My FSD Workplan

My project idea has been approved!

It has been difficult to think of a project that would be both beneficial and long-lasting for the hospital. The Foundation for Sustainable Development emphasizes that our projects must be sustainable by building upon the resources that are available at the hospital and working to develop those resources. The organization stresses the difference between aid and development; aid is that which views the community as objects of development whereas development promotes the involvement of the community in order for local ownership to take hold and development solutions to be maintained. During the internship, FSD encourages its interns to take an asset-based approach—in which the first step is to identify the needs and opportunities available, build open those means, and work with the organization to ensure its maintenance for our projects to be qualified as sustainable development.

There are three components to my project: the first is to increase the number of patients who are tested and counseled for HIV and AIDS; the second is to improve the management, transparency, and appearance of the hospital; and the third is to enhance service provision by decreasing patient wait time and increasing privacy.

The first part of the project is to create a VCT center at the hospital. Kenya currently is home to one of the world’s largest HIV and AIDS epidemics. An estimated 1.5 million people are living with HIV; and in 2009 80,000 people died from AIDS related illnesses. The Kenyan government has gone a long way to provide HIV prevention and treatment services. In 2000, there were only three voluntary counseling and testing (VCT) sites nationwide, and by 2007 there were almost 1000. There are now VCT centers in 73% of health facilities in Kenya. In addition, the Kenyan government subsidizes all costs for VCT services and antiretroviral drugs and therapy. Despite the improvement that Kenya has made over the decade, only 48% of Kenyans in need of HIV treatment are receiving it (Avert).

Shibwe Sub-District Hospital is one of the few hospitals in Kenya to not have a VCT center. Currently at the facility, patients who are tested for HIV are sent to the general laboratory where they are counseled in front of many others. This causes the rest of the patients to be aware of each person who is being tested for HIV at the facility. Because privacy is critical during HIV testing and counseling due to the stigma and discrimination people still face from the disease, and since Shibwe lacks the ability to offer privacy, HIV testing is rarely done at the facility. Shibwe has been unable to provide both the funds and the space for a VCT center.

For my project, I would like to provide the space and the funds to advertise for a VCT center. In the past week, space has already been made available after some of the staff helped me to organize and clean out one of the storage rooms in the back of the Female Ward. I am hoping to move the Nurses’ Office that currently is in the Comprehensive Care Center (which treats HIV/AIDS patients and is where the VCT is originally supposed to be) to the back of the Female Ward, allotting the space in the CCC for the VCT. However, donations will be needed in order to provide a door, a desk, and chairs for the VCT. In addition, I would like to advertise that Shibwe now has a VCT center so residents in the village can come get tested. I hope to make signs around the village and make a promotion for the first 20 people to come for its opening to receive T-Shirts.

Shibwe has generously offered to provide the funds necessary to pay for a VCT counselor – this was by far the most crucial aspect of the project. Last Monday, I wrote up the advertisement for the need of a VCT counselor at Shibwe to post around the city, and on Friday interviewed for the VCT counselor. She has begun to work already as of two days ago, but has yet to be given office space. (She is currently working out of the Nurses’ Office.) I can’t wait for the VCT center to be implemented!

The second component to the project deals with the management and appearance of the hospital. Currently, the clinician sees patients based upon whoever sits closest to his door. Because there is no way to tell who has come first, patients are cutting each other in line and constantly fighting. Therefore, I have already begun the implementation of a numbering system at the hospital as of yesterday. I have printed out numbers and laminated them, and have taught the staff how to use them. Once the patient signs in at the registration desk, they are given a number and then called upon by the doctor by the next number in line. The new numbering system has been so successful in one day that the staff has asked for a numbering system for each ward in the hospital! In addition, I am hoping to improve the record system at the hospital because much time is wasted and a great deal of data is not reported with the current system. However, I will need to research better record-keeping systems, so no promises if this will work! The last part is to improve the appearance of the hospital by creating notice boards in each room and designing posters to provide both education of illnesses and an awareness of numbers seen at the hospital.

Last but not least, the third part of the project is to enhance service provision by decreasing patient wait time and increasing privacy. I have already conducted 100 surveys of patients to acquire information about patient needs and satisfaction, written a report of the analysis, and presented my report to the rest of the hospital staff (about 15 people). There were very pleased with the report (and the new numbering system) that by the end of my presentation they did a standing ovation. I was very happy :) Of the 100 patients surveyed, 46 had only attended primary school and the majority were either self-employed or farmers. Overall, the central findings of the survey was that patients indicated that they were not given enough privacy and that they were not receiving enough information about their illness or about their prescription (and that we need to increase the staff but there is nothing I can do about that….). Therefore, I would like to increase the amount of privacy offered at the hospital by constructing a partition within the consultation room. Patients are currently examined, diagnosed, and treated in front of others, because there are no doors between rooms or partitions within rooms. I wish to provide a partition for the Consultation Room, thereby creating two rooms for the two clinical officers to see patients in separately. This would not only provide privacy within the Consultation Room, but also allow more patients to be examined by the two clinical officers who will be able to work more easily with the separated room. In order to provide for two Consultation Rooms, donations will be needed to construct the partition and buy an extra desk and chairs. Furthermore, Shibwe has offered to contribute to this privacy initiative by adding in funds to create a door at the Labour Ward. Currently, the Labour Ward and the Female Ward are separated without a door, making it very simple for patients to watch a delivery. It is not only an invasion of privacy, but painful for some of the patients to watch! Lastly, if I have time, I would like to create pamphlets for the patients to read while they wait to see the clinician about some of the major illnesses affecting the area, means of prevention, and treatment. A pamphlet would also be beneficial for expecting mothers (who wait an especially long time to be seen by a nurse) about the danger signs related to pregnancy and childbirth since Kenyan women face a 1 in 20 lifetime risk of maternal death.

That is my work plan as of today! Hopefully, this project will meet FSD’s, Shibwe’s, and my hopes for sustainable development. The staff is just as excited for each of these project outcomes (especially the VCT center) so I am not at all worried about them being able to execute and maintain these development solutions after I leave Kenya. The work plan, however, may continually change the longer I work at Shibwe and the more I discover opportunities and bounce back ideas off the other interns.

I have sent in my Online Campaign Form to the head office of FSD in San Francisco so hopefully it will be approved in the next couple days and I can begin fundraising for the VCT center and the partition for the Consultation Room! Donations will be very, very much appreciated :)

If you have any comments or ideas about other projects, do not hesitate to tell me!

Sidenote: Yesterday afternoon, I visited my homestay aunt at the girls secondary school she teaches at. It is a public boarding school (very common here), and apparently the girls must wake up at 4:30 AM to be in class by 5! I would have dropped out immediately...