Step 1: Empty the hospital
My first principle for moving the hospital was to try to empty it as much as possible. It's easier to move furniture, rather than furniture containing patients that you're trying to care for while displacing them.
So we have a multi-pronged plan for emptying: publicity campaign, rapid triage, lots of resources for transferring, restricted entrance criteria. That part is supposed to start on Friday.
Yesterday, we started with a slightly reduced entrance criteria: no normal deliveries unless the baby is crowning ('tete a la vulve'). Otherwise, we continue to admit pre-eclampsia, third-trimester bleeds, and incomplete or septic abortions.
And the hospital is empty. Nearly, anyway. Empty compared to the overflowing that happened in October and November. Today when I left: a total of five patients (capacity 18 beds) in antenatal, and 18 empty beds on post-partum (capacity 35, up to 40).
But the strange thing is that I don't think that it's much to do with our change in focus. Perhaps the publicity campaign is particularly effective. Women just aren't coming, aren't coming to be assessed in triage, and so aren't being admitted either. The rough statistics posted in reception indicated 49 women this morning (total patients in the building, admitted, discharged, waiting to be evaluated — we've had up to 140 during the peak).
It's weird, but we'll take it.
Postscript: Not everything is smooth. Came home this evening after a long day — mostly meetings to ensure that staff know what will happen and how the hospital will work — and had dinner while listening to other team members discuss consumption and pharmacy orders. (Thankfully didn't have to contribute meaningfully to that discussion.) Had a good discussion with one of the logisticians about what needs to be done to get this move accomplished.
And then: learned that the cold chain has failed. Four fridges plugged into same power bar; power bar failed. Thus, the clever technique of splitting the stock so if one fridge failed, we wouldn't lose all of any one item, was indeed clever. But four out of five fridges on the same extension cord, less so.
This led to a rapid logistical and medical assessment of our losses. Which items can stand to be warm for a while? (Let's say, 12h at 20 deg celcius.) What do we have extra of, in the fifth fridge? What is essential to the medical functioning of this project?
So, at 2130h, we have learned: that the blood typing reagents can be warm for a while, the vaccines are probably ruined but are not essential to the project (we get our patient vaccines from the Ministry of Health), the biochemistry reagents are no big deal because our machine hasn't worked in months, and the HIV, HepC, and syphilis tests are also OK. Thankfully, oxytocin and methylergometrine can also be at room temperature for several weeks. The biggest issue is the control substance for our hematology machine, which is toast, and has been difficult to obtain.
Disruption of the cold chain is extremely unfortunate and quite expensive. Not to mention a major headache and very time-consuming. But the project will be able to run.