Laura Spratling shares her experience of volunteering in a hospital of Sierra Leone
I’d always wanted to volunteer in a developing country, motivated like many by an interest in applying my skills to help a place in great need. I was attracted to the strong partnership ethos of the King’s Sierra Leone Partnership and delighted to have the chance to come and work with Connaught Hospital colleagues.
I joined the NHS as a graduate general management trainee in 2009, after which I worked in various roles, including most recently as programme director for Diabetes & Stroke Prevention at Health Innovation Network, the South London Academic Health Science Network. I am grateful to my managers at HIN for kindly allowing me a six month career break to come to KSLP in Freetown.
Different yet similar
During my first few weeks at Connaught I was struck by how hospital life is on the one hand of course so totally different, and yet on the other hand many of the issues are similar to the ones that NHS managers devote their careers to solving.
While there is what sometimes feels like an overwhelming amount of suffering, there is also a good deal of hope
Probably the most striking difference is the spectrum of common diseases. Infectious diseases (such as malaria, HIV, TB, measles, meningitis, pneumonia and others) are very prevalent. Spending time observing in an outpatient clinic during my second week here I was also taken aback by the severity of advanced disease.
In my years in UK hospitals I have never seen so many patients so poorly as I have seen here in just a few months.
But while there is what sometimes feels like an overwhelming amount of suffering, there is also a good deal of hope. Patients, relatives and staff are incredibly warm and friendly, greeting strangers they pass in the corridor.
I have met incredibly strong and resilient people here who have survived some terrible times and are committed to working towards a better healthcare system.
I’ve discovered that Connaught Hospital has the following issues in common with the NHS (I’m sure there are more!):
1. Issues around flow of patients through the hospital – together with Connaught doctors and nurses we’ve started some process mapping to better understand the problems before co-designing solutions
2. Rotas and handover processes
3. Ways to embed effective multidisciplinary working
4. Estates and maintenance issues
5. Effective management of outpatient services and ensuring patients do not become lost to follow up
6. Health records management
7. Robust systems for audit and quality improvement
And it’s the last two issues where I am focusing my energies for now.
There’s a great deal of enthusiasm for improving the records system, both to improve care quality as well as enabling staff to undertake meaningful quality improvement projects. The records office staff in particular are fantastic.
Whilst there are some tough times, it’s an incredible and very worthwhile experience
Together we have delivered the initial stages of our improvement plan and we are on track to launch a new system for managing health records shortly.
It’s also fascinating to work with colleagues to start a programme of quality improvement projects. We’ve established a committee where projects are proposed, registered and reported. One major project is about implementing the new World Health Organisation guidelines for the treatment of malaria.
The project is being led by a Connaught Internal Medicine specialist and his team, with facilitation from KSLP. With the support of the head of Medicine, KSLP coached two house officers in how to do a comprehensive clinical audit of the baseline position in malaria care.
We’re now starting to implement improvements in pharmacy processes and deliver training for staff to ensure that every patient with malaria receives optimal care, before reauditing to check progress.
My third project is an evaluation of a major educational programme run in partnership with the medical, nursing and pharmacy schools at the College of Medical and Allied Health Sciences. I’m developing some new skills in designing qualitative evaluations and I learnt a lot from the focus groups that we held with lecturers and students.
I’ve always thought that the role of an effective healthcare manager is to provide the best possible environment and conditions for clinicians and patients, so that the best possible patient outcomes are achieved. This means making sure that systems work and that staff have the right skills, equipment and support to meet patients’ needs.
As one of my first managers in the NHS memorably put it, “you have to be the glue” that brings the various parts of the system together. These principles are exactly the same here.
Volunteering overseas is a “less trodden path” for healthcare managers than it is for clinicians, but I would encourage anyone who has an interest to pursue it and get in touch via firstname.lastname@example.org if you would like to know more. KSLP is advertising vacancies for healthcare managers and clinicians.
Whilst there are some tough times, it’s an incredible and very worthwhile experience.
Laura Spratling, hospital management volunteer, King’s Sierra Leone Partnership