[LATE POST - our apologies!]
Well, it's going on 3 weeks now and I haven't told you guys what's happening. Sorry about that!
We've been slaving away (you might have seen the Tribute to Post It Notes) on the project proposal. MSF Swiss is taking on the ED of the General Hospital (public hospital) in Nuevo Laredo. This is where people go who have the social insurance or none at all (about 50% of the population is at risk). You would be astonished to see - there are 3 private hospitals with all the money in the world, look just like ERs in the US, TVs in the waiting rooms, marble floors and walls, polished spokespersons greeting you at the door ... And our hospital is the run down, doing their best with very little, dangerous part of town where all the traumas go.
The situation is that in Nuevo Laredo, over the past 13 years of the War on Drugs, two cartels have been fighting for control of this corridor - and civilians are caught in the crossfire. Everything is locked up tight, few people on the streets, "no go" areas of the city. 400,000 residents living in fear. This has caused the outlying public health clinics to limit services, hours, care and so everyone has become accustomed to coming to the ER for everything (sounds a bit familiar to our situation at home?). The ER has now become overwhelmed with 50 patients per day, boarding for days (including TB patients boarding for a week in an non-ventilated "isolation" room in the middle of the ER), no in ER pharmacy system, doctors who are not ER trained, nurses who learn on the job ... AND the pre-hospital EMS/911 system doesn't work.
What we've done so far is redesign the physical layout (working with the hospital architect), created the positions of Chief of Emergency Medicine and Nurse Manager of ED, created a new flow by having Triage and Fast Track, make lists for equipment, medications, training and systems that will help fix all of the above. Sounds like a lot, eh? Well, as we being to fix the ER, we will tackle the EMS system and fix that, plus repair the referral system to the clinics.
We started with blank faces and blank walls. The Mexican ER doctor had been here 3 weeks working and immersing himself in the ER, but had no idea how to go about creating a proposal to fix things. So they brought me in. My first task was to rearrange the office, put pieces of paper on the walls and a pad of post its in each hand. And began to brainstorm. I can only imagine what was going through their heads - no one on the team had ever seen such a thing! For 2 days we put ideas up on the wall, discussed, fine tuned and began to shape the ideas one by one and see how they could fit together.
Then came time to begin putting finger to keypad and bring it all together in a cohesive whole. Each day we work on collecting more information, adjusting original ideas and trying to figure out what the project ought to look like. The proposal will be sent to Geneva tomorrow and the discussions with the overseeing desk begins. A week later, the fully polished version is presented to the President of MSF Switzerland for approval. THEN the work really begins.
Our work day starts abouttil 2, then 1 1/2 hrs for lunch and back to the office til 6ish. My evenings are watching internet TV (The Daily Show and Colbert Report in order to keep up on the news :), chatting with Pete on Skype, reading, watching DVDs, etc. Weekends so far have found me happy with internet sites to watch the Seahawks wins and Formula 1 races. We've really not seen anything of the town - home to office by car, back again, to/from the hospital ... I walk a bit on weekends, but there's nowhere much to go that's safe. Most of the city is "no go."
Hoping they will find and send the field team before I go so we will have some handover. In the meanwhile, I'm going to be working on protocols, manuals, assessments and training and getting ready for the field team to implement what we've envisioned. It's going to be an interesting 2 years for them and I'd love to see the results one day.