In a mission hospital today the doctor needs a broad based clinical competency, and in addition often needs skills in personnel management, financial accountability, stock control, building maintenance, continuing medical education and liaising with central government about district health policies. One minute he or she will be devising staff rotas, the next approaching donors abroad, then assessing the future clinical development of TB work, then helping out in outpatients. Running a mission hospital can appear like juggling balls in the air, but there seem to be many more balls than at home and often there is a strong wind blowing in your face at the same time.
Here at Kisiizi Hospital the staff comprises five doctors (of whom two are expatriate), five clinical officers, 40 trained nurses and 40 student nurses and untrained assistants. There are many areas of recent development. The surgical theatre is busy every day, and the range of cases was recently expanded with the appointment of a surgeon.
Kisiizi has just been approved by the Ugandan government to train enrolled nurses. The hospital is trying to make its services accessible to the disadvantaged and has pioneered a community-based health insurance scheme and a community programme for the physically disabled. A rehabilitation centre is being built offering physiotherapy and occupational therapy and a mental health programme encourages the community to bring people to the hospital for treatment. Kisiizi is becoming more integrated within the government's health policy by being given responsibility for the local sub-district.
Kisiizi has always had the spiritual witness of the hospital at its heart, with the holistic vision of its founder to 'bring life in all its fullness'. It has had a strong impact in the local church and many of its staff have moved on to appointments in the government service far and wide.
However, there are two key vacancies coming up. First, the medical superintendent is returning to the UK in a year's time. At present there isn't a national doctor ready to take his place. Secondly, the surgeon will also be returning, in two years. A national doctor is going for specialist surgical training but there will be a two year gap before his return. Why do we need to replace these people with expatriate staff'?
One key reason is money. Kisiizi was deliberately set up in a rural area to meet the needs of the poorest. Today, only half the budget comes from patient fees. The rest comes from individual supporters overseas, NG0s, and the government, which provides less than a quarter of the budget deficit.
Expatriate staff come free of charge and with a wide network of contacts they can use to promote the development of the hospital. An equivalent national doctor would cost more than the hospital could afford. It is also a difficult reality of life that when expatriates leave, the readiness of NG0s to support projects also declines. National doctors are under huge pressure to employ their relatives and friends and provide financially for the school fees of their dependants. In their own comments to us here at Kisiizi, they are fearful that if development slows down or salaries are not paid under their leadership, then they will be accused of 'eating the money'. They are glad to be free of these pressures.
A second reason for wanting to use expatriate staff is less obvious. Although the development of Kisiizi has been marked by a steady improvement and expansion of services, it lives permanently on the edge of sustainability. When crises come, adaptability and lateral thinking are needed to get round the problem. Equipment tends to lie broken. Staff do not have the background of Meccano sets. It is sometimes easier for the expatriate to mend a broken suction machine or design a new computer database. In the NHS, doctors become exposed to many different styles of management which can be used for mission hospital problems.
The work represents a deep and testing challenge with a unique level of satisfaction. A previous medical superintendent said 'Working here is like a marathon relay race and each runner does his best until handing on the baton to someone else'. Are you up to the challenge?
More information about Kisiizi Hospital click here.
UPDATE Peter Taylor and family have now moved on from Kisiizi. Catch up with them in HealthServe Issue 3
Here at Kisiizi Hospital the staff comprises five doctors (of whom two are expatriate), five clinical officers, 40 trained nurses and 40 student nurses and untrained assistants. There are many areas of recent development. The surgical theatre is busy every day, and the range of cases was recently expanded with the appointment of a surgeon.
Kisiizi has just been approved by the Ugandan government to train enrolled nurses. The hospital is trying to make its services accessible to the disadvantaged and has pioneered a community-based health insurance scheme and a community programme for the physically disabled. A rehabilitation centre is being built offering physiotherapy and occupational therapy and a mental health programme encourages the community to bring people to the hospital for treatment. Kisiizi is becoming more integrated within the government's health policy by being given responsibility for the local sub-district.
Kisiizi has always had the spiritual witness of the hospital at its heart, with the holistic vision of its founder to 'bring life in all its fullness'. It has had a strong impact in the local church and many of its staff have moved on to appointments in the government service far and wide.
However, there are two key vacancies coming up. First, the medical superintendent is returning to the UK in a year's time. At present there isn't a national doctor ready to take his place. Secondly, the surgeon will also be returning, in two years. A national doctor is going for specialist surgical training but there will be a two year gap before his return. Why do we need to replace these people with expatriate staff'?
One key reason is money. Kisiizi was deliberately set up in a rural area to meet the needs of the poorest. Today, only half the budget comes from patient fees. The rest comes from individual supporters overseas, NG0s, and the government, which provides less than a quarter of the budget deficit.
Expatriate staff come free of charge and with a wide network of contacts they can use to promote the development of the hospital. An equivalent national doctor would cost more than the hospital could afford. It is also a difficult reality of life that when expatriates leave, the readiness of NG0s to support projects also declines. National doctors are under huge pressure to employ their relatives and friends and provide financially for the school fees of their dependants. In their own comments to us here at Kisiizi, they are fearful that if development slows down or salaries are not paid under their leadership, then they will be accused of 'eating the money'. They are glad to be free of these pressures.
A second reason for wanting to use expatriate staff is less obvious. Although the development of Kisiizi has been marked by a steady improvement and expansion of services, it lives permanently on the edge of sustainability. When crises come, adaptability and lateral thinking are needed to get round the problem. Equipment tends to lie broken. Staff do not have the background of Meccano sets. It is sometimes easier for the expatriate to mend a broken suction machine or design a new computer database. In the NHS, doctors become exposed to many different styles of management which can be used for mission hospital problems.
The work represents a deep and testing challenge with a unique level of satisfaction. A previous medical superintendent said 'Working here is like a marathon relay race and each runner does his best until handing on the baton to someone else'. Are you up to the challenge?
More information about Kisiizi Hospital click here.
UPDATE Peter Taylor and family have now moved on from Kisiizi. Catch up with them in HealthServe Issue 3
