As a part of my Community Public Health program, we get to observe in the clinics in the Greater Gaborone Area. Wake up call is at 5:30 a.m. every Tuesday. Once we enter the clinics, lab coats are on and pen and pad are in hand. During our four hour stay in the clinics, we are able to wander in and out of the different sections of the clinic gathering information for our end-of-semester “health intervention” project. We are to observe each clinic’s use of resources, proper health waste management techniques, and overall patient care.
This past week, I was able to shadow the nursing staff at the Gaborone West clinic. This clinic is a public clinic with a maternity ward, a pharmacy, an infectious disease care clinic, and an emergency medical services unit. After attending the G-West clinic, I was able to observe the stellar clinical work that they provide for Batswana. I was impressed by how quickly prescription for medication was filled. Prior to the start of my first clinic day, a lesson on financial management was presented to the nursing staff. This concept of teaching important life skills to healthcare employers was so foreign to me, but I see the value of the action. While the clinic excelled in certain areas, issues of hygiene, crowded waiting rooms and provider-patient communication was also present. After having conversations with the health workers, I am optimistic that these issues will not persist. The health workers are aware of the problems and would like to see that they are fixed in the near future.
The hygiene issue seems to be the biggest at the G-West clinic. There is hand soap present in every consultation room, but not present in the bathrooms. The liquid soap is placed usually in “Energade” sports drink bottle. The windows were kept open due to the fact that there was no air conditioning. Despite the capacity of soap in the consultation rooms, I was grateful there is some available for the nurses. Another problem is that the nurses have to constantly re- contaminant themselves because paper towels and/or reusable towels are not available to dry off their hands. Between patients, the nurse that I was observing wiped her hands off on her skirt. She was fully aware that this was a practice that should not continue. It would have to continue because of the shortage of resources. Being the germaphobe that I am, I immediately started to analyze the number of germs that lived on the nurse’s outfit.
The second week, I had gotten the chance to observe equipment package assembly in the maternity wing. The packages held equipment for procedures such as sutures, and cervix measurements. I expected the two women I was observing put together the packages to be midwives or nurses. One was a member of the cleaning stuff and the other was the secretary. It made more sense for a nurse to assemble the packages to limit the chance of error. This situation also occurred in the pharmacy and the infectious disease care clinic. The pharmacy technicians enlisted help from the other visiting undergraduate students and members of the cleaning staff to hand them label medication.
While I am still shocked at how fast it takes for patients to get their medications at the G-West clinic (at my local US pharmacy it takes anywhere from 2 hours to a day), the clinic is definitely making great strides to reach the goal: make G-West clinic healthy by 2050. The health workers have a such a positive attitude about changing the routine of G-West and the use of social programs when combating the prevalence of HIV/AIDS. The best course of action to improve the quality of health and infrastructure would be to reallocate funds to solve the issue of lack of necessary items in the consultation rooms. It would also be beneficial to hire more staff to take the stress off other personnel from having to work in other areas of the clinic.