“We always have a meeting on Monday morning. It informs the staff what their duties will be during the coming week. All government officers have a Monday morning meeting. It is how we do things here in Zambia.”
There have been some complaints to the District Commissioner about the health centre staff “sitting about talking when there are lots of sick patients queuing up to be seen”. She had received several SMS messages early on Monday morning. So the following day, she had visited the clinic and berated the health workers.
At a dinner party earlier this week, she asked me what was going on. I told her that the staff have a meeting every Monday from 8 – 9am. They normally speak in Nyanja, which excludes me, so I often miss the meeting and arrive for work at 9am. When I attend the meeting, they do switch to speaking English, but that makes the meeting drag on for longer.
But Monday is the busiest day of the week. We only provide emergency cover from noon on Saturday, so there are lots of clinic outpatients. Nurse midwife Regina runs a very popular Family Planning Clinic on Monday mornings. The clinic is heaving with patients, clogging up the waiting area, pushing into the ante-room outside the consulting rooms, lying down on the edge of the veranda.
If we have a full complement of staff, we can get to work quickly and clear the queues. But our senior nurse is away on long leave (three months) and another has to go to Lusaka to take an examination. One nurse has been on night duty and another is on “days off” following night duty. And recently we have had to send a nurse to the District HQ or Kamoto Hospital, to beg for supplies.
A health care assistant had to go to Mambwe to get a cheque for the clinic running costs. The cheque is then given to someone reliable who can deposit it in the nearest bank, at Chipata (two hours away). Four days later, the cheque will have cleared and someone will need to go to Chipata again to withdraw the funds and buy mops, cleaning materials, paint, soap, toilet rolls, paper, carbon copy sheets, batteries, pens, etc.
The DC told me that I need to show the health centre staff how to be more patient-centred. “You treat the patients with respect, you show that you care for them, you do not dismiss them. I think that the way you deal with them is almost as important as the drugs you prescribe,” she said. She’s correct.
This won’t be an easy task. I am only here for another two months. In other situations, I have tried to improve standards by “leading from the front”, offering a personal example of how to work more diligently and respectfully. However, here in Kakumbi, it has been known for the nursing staff to knock off and allow the expatriate doctor to finish the clinic by themselves, so I am not sure that this approach will work.
Regina approached me and asked me if I had been able to explain to the DC about the increased workload of the malaria season. I told her that the DC was well aware of the additional patients we were seeing and the pressure the clinic was under from drug shortages.
“But why do we hold a meeting on Monday morning, the busiest time of the whole week?” I asked her.
“Because all civil servants in Zambia have a meeting every Monday morning. It is what we do,” she replied.
“Well, why can’t we hold the meeting on a Tuesday, when it is quieter, and there is no huge Family Planning Clinic?” I said.
“Because we have to have the meeting on Mondays. To know what duties we have in the coming week,” Regina replied.
“But let’s assume the staff know what their duties are on Monday, let them start work on Monday morning at 8am and deal with the massive queues. Then on Monday afternoon, or Tuesday morning, we can hold the weekly meeting. Would that work?” I said.
“No, Ian, you don’t understand how we do things in Zambia. This is our way.”
“OK, perhaps you can make the patients aware that the clinic starts late on a Monday because of the important meeting. Tell them to come after 9am on Mondays, explaining the reason,” I said.
“But if they are sick they will come at any time. Sometimes we are called out of the meetings to see emergencies. They will not understand.”
“Regina, what is more important – the needs of the patients or the staff rota?”
“If the clinic is not running properly and efficiently, with everyone knowing their jobs, the patients will not get a good service,” she replied.
I’m not in charge here. I am a volunteer. I help where I can. It is not my job to impose change. But I wonder what would happen if the DC, the DMO or Dr Daniel suggested changing the time of the meeting. How would the staff respond?