogged in a month.  I was trying to blog daily but my work has put me in front of a computer tinkering with data and making presentations.  Since I last left you, I have had a meeting with USAID on the future of the sentinel sites, switched over to a new Country Director and had an emergency switching of a computer in Zwedru.  Now, I am back with some interesting details.  

Martha Tubman Hospital just came out with the first month of patient level data.  It was a bumpy road as a computer crash left a few days without data.  Also, I am using Dropbox to synchronize the remote hospital folder (with database in it) to my folder in my computer. To those who know Dropbox, it is a file syncing program but I am using it to get my data remotely from a hospital several hundred kilometres away.

For those interested, the staff are no longer tallying, which means that they are no longer counting the number of malaria cases.  Now, all the tallying will be done by the Sentinel Site staff through the paper hospital ledgers and, in parallel, a patient level database, using Epi Info, collects patient information by data entering each clinical note as it goes into the records room.

Now to the interesting part.  THE DATA…

I looked at three methods of collecting health data for the month of March:

1. By entering each record individually into the patient level database
2. By counting the number of malaria cases in the hospital paper ledgers
3. By counting the number of malaria cases which were tallied by the staff themselves.

 

The differences are quite big but here are some preliminary results:

The malaria rate for under 5 years old (number confirmed positive by lab results divided by all those who attended the hospital) was 56.4% for patient level database, 56.1% for hospital ledger and 45.1% for hospital staff tallying.

This means that between 45% to 56% of all hospital visits by children under five were for malaria.

The total malaria death rate (number who died of malaria divided by all those that confirmed positive for malaria in a lab test – also called the malaria case fatality rate) was 0.18%, 0.74% and 0.37% respectively.

This means that less that 1% of those who visited the hospital for malaria died from that disease. 

What is interesting about having patient level data is the ability to make pivot tables in your favourite spreadsheet program and tinker with the values.  Here we see what are the most common secondary diseases if someone already comes in with malaria (separated by age group):

 

Secondary Diagnosis	<5 years old	>=5 years old	Grand Total
Abscess	1	2	3
Amebiasis	8	7	15
Anemia	30	11	41
ARI	180	99	279
Candidasis	16	3	19
Conjunctivitis	2		2
Eye Condition	1	1	2
Hypertension		7	7
Lumbago		2	2
Measles	11	5	16
Otitis	4	1	5
PID		25	25
RIH		2	2
Skin Infection	20	20	40
STD		27	27
Typhoid		8	8
Urine Tract Infection	3	38	41
Worms	18	29	47
Wound	3	9	12
No Secondary Disease	269	500	769
Epilepsy		2	2
Acute Watery Diarrhea	3	4	7
CHAPS		1	1
Meningitis		1	1
Diabetes Mellitus		2	2
Grand Total	569	806	1375

 

As you can see, there were a total of 1375 visits which were diagnosed with malaria and 279 also had ARI (acute respiratory illness) while 27 also had an STD. 

It’s hard to say what you can do with this information right now.  Really, it is more important to get reliable data which is not easy.  Everything from improving the quality of records in the ledgers to renovating the records room is needed.  We’ll see what happens next month…

Pictured above: empty shelves where medicine should be. 

Technorati Tags: Health Information,Liberia,Malaria,Pivot Tables,Health Informatics,Epidemology,EMR,Epi Info,Dropbox

Ontario Jones to the Rescue!

My time in Zwedru was nothing short of a rollercoaster.  By the end of the first day, I was exhausted.  The heat of the day, the fire of the fight and the struggle with the people had all taken a toll on my soul.  I was staying at the Save the Children residence and guest house (highly recommended) when I got a call from an unknown number which turned out to be a MENTOR employee who was working on a KAP survey (A KAP Survey is a Knowledge-Attitude-Practice survey where you go out to the villages and ask them questions about their knowledge and use of your health promotion campaign – in our case, it was about knowledge of malaria and use of mosquito nets). 

He and the rest of the team got caught in a bridge (which is actually just a bunch of logs above a big ditch in the road – see photo above).  He left the rest of the team and headed off by motorbike to Zwedru where he called me.  I then got my driver to go into the field and get them out.  That was at 10pm.  By morning, I hadn’t heard from either my driver or the other team so, with the wonderful help of the NGO called MERLIN, I headed off for a Search and Rescue mission!  Indiana, err, ONTARIO JONES TO THE RESCUE!

Here are some photos of the rescue team:

As we were driving through the deep dark bush, we saw the other cars returning.  Here’s what happened:

1. The KAP survey team got stuck.
2. The sent out a team member to get to Zwedru and get help
3. I got the call for help and sent my driver out to help them
4. My driver got stuck on another bridge.
5. Both teams slept the night in the bush
6. Morning arrives and I head out into the field
7. My driver gets out on his own, gets to the survey team and pulls them out.
8. I find them as they are driving to Zwedru

Then, one of the cars get stuck again.

But since we had three cars, the car was easily pulled out.

Ok.  So I really didn’t do anything.  I just drove out into the bush but the thrill of the search and rescue was pretty fantastic at the time. I have video footage but it is impossible for me to upload it with the current bandwidth that I have.  Ontario Jones was taking it easy this time.

..and that was that.  Back to Zwedru to work on the sentinel sites.  Just another day in Africa.

Technorati Tags: Liberia,Rescue