Any and all proceeds from this book are used to support the work of Christian Health Service Corps missionaries serving in hospitals and health programs around the world.

When Healthcare Hurts

An Evidence Based Guide for Best Practices In Global Health InitiativesBy Greg Seager

AuthorHouse

Copyright © 2012 Greg Seager
All right reserved.
ISBN: 978-1-4685-8121-8

Contents

Introduction....................................................................................................xviiChapter 1—Safety First....................................................................................1Chapter 2—Best Practice Guidelines: Where did they come from?.............................................21Chapter 3 Patient Safety Culture: What is it and how do we achieve it in global health?.........................31Chapter 4—Training for Transformation: Orienting Global Health Volunteers.................................49Chapter 5—Empowerment.....................................................................................69Chapter 6—Transformational Partnerships...................................................................101Chapter 7—Facilitating Transformation.....................................................................123Chapter 8—Medical Records.................................................................................159Chapter 9—Standards for Cross-cultural Healthcare Delivery................................................165Chapter 10— Surgical Global Health Initiatives............................................................195Chapter 11—Best Practice Guideline 6 Participatory Design, Monitoring, and Evaluation.....................215Chapter 12—Best Practices Summary.........................................................................251

Chapter One

Self-Assessment of Short-term Global Health Initiatives

Self-Assessment of Short-term Global Health Initiatives Some may find this chapter challenging, because it is an important starting point: self-assessment. Do we who engage in global health initiatives see ourselves rightly? We must be willing to look honestly at our motives and the quality of services we provide. We are all broken, wounded, and deficient, and we have no hope of helping others until we first realize our own state. The same can be said about the projects and programs we create to serve the poor. Our projects and programs are often broken, and we must see them clearly before we can change them. Before we can create impact and change in others, we must first see clearly the need for change. We have many deficiencies—most of which are knowledge deficiencies, some of which are attitudes and assumptions—that further mar the identity of the poor.

There once was a wise king who cried out, "Search me, O God, and know my heart; try me, and know my anxieties; and see if there is any wicked way in me, and lead me in the way everlasting!" The king understood that there are many things in our thoughts and actions that may appear right but may be wrong. Whether we look outside or inside ourselves, we need to look honestly at our motives. Our motives for engaging in global health initiatives need to be our starting point; this is true for both faith-based and secular programs. The first question on the list of questions posed in the introduction asked whose needs we are trying to serve. This question examines our motives for serving in short-term medical and health projects, and this is an important first step. If our efforts in international health work are really about the recipients of care, not all about us, then we will begin to move patient safety to a place of top priority.

Maria's Story

A general medical team was serving a village community in Central America. Maria, a 29-year-old mother of five, arrived at the clinic pharmacy to receive her medication after having her entire family seen by one of the physicians. Maria had three prescriptions for herself, and each child received prescriptions for parasite medications and vitamins. In addition, three of the children were febrile, and two had been diagnosed with otitis media (ear infections) and one with strep pharyngitis (throat infection). Each of them also received prescriptions for antipyretics (Tylenol) and antibiotics. Maria waited patiently with the handful of prescriptions in the pharmacy waiting area. The pharmacy line was long with about 75 people waiting for prescriptions to be filled. There were also people waiting to be seen by the dental, medical, and health education volunteers. Maria finally got to the pharmacy counter, and her prescriptions were filled by a pre-med student under the supervision of a nurse and a paramedic. A paramedic provided instructions for each medication through a translator at the pharmacy counter in front of a crowd of people while Maria was trying to keep her children from getting lost in the crowd. Dosages were explained to Maria, and instructions were written in her own language for the 12-year-old, six-year-old, and six-month-old children. However, Maria could not read. Maria received multiple medications in Ziploc baggies and non-child-resistant containers, and she took them home to her one-room dirt-floor home with no place to store them away from her children. Less than a week after the team left the country, Maria's six-month-old child was brought to the public hospital in that region with acute liver failure and died. Maria had mixed up the dosages of medication and had been overdosing her six-month-old with Tylenol for the entire week.

Patient Safety in Global Health Initiatives

In 2001, the Institute of Medicine published a paper focused on closing the divide between what we know to be good evidence-based healthcare and the healthcare that is actually delivered to patients. This report, entitled "Crossing the quality chasm: A new health system for the 21st century," recommends six strategic aims on which to focus healthcare quality improvement efforts (Institute of Medicine, 2001). They are known as the "aims for improvement," and they are as follows: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Note that the first and most important of all is patient safety. The Institute of Medicine defines patient safety as "the prevention of harm to patients," and they direct special attention to creating a system of care delivery that "(a) prevents errors; (b) learns from the errors that do occur; and (c) is built on a culture of safety that involves healthcare professionals, organizations, and patients" (Mitchell, 2008). If we take these concepts seriously in our home countries, how important is it that we apply them when we practice as volunteer providers in developing countries?

Global health initiatives have great potential to help and alleviate much suffering, but as Maria's story illustrates, they also have great potential for harm. Both faith-based and humanitarian organizations often enter the realm of healthcare delivery in short-term projects without recognizing the responsibility inherent in healthcare. We often get so caught up in the good we are attempting to do that we lose sight of the potential for harm that is part of any healthcare delivery. We often return home from short-term initiatives reporting the glowing feeling from our time of service. We define the quality of our service by the quality of our experience, the number of patients treated, and the number of prescriptions filled. We rarely consider the potential for harm that comes from such efforts if patient safety is not a top priority.

As healthcare professionals, we agree that there is an ethical and moral...