Friday, June 3, 2011

Quality (of Life) Improvement

Day 31: June 3, 2011. Addis Ababa, Ethiopia.
Quality (of Life) Improvement

Submitted by: Raquel Reyes, MD, MPA, PGY3, Internal Medicine and Pediatrics, Massachusetts General Hospital.

This will be my last post from Ethiopia. And it will be a bit shorter than the others, as today is my last day and I have lots of good-byes and packing to do.

Over the past 2 weeks I have indeed been able to achieve the goals I set out for myself in my last post. I continued to see both “old” and “new” patients at St. Peter’s. I went back to the Missionaries of Charity and gave J a big hug. I returned to Black Lion to attend some morning reports, grand rounds, and morning rounds (AB is doing ok; his sputum still has not been sent but at least the communication has been opened and the coordination process is underway). I drafted some Quality Improvement and clinical guidelines for hypotension and respiratory distress for St. Peter’s. I was able to go on additional home visits to see how the patients are doing at home, where they store their medications, and talk to them about the problems and challenges they face. As to the latter, an essential aspect of GHC’s MDR-TB work is social support, including money for transport and food.

This brief post will focus on a new initiative at GHC/St. Peter’s, which is being led by Sister Rosemary Milazzo. Part of my contribution here has been the recommendations I made around quality improvement, which had to do with medication reconciliation, laboratory data review, and set up of critical care rooms. Rosemary’s contribution will be equally if not more important—she is working on increasing social supports while inpatient.

The patients at St. Peter’s are often hospitalized for months. It can be very boring and lonely. Some patients have family who spend a lot of time with them; other patients have no one. Rosemary is gathering volunteers to come to the hospital and companion the patients. She is getting games and books. Bingo was a huge hit! She is planning to start a few projects including potting plants and flowers and making collages. She invited a friend of hers, Costancia who is from Tanzania and who works with a practice known as “capacitar”—a body of holistic mind-body-soul techniques to help patients suffering from trauma and chronic illness, poverty, anxiety, social stressors. (see Costancia has been helping the patients with techniques to alleviate some of their pain, stress, and anxiety. She also had an initial training with nurses, which was lovely. Rosemary’s work is quality of life improvement and I have already seen the positive effects.

Today’s good-byes with the patients were tearful and heartfelt. I have been so glad to see so many of the patients I met a few weeks ago discharged. Today several patients, all of whom have been here for months, were excitedly awaiting their rides home. Many new patients have arrived, bringing the MDR-TB cohort to over 200. And the work will continue.

As for me, I return to MGH and my next rotation will be Infectious Disease. I’ll be cognizant of the privilege we and our patients have when we ask for labs and they are readily available later that day, when we recommend a particular antibiotic and it is administered within an hour, when we recommend additional imaging and we are able to obtain it within the day. And if we have any MDR-TB patients, I’ll be ready.


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