Hanyani Clinic at Elim Hospital

We’ve been at Hanyani Clinic for four weeks now, working closely with the doctors and nurses to improve clinic flow and patient care. It’s been a challenge, to say the least.

Each day, we arrive around 8:30 AM to a waiting room swarming with very sick patients-- there are never enough chairs, so some of the healthier patients lean against the walls or the windowsills. On nice days, there’s a sheltered area just outside the door of the clinic, and some patients opt to wait there in the grass rather than dealing with the chaotic mass of ailing, coughing bodies inside.

The clerks rush to get everyone registered, while the nurses hastily take weights and write down a cursory summary of the patients’ complaints (usually the chart reads something really specific and helpful, like “C/O aches,” or “C/O sores.”)

Then the patients wait. And wait. And wait.

The doctors saunter in around 10 AM, take a coffee break, hit on the pharmacists, and generally begin seeing patients by 11.

And I mean “seeing” patients in the most literal sense. The patient enters the examining room, and takes a seat across the desk from the doctor, who reads the nurse’s note and glances briefly at the patient. Then he’ll flip through the chart, see that the lab results ordered 4 months ago have not yet come in, and jot down a prescription vaguely based on the complaint described by the nurse before handing the chart back to the patient. The patient opens the door to shuffle out; the next patient has already squeezed herself into the room before the doctor can call out, “Next!”

The doctors get through most of the patients before lunch at 2 PM; they’re usually done for the day by 3:30.

The staff at the clinic consists of two doctors, six nurses, two clerks, two social workers, and four “data capturers.” This last position I find the most intriguing, as I’m yet to figure out what they actually do. Every time I’ve visited their office in the back of the clinic, I find them napping in front of their computers.

So we’ve had our work cut out for us. My father began by encouraging the two doctors to actually examine patients… and on a few occasions, I think they were pretty surprised by what they found. For instance, one woman came in with the unambiguous nurse’s note, “C/O rash.” The doctor started to write a script for cortisone cream, when my father paused him to ask, “Well, where is the rash?”

The doctor turned and repeated the question to the patient, who gestured to her groin.

“Why don’t we take a look at it?” Dr. Ray boldly proposed.

It turned out that the patient had genital herpes. For those of you who aren’t well versed in the treatment options for genital herpes, cortisone cream is not one of them. Furthermore, having chronic herpes would automatically place this woman at clinical stage IV HIV infection according to the WHO guidelines.

The second major project we undertook was to begin organizing the medical records. Patients’ charts consist of dozens of loose sheets of paper and some lab results shoved into a brown paper folder. Sifting through old progress notes and looking for old CD4 counts and viral loads takes up about ½ the time the patient is in the examining room. So my father found a box of patient history forms that had been hidden away in a dusty corner of the data capturers’ office, and audaciously called for their widespread use. This was, predictably, met with some resistance from the staff, as it required a tiny bit more work on the part of everyone. The head nurse, who is actually wonderful and genuinely cares about the patients and has expressed concern for the substandard medical care the clinic is doling out by the bucketful, has been incredibly helpful in convincing her colleagues to complete the forms for most patients. The doctors, meanwhile, have been pleasantly surprised to find that having a patient history in front of them and a chronological flow sheet of lab results has been useful and time-saving. In a few cases, actual physical exams have been performed without my father’s insistence, and a few actual diagnoses have been made and written in the charts to accompany the list of medications prescribed. Progress is being made, even if it’s at the pace of a giant African land snail.