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Management Skills

I am back in Mombasa, after spending a half week in Kokotoni.

It was interesting – I played a role that was unexpected.  A quick overview of the clinic: it is a community-run clinic, with a committee of ten members overseeing its management. Currently it is staffed by a PA, a nurse aide, a pharmacy tech, a lab tech, a receptionist, a cleaner, and a watchman. So, this week there was a big meeting of the committee about the roles of staff at the clinic. A problem had arisen where the staff was having questions about their roles in their positions, where basically they were competing to avoid having to do jobs. So, I was asked to assist the PA to write out job descriptions for each of the staff. In addition, I was asked if I had any impressions of the clinic. As it turned out, I did have some opinions. The clinic currently runs a deficit – meds are supposed to pay for themselves, although there is only a standard fee for each patient. However, there isn’t enough traffic, and the cash flow is negative about 10000 shillings a month. So, I told them I thought they needed to drop some staff – there is no need for 6 staff with a clinic that sees 8 to 15 patients a day – as well as a few other money-saving methods. I’m not sure they understood what I said, they mostly nodded when appropriate, but the PA translated the short version to them.

Regardless of what they decide to do with my advice and the job descriptions that the PA and I hammered out, I wasn’t totally comfortable with this particular role. I didn’t really come here to provide financial advice or staffing development. I was a little uncomfortable with it; one of the big problems is that the committee hired their own family members as staff, so it’s a little hard to critique staff when their mother is sitting right there. Also, I am in the clinic with these people every day, and I didn’t come to here to be a burr in their sides. So it’s interesting the roles that I have been able to experience; they seem interested in what I think about their clinic, and about the management. I’m used to corporate medicine – when I was hired, they handed me a manual, a book, about my role and about all the hospital protocols and rules. A Book. Here, there is nothing of the sort, so this is new territory for this clinic.

So, while definitely uncomfortable, it’s exciting to me that I might actually be able to help out the management of a rural clinic. I have mentioned before, the staff here is capable of seeing all the patients without my help, so mostly this has been a learning experience for me, and I haven’t been able to disperse much information or assistance to the staff. One day Jess and I scrubbed the whole clinic down with bleach, and it was a good feeling, knowing that we actually did something tangible and good for the clinic. That is kind of the feeling that I received helping the PA write out job descriptions, that hopefully this clinic will be better managed and hence have a better chance at surviving to help people. This clinic cannot run on a deficit forever - when meds can't be purchased, patients are dissuaded from returning or referring the clinic to people they know, so it is imperative that they are treated when they come. Also, it's important to consider that this is the only health care facility within walking distance of many people in the area - they come here from kilometers and kilometers away, walking or taking a matatu. This clinic is important to this community, and I really would like to see it continue.

 In other news, the PA and I learned a little something about sewer systems in Kenya, as we unplugged a stuck toilet. It was a disturbing and aromatic experience, and I saw the largest, most disturbing spider down there that I have ever seen. Nothing cute and furry about this guy, just huge legs. Huge, terrible legs.

So, I'll be in Mombasa to see off my friends, who are returning to the States Sunday. Then I have decided to go to a little island just off of Mombasa called Wasini Island. I'll be staying in a little hut called a banda, where there is no running water, power from generators, that sort of thing. I'll be snorkeling for a couple of days. So much for working hard. Mombasa continues to grow on me, I've started to really get a feel for it, and I can walk around in its busy center without getting lost. I'm getting savvier at not being ripped off and at bargaining, and I love the crowds, the markets, the sultry, vibrant feeling of this place. I'm thinking next year will be a good time to come back.

 Until later, keep safe.


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