inspection time

We had our 6 month visit from the Zambian board of health inspectors,
which are here to see how well we measure up to the hospital standards
set for us by the government. It's a interesting time, a combination
between us being defensive about things that we haven't done, optimistic
about things we think we're doing but not really sure, and cajoling
about things that we think the government should help us with but
isn't. It's also a bit ironic because I'm trying to give answers for
how the hospital performed in the 3rd and 4th quarters, when I wasn't
even here, and have little idea about what went on for various
committees like the quality assurance, drugs and therapeutics, and
infection control. Fortunately, I am able to say that we are doing
these things now, so even if they weren't done before, we can say we are
compliant now.
It's funny, because the hospital inspections in the US by JCAHO are one
of the things that scares every hospital administrator, and people spend
lots of money and time getting ready for them. Here, even if we didn't
meet the standards (which we we told about at the meeting for the first
time), no one seemed particularly upset or worried. Many parts of
Zambian administration seem more interested in making sure all the
blanks are filled, rather than caring how well they are filled, which
leads to the appearance of a functioning bureaucracy but only adds the
paperwork without the substance. I find this all the time on the wards
-- people insist that I fill out some form for the police or whatever,
and I can write one word or three paragraphs about what is actually
going on and everyone will be happy, as long as I put my name and a
stamp on it. But no matter how good the substance is, without a stamp
it's no good. So the bureaucrats don't always ensure the things that a
good civil service should ensure -- like safety checks, accountability,
etc. This is a problem for some things; for example, we've complained
that our blood supply that we get from the district hospital is not
tested or labelled properly -- HIV positive blood, wrong blood type
labelled, etc -- but even though they've known about this for close to a
year, no action has been taken. On the other hand, it seems unlikely
that they'll shut us down for not having the statistics on how many
mothers are being offered counselling on breastfeeding during
admissions. But you never know.