Final Days on Site

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a day in the life working alongside the CLI research team

I spent my last few days doing data entry (real glamorous, I know), getting all the physical materials in the office in order, and trying to meet with as many people as possible to get some decisions made.

But decisiveness never comes easy. I offered up a needs assessment and an analysis of five potential interventions that address prenatal and perinatal needs in the community. Now the leaders in the clinic and the research team need to discuss and decide: is it TBA supply we want to address? the lack of autonomy we see amongst mothers? the transport issue? There’s pros and cons to each, considering project feasibility, anticipated effectiveness, costs, political implications, etc…

transport issues are a commonly reported barrier to facility births (and thus, births with expert assistance). this ambulance is reserved for emergency transfers from CLI to other hospitals.
transport issues are a commonly reported barrier to facility births (and thus, births with expert assistance). this ambulance is reserved for emergency transfers from CLI to other hospitals.

When everything is so interconnected, it’s hard to imagine addressing one obstacle and not the others. But we have to start somewhere, and with no existing budget for a new intervention, we’ll have to narrow in on a single project, at least for now.

Waiting isn’t fun, but it’s important to me that we make sure everyone is on board with any active response we decide to take on. The clinic team has to make tough decisions all the time about how much activity beyond patient care can really take place before you’re putting people at risk. It’s possible that no new interventions come from the data, and even that would be better than doing a half-intervention because not everyone was committed.

I’m back at home now, back to communicating via email and What’s App, back on the nights and weekends grind, but I’m excited to see what’s next.

Happy to be reunited with Barry, Binja and (not pictured) Blue.
Happy to be reunited with Barry, Binja and (not pictured) Blue.

Sometimes I catch myself feeling a little too attached to the final outcome of the (potential) intervention, but realize I’m getting ahead of myself. We started with virtually no data on the maternal and neonatal outcomes in the catchment area. Even if we can get access to the Ministry of Health records, now that we’re a facility providing delivery services, we’d never have these audits on the deaths that took place in the community. The findings can feel kind of hollow when most of what you report aligns with assumptions of the staff who already work with these patients day in and day out. But having estimated frequencies, having records of actual cases, having interviews with typical residents in the catchment area (our staff aren’t exactly representative of the average CLI patient), it’s all valuable for expressing need in the community, asserting or questioning existing assumptions, and maybe supporting a grant application some time down the road.

Thanks for following along! My next update will share findings from the project evaluation.

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