Patient Satisfaction Survey
As agreed, this took place at the health centre on Thursday. My team of community workers (volunteers) were very good although the 9 o’clock start sort of staggered its way from 9.30 to 11.15. The staff were a bit wary but I explained as well as I could before we started so that they knew what to expect.
The results were fascinating and some areas come up in the comments that had not occurred to me at all. The community workers were also very good at placing themselves so that they spoke to as many people as possible – we 48 interview in the end. It was their suggestion to place some of them at the gate so that they could talk to people who were leaving who had completed the episode – my mindset was very much at the health centre.
I have completed the initial report and we have a meeting booked for Tuesday to discuss the findings. I’m sure there are some quick hits we can make that are almost cost neutral that will address several of the issues. E.g. making information about charges on display so that users are aware of the financial commitment before treatment is commenced, and then having itemised receipts that show what people have paid for. Where people have very limited amounts of disposable income or savings it must be quite worrying to enter into a transaction not knowing how much it will cost. Other issues need further consideration and prioritisation by the team - should be very interesting.
Kampala and the Ministry of Health
On Friday I took the Elgon Flyer from Mbale to Kampala. This is an express bus/coach that takes 4 hours and costs 10,000 Uganda shillings UGX (about £3). The coach seats approximately 50 people and provides comparative luxury travel for where we are. There is no air conditioning on the bus but the windows all open so it’s not too bad. AS we started off the conductor walked down the bus thanking people for using he service and hoping they enjoyed ‘flying with them today’. The seats were quite tightly packed as there is a 2 seat row and a 3 seat row on the other side to the bus and it gets a bit hot and sticky where bodies are pressed against each other – but at least each person gets a seat each. The price of the bus is very good considering it cost me 50,000 UGX to get back from the hotel (15 minutes down the road) the other night when I was invited to meet some of the visitors from Wales. As the taxi had been booked for me I thought a price had also been agreed. Big mistake. It’s very difficult to argue about the price where you are at your destination and don’t have any change. A lesson not to be forgotten though – I’ll make sure of the price before I travel anywhere in future.
The trip to Kampala was partly to accompany Vanessa one of the volunteers as she had to go to the dentist – and I thought I would take the opportunity to go to the Ministry of Health to see if I could get copies of the standards and guidelines for health centres so that we can start to put mechanisms in place to show that these are being met. As I had a chance meeting with someone from the Ministry of Health during the previous week I was directed to the Central Pubic Health Laboratory. I found this quite easily and asked to see the person whose name I had been given. When I got there e she spoke to her boss who said that copies of guidelines were kept at the serology office up the road and I was directed up there. I eventually found it after getting a bit lost, so I arrived hot and a bit sweaty having walked nearly 3km in the afternoon sun. When I got to the office it was mostly deserted but I managed to find someone who said they did not really keep any publication there – they were mostly at the public health lab. So – off I walked all the way back again, with the name of a public health doctor to ask for. When I got back to the office I was directed to a person to help who said that they did not keep anything there. After some discussion he said that the clinical guidelines for most services had just been updated and printed and copies of these were available at the main office for the Ministry of Health (close to where I had just walked from). He telephoned and spoke to someone and I heard him agree that I could have 2 copies of this document. As it is a newly updated document that is quite a large book I though great – success at last. It was 4pm by this time so he said I needed to hurry as people would be going home soon, and he told me which office to ask for (who shall remain nameless for the purposes of this blog). So off I walked again trying to go as quickly as possible and wishing I could take a boda. When I arrived I was directed to the appropriate office of a senior person. I explained what I had come for but he was adamant that I could not have any copies of documents. He gave me lots of stories about the documents ending up in Sudan, Kenya and neighbouring countries and the cost that all this incurs. On discussion and reflection on my return I think I missed here that maybe he was asking for money – but not being used to this type of discussion I missed the cues. I explained that the purpose in asking for the document was to work with the organisation I am placed with to help put systems in place to meet the standards – as it is difficult to do this if the standards and guidelines arte not known. He said that they had the documents and were planning to start distribution on Monday. Again I asked if it were possible to have just one copy but he looked me in the eye and flatly refused even though it has been agreed on the telephone that at least one would be available. At this point I had to remind myself that as a representative of another country I needed to put my diplomatic head on, but this took a lot of effort. I was very complimentary about the content of the guidance etc etc as they are good documents – but completely wasted if no one sees them. He admitted that the web page for the ministry is not that good and he said that there internet providers were poor but it didn’t seem to be anyone’s responsibility to do any about this. I left feeling quite frustrated and deflated. Having to walk all the way back into town to meet Vanessa – by now it was nearly 5 pm. I calculated I walked about 15km that day, and the temperature was about 28C.
I confess I cursed to myself as I walked back up the road again but by the time I got back to town I had walked it off. I think it has made me realise that when I get back to my job in Wales I need to be mindful that we do not create these types of situations for people who need information to try to be able to deliver good quality services.
The hotel we stayed in is very popular with backpackers and volunteers travelling through. It was by no means luxurious but is was clean and felt quite safe. We had a family room with 3 beds and use of a shared shower and facilities which cost 45,000 UGX (about £15). When we got back to the hotel there was an event going on across the road. As our room had access to a veranda above the shop fronts http://www.pbase.com/bmcmorrow/image/63364464 we went out to look and had a good view of the African drummers and dancers – it was loud but very good. Thankfully they packed up at 11pm. We were afraid ait was going to go on all night. I tried to take some photos but it was too dark.
We had a good look around the craft stalls on Saturday morning, I have some good ides now for Christmas presents to bring back, but I think it will be better to get these on a stopover on the way back to the airport when I leave.
We got the 12 o’clock bus back which left at 11.45. Apparently once they have sold enough tickets for the bus to leave it just goes. The bus makes a couple of very quick stops on the journey back. Forget MacDonald’s as fast food. The stops are at pre arranged places and the locals rush up to the windows to compete to sell chicken on sticks, chicken kebabs, roasted banana, and water or fanta.
Then the conductor on the bus comes around with napkins and a rubbish bag. It’s a shame but most of the local people throw their rubbish out of the windows of the bus and don’t make use of the rubbish bag.
There is also a stop for a ‘short call’ – This is along a deserted strip of road with high buses and tall grass – almost everyone piles ff the bush and disappears into the buses etc reappearing a few minutes later. I didn’t partake but apparently it is agreed that the men go one way and the women go the other. As we stopped a bus stopped on the other side of the road as well. I have to say the men were particularly bothered that they were in full view of the bus on the other side of the road!
A little tipple
When I was looking around the supermarket in Kampala on Friday I saw a little carton of whiskey made in India – the kind of carton that kids have for fruit juice – certainly not what we see at home.
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