Challenges, Crises, and the slow grind to improvement.

My previous team leader answered most my questions about problems we had would be solved by the new hospital. A beacon of hope which could shine a light on the all the many dark grimy corners that existed in a newly built field hospital.

But first we had to move. A challenge to be sure. But at 7am, when I discovered that my emergency room was already in boxes and if I had an acute case I would have nothing easily accessible I released we had to get a move on with this move. But, once again, the full team came to the fore and whilst the logistic team were still trying to organise hiring of their day workers the medical team had moved shelves, beds and boxes of medications and by 8am our new (almost identical) emergency room and outpatient department opened on time.

We managed one day without another crises, but then the Covid case was detected. Four days previously the water and sanitation team had to mobilise to counter the rain conditions, now it was the medical department turn to awkward try and scramble for solutions. As with all sub-crises within the larger refugee crises compromises must be made. With very little slack in the system and not much physical spaces we can use to isolate we adapt and make some decision; only time will tell if these were the correct ones. Hopefully the largely open-air life of the refugees and local community will protect them from the global pandemic. Spending the last 12 months treating Covid was bad, doing so without oxygen is not something on my list of career goals.

It is easy to get lost in these days that feel like a day and a lifetime. To feel we are lurching from crises to challenge to crisis. You can loose site of the slow grind of improvements that are being made. But as we try and jump over these huge hurdles we jump over several little ones. We obtained re-feeding milk so now we can start feeding malnourished children better, we have more spacious inpatient department and the many infectious patients are further away from each other, I managed to employ two more doctors temporarily so now we can cope with the post Ramadan influx of Sudanese patients, I re-arranged our ED and put up a divider so the waiting area cannot casually view our sickest patients whilst they wait, we improved communication between the hospital and the community team to follow up better our more vulnerable patients, I was allowed to create a leadership position for the local doctors creating ownership of the service, my manager spent 3 days organising the pharmacy so now we actually know what stock we have. Positive changes creep us forward to provide a service that we can be proud of.

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