Gulu blog: Ebola, TQM, and never hearing another excuse about lack of resource again

In the last few days, I was absolutely privileged to be given tours of Lacor and Lira hospitals. I don’t use the words lightly; I’m still working my way through my emotions about the visits, and about Gulu itself. But in two days I have already met some of the most astonishing, inspirational people I could have ever met.

 

Northern Uganda has had severe problems in its recent history. There was a severe outbreak of Ebola in 2000, and several years of a vicious LRA insurgency.  The area has severe health challenges posed by the impact of the war on both health and resource development; HIV, TB, not enough maternal and mental health services to meet demand, a shortage of trained staff, bad roads and malaria. The mere existence of hospitals through the insurgency was impressive enough.

 

On the visit to Lacor, we were shown the last of the huge relief tents set up when the compound housed tens of thousands of children and other vulnerable people – the Night Commuters.  To avoid abduction, they walked for miles every night to reach the hospital compounds, or failing that at least the safer streets of Gulu, where they were less likely to be abducted, forced into being child soldiers or “wives”, tortured or killed.  There were thousands of people in internally displaced person camps, but some struggled on in their villages, fleeing by night and returning by day.  The tent now offers some facilities for the hospital attendants – the friends and relatives that dress, feed and wash patients in most hospitals here.

In Lira, I met one of the nurses who had led the Ebola response in Gulu in 2000.  She is now the Principal Senior Nursing Officer for Lira Regional Referral Hospital.  Her description of having to “hold hands and stand firm” against the disease, with no modern protective equipment, in the face of the horrific symptoms and terror in the community, were  – actually, I’m really not sure I have a word for it.  It took all my professionalism not to actually cry when she described how she believed God had protected her (although to protect her family she relied on bleach), and how she had to take survivors back to their families and work hard with them to take them back, due to the fear the disease caused.  The Lacor and Gulu teams did astonishing work controlling the spread. I can’t imagine what it takes to stand firm against hemorrhagic fever or against an army that are prepared to execute children to make a point.

 

 

The other truly inspiring thing in the visit to Lira is that they are implementing Total Quality Management, the management system (very similar to Toyota Lean and the UK Productive Ward Series).  Most wards have large posters up about the 5 S (Sort, Straighten, Shine, Standardise, and Sustain).  The nurses and students are working hard to use the methodology to improve care, and the Sisters told me that they have data (although it’s not fully analysed yet) to suggest that mortality and morbidity are falling.  These are 30 bedded nightingale wards, and maternity wards with beds down the centre of the ward to make more space.  But there is a spotless Critical Care Unit waiting for opening, and a Neonatal Intensive Care Unit (with one working incubator at the moment as the other is in for repair), and increasingly good outcomes.  The experiment is ready for roll out. Lira, Lacor and Gulu hospitals are genuinely inspiring.  I can’t promise never to complain again.  But I think I can promise not to give up.  If nurses can hold firm, with no PPE, against Ebola, and go on to implement TQM in subsaharan Africa, then there is no excuse at all not to eliminate hospital acquired MRSA and no excuse not to implement quality improvement systems in the UK.

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