May 2011

Hard work spotlights people, some turn up sleeves, some noses, and some not at all….

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May has been a long month.  We (mentors) continue to work hard but, progress is slow and successes are minor.  We try to keep a perspective that the system we are helping to build when projected out a decade plus, will return dividends to the Afghan citizens.

We now have a Greek team to complement our French team!  They are a welcomed and admired group.  We are lucky to have them and are so grateful for the expertise and friendships they bring.

Hospital cleanliness has been stable but, needs to be moved a bit further.  I am not completely sure where the end point is on this one.  The city is quite dusty and things dirty quickly.  I am proud of the staff for their willingness to take on this challenge!  One of the Greek nurses is working with me on the fourth floor.  Her name is Asimenia, and she is as crazy as I am!  She was chasing the housekeepers down the hall a few days ago about how they were not using enough cleaning solution.  The housekeepers found me and asked if I could make her stop, I said, “If you had listened to me earlier she wouldn’t be here….!”  The floors are clean now.

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Since the Greek team has arrived (they are a force of nurses and doctors) I have been able to focus on wound care.  The NMH leadership has identified this as a priority to focus efforts on.  A 3-star General was appointed to oversee this program.  Dr. Sohila is the first female general ever in Afghanistan.  She was working at NMH when the Taliban were in power.  The Taliban told her to wear a head covering, and she refused, said the Taliban needed her surgical skills more then she needed them!  I LOVE IT!  Well she decided to name me as her deputy.  We have begun to help the Afghans to create a wound care system.

Applying my People/Process/Tool/Metric approach, my plan thus far is to help them with a trial on the 4th floor of instruments that they clean daily, refining their dressing change techniques, and using basic and easily obtainable products.  Then roll out the changes (process) to other floors.  In time I would like to see this become the way of wound care across Afghanistan.  I suspect I will be back in Florida by the time wound care is finally put together and makes it’s way around Afghanistan.

I have not measured the number of infections, but I feel that in recent weeks the severity has diminished and the soldiers spend less time on the floor.  Something I am going to look at is length of stay and severity of infection.  This is a very difficult metric to look at because there is NO charting.  Thus I must see every patient and ask the same questions, no chart reviews here, bummer.

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ENTER CAPTAIN LOWE!  She is a nurse practitioner in the Navy reserve and she has arrived!  So we now have a few skilled and creative people working on this problem of documentation.  She has taken up charting as her area to focus on.  I am excited for the nurses to get some recognition and begin to provide a level of care that they are more than capable of.

My days are long and I am getting tired.  I am looking forward to R&R sometime in August.  I usually begin my day in the office to check email and deal with any pressing computer problems (70 computers).  Then it is up to NMH for the day!  I don’t usually leave until the very last moment because I have many things I am doing in the hospital.  In the afternoon I continue to work on long range computer issues (we will be changing office areas) and refining my new wound care plans!  I try to exercise every day.  I try to do this around 4:30 or 5 PM.  I exercise until 6:15ish, shower, and dinner.  Skype Grace and Connor around 7:30 PM.  Maybe a movie to end the evening?

I am appreciative of all the emails, letters and packages I have been receiving.  If I can’t use it I find it a home.  I would also like to make sure I mention 24-Hour fitness.  They work with a nonprofit Jessica’s Hope Project to supply protein supplements to soldiers.  They sent me 5 boxes of supplies for the Afghan soldiers!  Nutrition is a great force multiplier!

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