Sandra Lako: coordination and clinical work

Sandra LakoA lot of the work the Welbodi Partnership does is to coordinate and facilitate projects and training programs within the hospital. Our aim is capacity building – helping others to improve their skills rather than coming in to solely provide patient care. We believe that in the long run more patients will receive high-quality treatment and have better outcomes if we focus our current efforts on improving the services delivered in the hospital. That is why we have engaged in projects like electricity and water supply, the medical records/data collection and reporting system, the laboratory services, nursing care, the triage and emergency process, and training for the doctors.

This does mean that my job as a medical coordinator, although diverse, does not leave much room for clinical work. As I am trained as a doctor, that is not always easy. Fortunately, for my own professional development and to see how hospital systems are or aren’t functioning, I try to do some clinical work. However, usually my role as coordinator keeps me so busy, I don’t make it to the wards. If I do make it, it’s usually just to see a few patients. I decided that for now it is best not to do ward rounds on a ward because it is unlikely that I will be available to the nurses and patients for the rest of the day due to meetings and other responsibilities. 

The last few weeks have been so busy, I have really only been able to see a few patients on the ward adjacent to our office, but it has been good to be able to be involved with patients a bit more.

It started one evening when I happened to be at the hospital and ran into a family with a very sick child looking for the Emergency Room. The child was admitted and stabilized but unfortunately remained in a very critical condition. Sadly, the infant died in the course of the following day. I was again hit by the reality of the mortality figures in this country. And I realized again that although it can be very rewarding to do clinical work, it is also pretty tough.

I was also involved in the case of an infant admitted a few days ago. The child needed blood urgently. Fortunately there was a relative who was able to donate and the child received blood soon after admission. After that it was a waiting game. Thankfully, the next day the child looked much better. Unfortunately the child had not received all of the correct medication within the first 24 hours of admission as something went wrong with the supply. So, I wrote a prescription and later checked up on it again. The child was stable and I expect will make a good recovery. Now, if I can only convince the mother to stop giving the child hot water and encourage her to exclusively breastfeed) I will be really happy!

I love the clinical work and honestly do miss it, but I also have to admit that it can be quite frustrating. Yes, there have been many improvements over the last few years, but there is still a long way to go. I think all of the clinicians in the hospital would agree that clinical work in the hospital is challenging. The patient numbers can be high, working hours can be long, (once a week when on-call overnight the doctors work for about 30 hours straight) and the cases coming to the hospital are often quite severe, which means that on a daily basis one is faced with children dying. For doctors and nurses alike this can be very demoralising. Yet somehow, everyone must continue. Despite the frustrations, spending time on the wards gives me more insight into how the various systems (pharmacy, lab, blood bank, nursing, medical records, doctors) work (or not) and how they have improved (or not) over time. The barriers and delays to achieving good patient care become more apparent. This information can in turn re-start the thought process and refinement of how Welbodi continues to work alongside hospital management and other partners to improve systems within the hospital with the overall aim to improve pediatric care. And that is when I put my coordinating hat on again!

Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.