Monday, November 21, 2011

Organized Chaos

Sielmat Christian Hospital, the site of the aforementioned week-a-thon health clinic, has only been the current 36 bed, 1 full time doctor and 20 full time nurse incarnation for a few years. Before the construction of the maternity wards, optometrist office, lab and operating theater it was little more than a mud hut. That all changed when John decided to make the hospital a central part of the ministry. Funds were raised, plans drawn up, concrete was poured and, voila! A modern (by Indian standards) hospital was raised. The freshly hired nurses and doctors began treating the sick with the newly purchased modern medical technology housed in the clean, white tiled rooms; in short the hospital was transformed. The reception and billing office however, apparently didn’t get this memo.

A week ago I was sitting at dinner with Lawm, John’s pregnant wife, when she said, “Travis the hospital’s office doesn’t run well. I want to make it more efficient. Come down tomorrow, watch how the office works and tell us what to change.” I was a little dumbstruck. I mean, one of the principal reasons I came here was to have work that was stimulating and challenging (a bill the food service industry wasn’t quite fitting), but reorganize the structure of a hospital’s reception and bookkeeping system? Despite my 2 college biology classes (one of which was marine bio) I can barely fill out medical paperwork, let alone organize an efficient way to run an entire hospital office. So of course I said yes, I’d love to, and hoped that in the next 12 hours, 8 of which I would spend sleeping, some blinding flash of organizational insight would hit.

It didn’t. After introducing myself to the staff the next morning I sat down on a stool, sweaty palmed, and observed. At first, what I was watching didn’t make any sense. So I asked one of the English speaking staff to explain it to me.

During her explanation I was reminded of an anecdote Gen. Jimmy had told me about when Soviet advisers had first arrived in India. They had promised to look around the subcontinent and present the government with a 5 year plan to modernize India. After a month of traveling the country they came back to Delhi and gave an eagerly awaiting audience of government officials their report. The Russians said, “We have no idea how your country functions. We don’t believe in God but he must be running this country because its obvious no one else is.” Then they got on a plane and went home.

Though certainly not quite as extreme, my first impression of the how the hospital office ran paralleled this pretty closely.

The hospital hadn’t changed their system since they were a 5 bed mud hut, and at that time the system had been more than adequate. Now, however, as real medical center, by any western standards it wasn’t a system; two ladies, interchangeably, gave out money for expenditures, collected receipts and gave OPDs to patients. They then handed the hospital copy of the OPD to a guy who checked the bill then stuck it an envelop with the rest of that months cases and piled it in a corner. Though this may sound overly critical, the fact that the hospital managed to continue functioning deserves the highest praise I can give its employees; they are so honest and hard working that they somehow make it work. That and they are too busy/had no experience or reason to change the way it was.

In many ways this is like a microcosm for India- they somehow derive a kind of order from chaos. I think if the world ended tomorrow and all government broke down, America would implode, but life for the average Indian probably wouldn’t change that much. While we rely on the rule of law, they follow the law of rules. While our everyday life is governed by legal institutions, theirs is governed by far more durable social institutions.

Though the system worked, it was anything but efficient. So I set to work, talking with each of the workers about what they think works and what should be done to make it run smoother. After getting their input I planned it out. I based the filing system on what I remember from visits to my optometrist and orthodontist (6 years of braces and being legally blind without corrective lenses means I spent a bit of time in both). The patient payments and expenditure reimbursements now go through separate people and with a system based on the hyper-paranoid and time-tested one anybody who has worked in a restaurant knows. Filing is now to be done chronologically and alphabetically, with each patient getting their own folder. The men’s are a subtle forest green and women’s a dark ugly pink. The goal is to make the institution strong enough that it will function well even with employees that don’t have the experience or ethics of this group.

Now, in the second week, things seem to be starting off well. A bit slow and confused at times because of the change, but it seems that the staff realizes it will make their lives easier. Of course, it still remains to be seen if this system will have any long-term staying power, but it’s a start.

Now, it’s certainly not that the hospital administration could not have come up with this, or probably a far better system. It’s that, being a charity, they are understaffed and overworked, dealing with issues like making sure life saving medicine gets in and that there is enough money to keep the hospital open. Seeing that I, with no meaningful organizational or NGO experience, can do this in less than week doesn’t speak to my ability so much as to how easy it is to make a positive difference, however small, when you decide to focus and do it.

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