Monday, June 13, 2005

Visible again

OK, so things seem to be working again. The road crew blocked my road into my house because they finally put the coat of tar down. My cat already gave birth to 3 orange kittens by the time I got home, alleviating my fear that she would give birth in a neighbor's attic and then get locked out (happened with the last set of kittens). My paraplegic patient may have decided to accept vocational training. And Blogger seems to be working now.

Some of the other links that I like on Blogger, which I can now view:

No Star Where - about the life of an expatriate in Vietnam:

Linksaplenty - where to go if you need to look at something new to stimulate your mind, writing, or whatever:

That's enough for now. My alternative blog is:
Mekong River Review

Monday, June 06, 2005

Hot Times

I finished my first exam today. I feel better already. Health management on Wednesday, and then I can return to worrying about the other things in my life. Will my pregnant cat have her kittens in an appropriate location (not in a neighbor's attic)? Will the village ever finish the paving of the side streets (they started after the rains started so they are often working in knee deep muck)? When we will be able to start work on the new project? Oh, the list goes on.

Right now, the sky is clearing. After the test, I sat by the pool for a while, then as I was riding my bicycle home, the sky opened up. I ducked into an internet cafe for an hour until the rain stopped and the mists started to rise from the pavement. Now the sky is clearing and the sun's starting its descent to the west. The Mekong is brown and flat.

Saturday, June 04, 2005

Health Systems Management

When I visited my old clinic in California, my former colleagues thought I had gone bonkers. I told them that I was working on my Master's degree in 'Health Systems Management.' I have to admit that I agree with them; when we worked together, I just hated the whole concept. I considered myself to be a clinician - willing to work overtime to see more patients, leave my day job to drive an hour to make sure the homeless clinic had a medical provider, set up health clinics at migrant farmworker camps, etc. When we had discussions about financing, quality assurance, and cost-benefit analysis, I went to sleep; it never seemed relevant to me.

Since I've been working in Laos, health systems management has grown in importance for me. I realized - quickly - that if I train medical staff in some skill, and then they can not use this skill, then it's as if they never had the training at all. However, when we have planning meetings, medical staff usually say that they need medical training, and don't address other issues.

An example: One day, in 1998, I was talking with a lab technician in a district hospital. I asked her how many Gram stains they were doing (a staining procedure so you can see bacteria to determine if they are Gram + or Gram - so you can start the decision tree about the probable causitive organism). She said that they didn't do any because she didn't have the chemicals. I remembered giving them a set of premixed chemicals and after rummaging in the cabinet, I pulled it out (unopened!). She then sheepishly admitted that although she knew how to do the procedure, and had the chemicals, the doctors were not ordering it. This led to other discussions that involved changing habits (doctors were not accustomed to ordering other tests because they didn't have the opportunities before) to advocating to patients about the need for the tests to guide treatment.

I quickly realized that upgrading medical treatment is very complex. So to pick up the skills to make the changes in behavior sustainable, I've been working my way through this program.

So next week, I'm taking the exams in Health Economics and Financing and Health Management. For the past few weeks, after studying for an hour, I've been rewarding myself with a half hour of writing. I'm trying to do the same thing this weekend.