We — as in the gynecologists and midwife-supervisors — had mortality rounds this morning, late because all of our regular reports and meetings were delayed for the move. Four deaths in January, an average number for us. The discussion was pretty good, although the deaths were inevitable.
At the same meeting, we discussed our admission criteria for the new hospital. Our annual plan says we should be focussing more specifically on really critical cases. We do too many normal deliveries, over fifty percent of our total, when there are other structures here who are capable of managing them. There are also other structures who can manage some complicated cases, so, as I am fond of saying, there are a lot of patients who need care because of their complicated or high-risk pregnancy, but do they need to be cared for by us? It is a difficult ethical distinction to make, but it must be made, or we would be rapidly overwhelmed.
As part of this discussion, we also debated whether to continue the donation kits that we currently give to each patient we transfer. There is a free obstetrical care program here, funded by the World Health Organisation (WHO). It is supposed to cover all the costs of delivery and follow-up. So we have been thinking of stopping the donation kits.
The meeting today, then, was actually a wonderful experience: with 15 or so local staff, we had an excellent discussion. About MSF and our current goals. About worrying for the well-being of patients. About why patients are at risk, whose responsibility it is, whether our donation kits help or not. About the ability of public hospitals to function and what their barriers are. The gynecologists did most of the talking. The most satisfying part is that they, like me, do this work for a reason. They have chosen it. They understand and believe in our role here. They acknowledge our limitations. They understand — I'm sure better than I do — the political, structural, social context here. I am impressed by their perception and analysis.
Other observations: We've been officially open for five days. By 5PM today, we had admitted a total of 125 patients in the last five days.
Logistics is recruiting a technical logistician, so there is a job notice posted on the gate of the hospital. (I am also recruiting a gynecologist, for which the notice is posted right beside the logistics one.) They are receiving a massive quantity of applications, so much that it is better measured by altitude rather than number. I do not exaggerate here: they are over-flowing from a box. Maybe 30cm high? Or 40cm? And the deadline is next week, so there will be many more.